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The use of a novel perfusion-based cadaveric simulation model with cerebrospinal fluid reconstitution comparing dural repair techniques: a pilot study.
Spine J 2017; 17(9):1335-1341SJ

Abstract

BACKGROUND CONTEXT

Watertight dural repair is crucial for both incidental durotomy and closure after intradural surgery.

PURPOSE

The study aimed to describe a perfusion-based cadaveric simulation model with cerebrospinal fluid (CSF) reconstitution and to compare spine dural repair techniques.

STUDY DESIGN/SETTING

The study is set in a fresh tissue dissection laboratory.

SAMPLE SIZE

The sample includes eight fresh human cadavers.

OUTCOME MEASURES

A watertight closure was achieved when pressurized saline up to 40 mm Hg did not cause further CSF leakage beyond the suture lines.

METHODS

Fresh human cadaveric specimens underwent cannulation of the intradural cervical spine for intrathecal reconstitution of the CSF system. The cervicothoracic dura was then exposed from C7-T12 via laminectomy. The entire dura was then opened in six cadavers (ALLSPINE) and closed with 6-0 Prolene (n=3) or 4-0 Nurolon (n=3), and pressurized with saline via a perfusion system to 60 mm Hg to check for leakage. In two cadavers (INCISION), six separate 2-cm incisions were made and closed with either 6-0 Prolene or 4-0 Nurolon, and then pressurized. A hydrogel sealant was then added and the closure was pressurized again to check for further leakage.

RESULTS

Spinal laminectomy with repair of intentional durotomy was successfully performed in eight cadavers. The operative microscope was used in all cases, and the model provided a realistic experience of spinal durotomy repair. For ALLSPINE cadavers (mean: 240 mm dura/cadaver repaired), the mean pressure threshold for CSF leakage was observed at 66.7 (±2.9) mm Hg in the 6-0 Prolene group and at 43.3 (±14.4) mm Hg in the 4-0 Nurolon group (p>.05). For INCISION cadavers, the mean pressure threshold for CSF leakage without hydrogel sealant was significantly higher in 6-0 Prolene group than in the 4-0 Nurolon group (6-0 Prolene: 80.0±4.5 mm Hg vs. 4-0 Nurolon: 32.5±2.7 mm Hg; p<.01). The mean pressure threshold for CSF leakage with the hydrogel sealants was not significantly different (6-0 Prolene: 100.0±0.0 mm Hg vs. 4-0 Nurolon: 70.0±33.1 mm Hg). The use of a hydrogel sealant significantly increased the pressure thresholds for possible CSF leakage in both the 6-0 Prolene group (p=.01) and the 4-0 Nurolon group (p<.01) when compared with mean pressures without the hydrogel sealant.

CONCLUSIONS

We described the feasibility of using a novel cadaveric model for both the study and training of watertight dural closure techniques. 6-0 Prolene was observed to be superior to 4-0 Nurolon for watertight dural closure without a hydrogel sealant. The use of a hydrogel sealant significantly improved watertight dural closures for both 6-0 Prolene and 4-0 Nurolon groups in the cadaveric model.

Authors+Show Affiliations

Department of Neurological Surgery, Keck School of Medicine, University of Southern California, 1200 North State St, Suite 3300, Los Angeles, CA 90033, USA. Electronic address: Joshuabakh@gmail.com.Department of Neurological Surgery, Keck School of Medicine, University of Southern California, 1200 North State St, Suite 3300, Los Angeles, CA 90033, USA.Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, 1540 Alcazar St, Los Angeles, CA 90033, USA.Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, 1540 Alcazar St, Los Angeles, CA 90033, USA.Department of General Surgery, University of Southern California, 1520 San Pablo Street, Suite 4300, Los Angeles, California 90033, USA.Department of Neurological Surgery, Keck School of Medicine, University of Southern California, 1200 North State St, Suite 3300, Los Angeles, CA 90033, USA.Department of Neurological Surgery, Keck School of Medicine, University of Southern California, 1200 North State St, Suite 3300, Los Angeles, CA 90033, USA.Department of Neurological Surgery, Keck School of Medicine, University of Southern California, 1200 North State St, Suite 3300, Los Angeles, CA 90033, USA.Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, 1540 Alcazar St, Los Angeles, CA 90033, USA.Department of Neurological Surgery, Keck School of Medicine, University of Southern California, 1200 North State St, Suite 3300, Los Angeles, CA 90033, USA.Department of Neurological Surgery, Keck School of Medicine, University of Southern California, 1200 North State St, Suite 3300, Los Angeles, CA 90033, USA.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

28412565

Citation

Bakhsheshian, Joshua, et al. "The Use of a Novel Perfusion-based Cadaveric Simulation Model With Cerebrospinal Fluid Reconstitution Comparing Dural Repair Techniques: a Pilot Study." The Spine Journal : Official Journal of the North American Spine Society, vol. 17, no. 9, 2017, pp. 1335-1341.
Bakhsheshian J, Strickland BA, Patel NN, et al. The use of a novel perfusion-based cadaveric simulation model with cerebrospinal fluid reconstitution comparing dural repair techniques: a pilot study. Spine J. 2017;17(9):1335-1341.
Bakhsheshian, J., Strickland, B. A., Patel, N. N., Jakoi, A. M., Minneti, M., Zada, G., ... Pham, M. H. (2017). The use of a novel perfusion-based cadaveric simulation model with cerebrospinal fluid reconstitution comparing dural repair techniques: a pilot study. The Spine Journal : Official Journal of the North American Spine Society, 17(9), pp. 1335-1341. doi:10.1016/j.spinee.2017.04.007.
Bakhsheshian J, et al. The Use of a Novel Perfusion-based Cadaveric Simulation Model With Cerebrospinal Fluid Reconstitution Comparing Dural Repair Techniques: a Pilot Study. Spine J. 2017;17(9):1335-1341. PubMed PMID: 28412565.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The use of a novel perfusion-based cadaveric simulation model with cerebrospinal fluid reconstitution comparing dural repair techniques: a pilot study. AU - Bakhsheshian,Joshua, AU - Strickland,Ben A, AU - Patel,Neil N, AU - Jakoi,Andre M, AU - Minneti,Michael, AU - Zada,Gabriel, AU - Acosta,Frank L, AU - Hsieh,Patrick C, AU - Wang,Jeffrey C, AU - Liu,John C, AU - Pham,Martin H, Y1 - 2017/04/12/ PY - 2016/10/06/received PY - 2017/02/14/revised PY - 2017/04/10/accepted PY - 2017/4/17/pubmed PY - 2018/4/24/medline PY - 2017/4/17/entrez KW - Cadaveric model KW - Cerebrospinal fluid leakage KW - Complications KW - Dural repair KW - Dural sealant KW - Simulation model SP - 1335 EP - 1341 JF - The spine journal : official journal of the North American Spine Society JO - Spine J VL - 17 IS - 9 N2 - BACKGROUND CONTEXT: Watertight dural repair is crucial for both incidental durotomy and closure after intradural surgery. PURPOSE: The study aimed to describe a perfusion-based cadaveric simulation model with cerebrospinal fluid (CSF) reconstitution and to compare spine dural repair techniques. STUDY DESIGN/SETTING: The study is set in a fresh tissue dissection laboratory. SAMPLE SIZE: The sample includes eight fresh human cadavers. OUTCOME MEASURES: A watertight closure was achieved when pressurized saline up to 40 mm Hg did not cause further CSF leakage beyond the suture lines. METHODS: Fresh human cadaveric specimens underwent cannulation of the intradural cervical spine for intrathecal reconstitution of the CSF system. The cervicothoracic dura was then exposed from C7-T12 via laminectomy. The entire dura was then opened in six cadavers (ALLSPINE) and closed with 6-0 Prolene (n=3) or 4-0 Nurolon (n=3), and pressurized with saline via a perfusion system to 60 mm Hg to check for leakage. In two cadavers (INCISION), six separate 2-cm incisions were made and closed with either 6-0 Prolene or 4-0 Nurolon, and then pressurized. A hydrogel sealant was then added and the closure was pressurized again to check for further leakage. RESULTS: Spinal laminectomy with repair of intentional durotomy was successfully performed in eight cadavers. The operative microscope was used in all cases, and the model provided a realistic experience of spinal durotomy repair. For ALLSPINE cadavers (mean: 240 mm dura/cadaver repaired), the mean pressure threshold for CSF leakage was observed at 66.7 (±2.9) mm Hg in the 6-0 Prolene group and at 43.3 (±14.4) mm Hg in the 4-0 Nurolon group (p>.05). For INCISION cadavers, the mean pressure threshold for CSF leakage without hydrogel sealant was significantly higher in 6-0 Prolene group than in the 4-0 Nurolon group (6-0 Prolene: 80.0±4.5 mm Hg vs. 4-0 Nurolon: 32.5±2.7 mm Hg; p<.01). The mean pressure threshold for CSF leakage with the hydrogel sealants was not significantly different (6-0 Prolene: 100.0±0.0 mm Hg vs. 4-0 Nurolon: 70.0±33.1 mm Hg). The use of a hydrogel sealant significantly increased the pressure thresholds for possible CSF leakage in both the 6-0 Prolene group (p=.01) and the 4-0 Nurolon group (p<.01) when compared with mean pressures without the hydrogel sealant. CONCLUSIONS: We described the feasibility of using a novel cadaveric model for both the study and training of watertight dural closure techniques. 6-0 Prolene was observed to be superior to 4-0 Nurolon for watertight dural closure without a hydrogel sealant. The use of a hydrogel sealant significantly improved watertight dural closures for both 6-0 Prolene and 4-0 Nurolon groups in the cadaveric model. SN - 1878-1632 UR - https://www.unboundmedicine.com/medline/citation/28412565/The_use_of_a_novel_perfusion_based_cadaveric_simulation_model_with_cerebrospinal_fluid_reconstitution_comparing_dural_repair_techniques:_a_pilot_study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1529-9430(17)30141-9 DB - PRIME DP - Unbound Medicine ER -