Nonsuture Sealing of a Dural Substitute Utilizing a Plastic Adhesive, Methyl 2-Cyanoacrylate

Abstract

T HREE basic purposes of the use of dural substitutes in neurosurgery are to prevent adhesions between brain and overlying soft tissue, to prevent leakage of cerebrospinal fluid, and to replace membrane affected by injury or disease. Many synthetic plastics and fibers have been used as dural substitutes, including polythene film, 1,2 Vinyon N, ''17 Orlon, 3,1~ and polyvinyl sponge. 6 These agents have been applied with the use of a suturing technic to obtain a leakproof seal. Regardless of the type of dural substitute employed, the placement of sutures to ensure a watertight dam is often difficult and laborious, bringing with it the added hazard of a foreign-body reaction about the site of the sutures which may encourage the formation of meningocerebral adhesions. During the past few years, synthetic plastic adhesives have been used in both experimental animals and humans for coating and reinforcement of intracranial aneurysms, TM closure of arterial incisions and blood-vessel anastomoses, 4,1I,~4 closure of skin incisions, 1' and anastomoses of small bowel. 1~ Inou and associates 1~ reported using methyl ~-cyanoacrylate monomer on humans for closure of skin incisions, closure of an intestinal fistula, and reinforcement of a gastrojejunostomy. This report concerns the evaluation of a method to produce rapid, watertight sealing of a synthetic dural substitute, Teflon, by means of plastic adhesive, methyl ~cyanoacrylate. ++