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. 2021 Apr 26:12:182.
doi: 10.25259/SNI_132_2021. eCollection 2021.

Efficacy and safety of polyethylene glycol dural sealant system in cranial and spinal neurosurgical procedures: Meta-analysis

Ahmed Diab  1 , Hieder Al-Shami  2 , Ahmed Negida  3 , Ahmed Gadallah  4 , Hossam Farag  3 , Doaa Mahmoud Elkadi  5 , Mo'tasem Muhamed Gaber  4 , Mahmoud Ahmed Ebada  3
Affiliations

Efficacy and safety of polyethylene glycol dural sealant system in cranial and spinal neurosurgical procedures: Meta-analysis

Ahmed Diab et al. Surg Neurol Int. .

Abstract

Background: We aimed to assess the efficacy of polyethylene glycol (PEG) dura sealant to achieve watertight closure, prevention of cerebrospinal fluid (CSF) leak and to investigate its possible side effects.

Methods: We searched Medline (through PubMed), Scopus, and the Cochrane Library through December 2019. We included articles demonstrating cranial or spinal procedures with the use of PEG material as a dural sealant. Data on intraoperative watertight closure, CSF leak, and surgical complications were extracted and pooled in a meta-analysis model using RevMan version 5.3 and OpenMeta (Analyst).

Results: Pooling the controlled trials showed that PEG resulted in significantly more intraoperative watertight closures than standard care (risk ratio [RR] = 1.44, 95% confidence interval [CI] [1.24, 1.66]). However, the combined effect estimate did not reveal any significant difference between both groups in terms of CSF leaks, the incidence of surgical site infections, and neurological deficits (P = 0.7, 0.45, and 0.92, respectively). On the other hand, pooling both controlled and noncontrolled trials showed significance in terms of leak and neurological complications (RR = 0.0238, 95% CI [0.0102, 0.0373] and RR = 0.035, 95% CI [0.018, 0.052]). Regarding intraoperative watertight closure, the overall effect estimate showed no significant results (RR=0.994, 95% CI [0.986, 1.002]).

Conclusion: Dura seal material is an acceptable adjuvant for dural closure when the integrity of the dura is questionable. However, marketing it as a factor for the prevention of surgical site infection is not scientifically proved. We suggest that, for neurosurgeons, using the dural sealants are highly recommended for duraplasty, skull base approaches, and in keyhole approaches.

Keywords: Dura sealant; Dural closure; Hydrogel; Polyethylene glycol.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1:
Figure 1:
Preferred reporting items for systematic reviews and meta-analyses (PRISMA) flowchart. Figure 1 shows PRISMA flowchart summarizing our literature search.
Figure 2:
Figure 2:
Risk of bias summary and graph. Figure 2 shows summary and graph for risk of bias of controlled trials.
Figure 3:
Figure 3:
Forest plots of Controlled trials. It shows analysis of controlled trials, (a) intra-operative watertight closures, (b) CSF leaks after operation, (c) surgical site infections, and (d) neurological deficits
Figure 4:
Figure 4:
Analysis of non-controlled trials, (a) intra-operative watertight closures, (b) CSF leaks after operation, and (c) surgical site infections.
See this image and copyright information in PMC

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