A Simple Technique of Cerebrospinal Fluid Leak Prevention Following Endoscopic Third Ventriculostomy: A Technical Note
Abstract
BACKGROUND: There are a variety of complications of endoscopic third ventriculostomy (ETV) that have been described in the literature. Cerebrospinal fluid leak is one of the common complications that need to be addressed properly and timely management plays a crucial role in prevention of meningitis/encephalitis. OBJECTIVE: To share our experience of using autologous bone (from burr hole) debris and "BloodSTOP" absorbable hemostatic agent as an effective tool in cerebrospinal fluid leak prevention. METHODS: We have observed 14 individuals who have undergone an ETV procedure using the abovementioned multilayered technique of burr hole closure at our institution in 2024. RESULTS: A watertight dural closure is a mandatory step in every case of neurosurgical procedure. But when primary dural closure is not possible in endoscopic intraventricular surgeries, there is a way out using more affordable hemostatic materials like BloodSTOP. There are plenty of strategies in surgical closure technique, including pericranial graft, dural allografts and synthetic substitutes, and various sealants but no single consensus on the best practice regarding dural closure. TachoSil is a hemostatic agent consisting of human fibrinogen and thrombin coated onto an equine collagen sponge and has proven efficacy as a sealant for easy repair of encephalocele, incidental spinal durotomy, transsphenoidal surgery, and intradural cranial and spinal lesions. CONCLUSIONS: We report the use of a simple novel, sutureless BloodSTOP sandwich dural closure technique for post ETV dural defects, which has proven efficacy in our study when watertight primary dural closure is not technically feasible.