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

Content Provider	Europe PMC
Author	Diab, Ahmed Al-Shami, Hieder Negida, Ahmed Gadallah, Ahmed Farag, Hossam Elkadi, Doaa Mahmoud Gaber, Mo’tasem Muhamed Ebada, Mahmoud Ahmed
Copyright Year	2021
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.
ISSN	22295097
Volume Number	12
PubMed Central reference number	PMC8168650
PubMed reference number	34084610
Journal	Surgical Neurology International [Surg Neurol Int]
e-ISSN	21527806
DOI	10.25259/SNI_132_2021
Language	English
Publisher	Scientific Scholar
Publisher Date	2021-04-26
Publisher Place	USA
Access Restriction	Open
Rights License	This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms. Copyright: © 2021 Surgical Neurology International
Subject Keyword	Dura sealant Dural closure Hydrogel Polyethylene glycol
Content Type	Text
Resource Type	Article
Subject	Neurology (clinical) Surgery