Failure pressures after repairs of 2-cm × 2.5-cm rhinologic dural defects in a porcine ex vivo model

Background: The objective of this study was to determine failure pressures of 6 rhinologic repair techniques of large skull base/dural defects in a controlled, ex vivo model. Methods: Failure pressures of 6 dural repairs in a porcine model were studied using a closed testing apparatus; 24-mm × 19-mm dural defects were created; 40-mm × 34-mm grafts composed of porcine Duragen (Integra), fascia lata, and Biodesign (Cook) were used either with or without Tisseel (Baxter International Inc.) to create 6 repairs: Duragen/no glue (D/NG), Duragen/Tisseel (D/T), fascia lata/no glue (FL/NG), fascia lata/Tisseel (FL/T), Biodesign/no glue (B/NG), and Biodesign/Tisseel (B/T). Saline was infused at 30 mL/hour, applying even force to the underside of the graft until repair failure. Five trials were performed per repair type for a total of 30 repairs. Results: Mean failure pressures were as follows: D/NG 1.361 ± 0.169 cmH₂O; D/T 9.127 ± 1.805 cmH₂O; FL/NG 0.200 ± 0.109 cmH₂O; FL/T 7.833 ± 2.657 cmH₂O; B/NG 0.299 ± 0.109 cmH₂O; and B/T 2.67 ± 0.619 cmH₂O. There were statistically significant differences between glued (Tisseel) and non-glued repairs for each repair category (p < 0.05). Conclusion: All glued repairs performed better than non-glued repairs. Both D/T and FL/T repairs performed better than B/T repairs. No repair tolerated pressures throughout the full range of adult supine intracranial pressure.