Augmentation of Dural Defect Repairs Strength With an Acrylic Plate in a Porcine Ex Vivo Model

Philip G. Chen, Michael R. Clampitt, Kevin T. Chorath, Ryan P. Lin, Erik K. Weitzel, Kevin C. McMains, Leonid Bunegin

Research output: Contribution to journalArticle

1 Scopus citations

Abstract

Background: Large skull base defects can be challenging to repair. This study uses a controlled ex vivo model to examine the failure pressures of various dural repairs of large skull base defects using mucosa with fibrin glue under 3 conditions: No Additional Support of the repair, support with a Foley catheter (Direct Support), and with Foley catheter contact over a rigid acrylic plate (Diffuse Support). Methods: Failure pressures of dural repairs with and without support were determined in a porcine model using an ex vivo closed testing apparatus. In addition, 20 mm × 15 mm dural defects were created. Skull base repairs were performed using porcine dura as an underlay graft followed by a septal mucosa overlay. Saline was infused at 30 mL/h, applying even force to the underside of the graft until repair failure occurred for each condition (none, direct, and diffuse support). Five trials were performed per repair type for a total of 15 repairs. Results: The mean failure pressures were as follows: No Additional Support, 6.494 ± 2.553 mm Hg; Direct Support, 5.103 ± 3.913 mm Hg; and Diffuse Support, 15.649 ± 2.638 mm Hg. A post hoc Bonferroni-Holm test demonstrated significant difference between No Additional Support and Diffuse Support (P =.001), as well as Direct Support and Diffuse Support (P =.002). Conclusion: Support of dural repairs in this model withstood higher pressures when the Foley catheter’s support is distributed evenly using a flat acrylic plate. Use of this plate is the only repair tested in this model that tolerated normal adult supine intracranial pressures.

Original languageEnglish (US)
Pages (from-to)757-762
Number of pages6
JournalAmerican Journal of Rhinology and Allergy
Volume33
Issue number6
DOIs
StatePublished - Nov 1 2019

Keywords

  • Foley balloon catheter
  • acrylic plate
  • cerebrospinal fluid leak repair
  • dura
  • endonasal surgery
  • failure strength
  • fibrin glue
  • porcine
  • rhinology
  • skull base

ASJC Scopus subject areas

  • Immunology and Allergy
  • Otorhinolaryngology

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