Bioadhesives in neurosurgery: a review

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OBJECTIVE

Neurosurgery presents unique surgical challenges arising from delicate neural structures, limited accessibility, and the risk of CSF leakage that can lead to CNS infections. Sutures and staples may have limited applicability in the complex anatomical constraints of cranial and spinal surgeries, especially in trauma settings when time is of the essence. Surgical bioadhesives are emerging as attractive alternatives because they avoid traumatic application methods, provide a stress-distributed fixation, and provide good cosmesis and outcomes. This article presents the history of the development of surgical bioadhesives, and is also a review of current applications of commercial surgical bioadhesives within neurosurgical procedures and the unmet clinical needs that should be addressed in bioadhesives technologies.

METHODS

A PubMed literature search was performed using the terms “(glue OR bioadhesive OR fibrin OR tisseel OR evicel OR tachosil OR cyanoacrylate OR duraseal OR bioglue) AND (neurosurgery OR spine OR spinal OR dural OR microvascular decompression OR transsphenoidal OR endovascular).” Of 2433 records screened, 168 studies were identified that described the use of bioadhesives in neurosurgical procedures.

RESULTS

The greatest number of studies describing the use of bioadhesives in neurosurgery were identified for endovascular embolization, followed by dural closure and transsphenoidal surgeries. Other common areas of application were for microvascular decompression, skin closure, peripheral nerve repair, and other novel uses. Numerous case reports were also identified describing complications associated with bioadhesive use.

CONCLUSIONS

Despite the paucity of approved indications, surgical bioadhesive use in neurosurgical procedures is prevalent. However, current bioadhesives still each have their own limitations and research is intense in the development of novel solutions.

ABBREVIATIONS DOPA = 3,4-dihydroxy-l-phenylalanine; GelMA = gelatin methacryloyl; iCMBA = citrate-based mussel-inspired bioadhesive; MAP = mussel adhesive protein; MeTro = methacryloyl-substituted tropoelastin; NBCA = N-butyl 2-cyanoacrylate; PEG = polyethylene glycol; UV = ultraviolet; UVA = ultraviolet A.

Supplementary Materials

  • Supplementary Tables S1A–1G (PDF 407 KB)
Article Information

Contributor Notes

Correspondence Nicolas Kon Kam King: National Neuroscience Institute, Singapore. nicolas.kon.k.k@singhealth.com.sg.INCLUDE WHEN CITING Published online November 15, 2019; DOI: 10.3171/2019.8.JNS191592.Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.
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