Use of Spongostan on Prevention of Cranial Subdural Adhesions Following Craniotomy in a Rabbit Model

Introduction:Reoperations in neurosurgical practice pose a significant risk due to adhesions developed after primary surgery. This fact should be taken into account particularly in patients who might necessitate reoperations due to recurrence of tumor or spinal operations. In fact, prevention of epidural fibrosis is significantly associated with postoperative reduced pain after spinal procedures. Numerous reported studies address to importance of decreased epidural fibrosis after spinal operations (4,6,13,21). Thus, the scope of many current clinical and experimental reports is mainly prevention of epidural fibrosis (2,5,8,10,19,23,27). Fibrosis is not only a problem in spinal operations but also a problem in cranial operations like cerebollopontine angle and posterior fossa tumors, cranioplasty or treatment of intracranial infections (12,14,16).

In fact, the main concept regarding fibrosis is decreased microvasculature and less permeability for agents like antibiotics and anti-inflammatory drugs. Accordingly, studies towards decreased fibrosis point to improved healing process (25,26). Furthermore, subdural adhesions and bands that include vascular adhesions to cortical arteries and veins usually create a problem in patients previously operated for intracranial tumors. Dural opening and subarachnoid dissection of brain-arachnoid membrane might increase the surgical risk and length of operation. Up to date, there was not any report pointing to the prevention of subdural adhesions after cranial approaches, nevertheless there are several reports which pointed to the reactive potential of the dural and arachnoid membrane (3,7,13,24).

Spongostan (Absorbable Haemostatic Gelatin Sponge, Johnson and Johnson Ethicon Inc, USA) is a sterile, water-insoluble, malleable, porcine gelatin absorbable sponge intended for haemostatic use by applying locally to the bleeding surface. It is a widely used hemostatic material used in many fields of surgery. The present experimental study in rabbits focuses on the use of spongostan as a preventive measure for dural or arachnoidal adhesions to cortex. To our knowledge this is the first study that investigates the spongostan to prevent fibrous adhesions after cranial surgery.