CO₂ Laser Fascia to Dura Soldering for Pig Dural Defect Reconstruction

ABSTRACT

Background and objectives: The purposes of this study were to demonstrate that laser soldering is safe and effective for tissue bonding in dural reconstruction and to compare this new reconstruction technique to an established one. Study design: A temperature-controlled fiberoptic CO₂ laser system or fibrin glue were used for in vitro dural defect reconstruction in two groups of pigs. The CO₂ laser technique was also used for dural reconstruction in live pigs. Results: The burst pressure of the reconstructed dura by the laser system was significantly higher than that of fibrin glue (mean pressure 258.5 ± 117.3 cm H₂O and 76.8 ± 47.2 cm H₂O, respectively). There were no postoperative complications and no signs of thermal damage to the dura, fascia, or underlying tissue on histological analysis following the in vivo CO₂ laser experiments. Conclusions: Temperature-controlled laser soldering is an effective technique for dural repair. It creates a strong tissue bonding with no thermal damage to the tissue. The burst pressure of the reconstructed dura done with laser soldering is significantly higher than that of fibrin glue.

Anterior skull base - reconstruction - dura - CO₂

REFERENCES

• 1 Fliss D M, Zucker G, Cohen A et al.. Early outcome and complications of the extended subcranial approach to the anterior skull base.  Laryngoscope. 1999;  109 153-160
• 2 Carrau R L, Snyderman C H, Kassam A B. The management of cerebrospinal fluid leaks in patients at risk for high-pressure hydrocephalus.  Laryngoscope. 2005;  115 205-212
• 3 Mirza S, Thaper A, McClelland L, Jones N S. Sinonasal cerebrospinal fluid leaks: management of 97 patients over 10 years.  Laryngoscope. 2005;  115 1774-1777
• 4 Simhon D, Brosh T, Halpern M et al.. Closure of skin incisions in rabbits by laser soldering: I: Wound healing pattern.  Lasers Surg Med. 2004;  35 1-11
• 5 Chikamatsu E, Sakurai T, Nishikimi N et al.. Comparison of laser vascular welding, interrupted sutures, and continuous sutures in growing vascular anastomoses.  Lasers Surg Med. 1995;  16 34-40
• 6 Gil Z, Shaham A, Vasilyev T et al.. Novel laser tissue-soldering technique for dural reconstruction.  J Neurosurg. 2005;  103 87-91
• 7 Lobik L, Ravid A, Nissenkorn I et al.. Bladder welding in rats using controlled temperature CO₂ laser system.  J Urol. 1999;  161 1662-1665
• 8 Shumalinsky D, Lobik L, Cytron S et al.. Laparoscopic laser soldering for repair of ureteropelvic junction obstruction in the porcine model.  J Endourol. 2004;  18 177-181
• 9 Simhon D, Ravid A, Halpern M et al.. Laser soldering of rat skin, using fiberoptic temperature controlled system.  Lasers Surg Med. 2001;  29 265-273
• 10 Cohen M, Ravid A, Scharf V et al.. Temperature controlled burn generation system based on a CO₂ laser and a silver halide fiber optic radiometer.  Lasers Surg Med. 2003;  32 413-416
• 11 Foyt D, Johnson J P, Kirsch A J et al.. Dural closure with laser tissue welding.  Otolaryngol Head Neck Surg. 1996;  115 513-518
• 12 Hadley M N, Martin N A, Spetzler R F et al.. Comparative transoral dural closure techniques: a canine model.  Neurosurgery. 1988;  22 392-397
• 13 Eyal O, Scharf V, Katzir A. Fiber optic pulsed photothermal radiometry for fast surface-temperature measurements.  Appl Opt. 1998;  37 5945-5950
• 14 Martinot V L, Mordon S R, Mitchell V A et al.. Determination of efficient parameters for argon laser-assisted anastomoses in rats: macroscopic, thermal, and histological evaluation.  Lasers Surg Med. 1994;  15 168-175
• 15 Schober R, Ulrich F, Sander T et al.. Laser-induced alteration of collagen substructure allows microsurgical tissue welding.  Science. 1986;  232 1421-1422
• 16 Fliss D M, Gil Z, Spektor S et al.. Skull base reconstruction after anterior subcranial tumor resection.  Neurosurg Focus. 2002;  12 e10
• 17 Kitano M, Taneda M. Subdural patch graft technique for watertight closure of large dural defects in extended transsphenoidal surgery.  Neurosurgery. 2004;  54 653-660 discussion 660-651
• 18 Sekhar L N, Nanda A, Sen C N et al.. The extended frontal approach to tumors of the anterior, middle, and posterior skull base.  J Neurosurg. 1992;  76 198-206
• 19 Briggs R J, Wormald P J. Endoscopic transnasal intradural repair of anterior skull base cerebrospinal fluid fistulae.  J Clin Neurosci. 2004;  11 597-599
• 20 Landeiro J A, Lazaro B, Melo M H. Endonasal endoscopic repair of cerebrospinal fluid rhinorrhea.  Minim Invasive Neurosurg. 2004;  47 173-177