Failure pressures of three rhinologic dural repairs in a porcine ex vivo model

Background: The objective of this work was to determine the failure pressures of 3 commonly performed repair techniques of 5-mm dural defects in a controlled setting. Methods: This was a pig dura ex vivo study. A testing apparatus was fabricated to study failure pressures of 3 different repairs in a porcine model. Five-millimeter (5-mm) dural defects were created and plugged with autologous mucosa/Tisseel (MT) (Baxter International Inc.), fat graft (FG), and bath plug (BP) techniques. Saline solution was infused at 30 mL/hour to apply unidirectional pressure to the repair until failure occurred. Five dural repairs were performed for each arm of the trial, for a total of 15 trials. Results: The mean failure pressure of the MT repair was 4.3 ± 1.9 cmH₂O, of the FG repair was 10.9 ± 4.2 cmH₂O, and of the BP repair was 20.7 ± 2.2 cmH₂O. Differences among mean failure pressures were statistically significant. Conclusion: The BP repair showed significantly higher tolerances for pressure than the other 2 repairs. The BP repair was the only technique that withstood adult physiologic supine cerebrospinal fluid (CSF) pressure.