Tissue Sealant Impact on Skull Base Reconstruction Outcomes: A Systematic Review and Meta-Analysis

Jonathan C Pang; Benjamin F Bitner; Madeline M Nottoli; Arash Abiri; Anh-Tram Bui; Cecilia H Nguyen; Timothy I Hsu; Theodore V Nguyen; Frank P K Hsu; Edward C Kuan

doi:10.1002/lary.31390

Tissue Sealant Impact on Skull Base Reconstruction Outcomes: A Systematic Review and Meta-Analysis

Laryngoscope. 2024 Mar 12. doi: 10.1002/lary.31390. Online ahead of print.

Authors

Affiliations

¹ Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, California, U.S.A.
² Department of Neurological Surgery, University of California, Irvine, Orange, California, U.S.A.

PMID: 38470297
DOI: 10.1002/lary.31390

Abstract

Objective: Despite significant advances in understanding of skull base reconstruction principles, the role of tissue sealants in modifying postoperative cerebrospinal fluid (CSF) leak outcomes remains controversial. We evaluate postoperative CSF leak incidence associated with tissue sealant use in skull base defect repair during endoscopic skull base surgery (ESBS).

Data sources: Web of Science, PubMed/MEDLINE, Scopus, and Cochrane Library.

Review methods: Systematic review and meta-analysis of risk differences (RD). A search strategy identified original studies reporting CSF leakage following ESBS with disaggregation by tissue sealant use and/or type.

Results: 27 non-randomized studies (n = 2,403) were included for qualitative and meta-analysis. Reconstruction with a tissue sealant did not significantly reduce postoperative CSF leak risk compared with reconstruction without sealant (RD[95% CI] = 0.02[-0.01, 0.05]). Sub-analyses of dural sealant (-0.02[-0.11, 0.07]) and fibrin glue (0.00[-0.07, 0.07]) compared with no sealant were similarly unremarkable. Postoperative CSF leakage was not significantly modulated in further sub-analyses of DuraSeal (0.02[-0.02, 0.05]), Adherus (-0.03[-0.08, 0.03]), or Bioglue (-0.06[-0.23, 0.12]) versus no dural sealant use, or Tisseel/Tissucol versus fibrin glue nonuse (0.00[-0.05, 0.05]). No significant association was seen comparing dural sealant use versus fibrin glue use on pairwise (0.01[-0.03, 0.05]) or network meta-analysis (-0.01[-0.05, 0.04]). Limitations in source literature prevented sub-analyses stratified by leak characteristics, defect size and location, and accompanying reconstruction materials.

Conclusion: Tissue sealant use did not appear to impact postoperative CSF leak incidence when compared with nonuse. Higher quality studies are warranted to thoroughly elucidate the clinical value of adjunct sealant use in endoscopic skull base reconstruction.

Level of evidence: N/A Laryngoscope, 2024.

Keywords: cerebrospinal fluid leak; endoscopic endonasal approach; multilayer reconstruction; sealants; skull base surgery; tissue glue.

Publication types

Review