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Use of Tissue Glues in Endoscopic Pituitary Surgery: A Cost Comparison

Published online by Cambridge University Press:  02 December 2014

Lukas H. Kus ,
Brian W. Rotenberg  and
Neil Duggal
Lukas H. Kus
Affiliation:
School of Medicine, Queen's University, Kingston
Brian W. Rotenberg*
Affiliation:
Department of Otolaryngology - Head & Neck Surgery, London Health Sciences Centre, London, Ontario, Canada
Neil Duggal
Affiliation:
Division of Neurosurgery, Department of Clinical Neurological Sciences, London Health Sciences Centre, London, Ontario, Canada
*
Department of Otolaryngology – Head & Neck Surgery, 268 Grosvenor Street, E3-104, London, Ontario, N6A 4V2, Canada.
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Abstract

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Background:

Post-operative cerebrospinal fluid (CSF) leaks are a common complication of endoscopic pituitary surgery and account for a significant proportion of hospital costs associated with this procedure. Tisseel® is a tissue glue commonly used as an adjunct in dural repair but is not optimal for this purpose. DuraSeal® has several properties advantageous for dural repair but is not widely accepted in Canada partly due to its increased cost.

Objective:

A cost analysis of DuraSeal® versus Tisseel® in endoscopic pituitary surgery.

Methods:

A cost analysis was performed based on typical endoscopic pituitary surgery cases performed at our tertiary care institution. Operating room, hospital admission, and surgical sealant costs were obtained directly while estimates of patient recovery time and post-operative CSF leak rates were based on consensus values reported in the literature. Outcomes were reported for various possible clinical scenarios of sealant use.

Results:

In a model where surgical sealant is employed only in high-risk cases, use of DuraSeal® allows for a yearly cost savings of at least $4486.72. If surgical sealant is used in all cases, regular use of DuraSeal® versus Tisseel® either marginally reduces yearly costs or increases them by a maximum of $7619.25, depending on the case volume and estimated post-operative CSF leak rate.

Conclusion:

In most clinical scenarios, use of DuraSeal® in endoscopic pituitary surgery may reduce overall yearly hospital costs compared to Tisseel®.

Résumé:

RÉSUMÉ:Contexte:

Les fuites postchirurgicales de liquide céphalo–rachidien sont une complication fréquente de la chirurgie pituitaire endoscopique et génèrent une portion importante des coûts hospitaliers associés à cette intervention. Tisseel est une colle à tissus qui est utilisée fréquemment comme traitement d’appoint pour la réparation durale, mais ne constitue pas une solution optimale dans cette situation. La colle DuraSeal possède plusieurs propriétés avantageuse pour la réparation durale, mais elle n’est pas largement utilisée au Canada, en partie parce que son coût est plus élevé.

Objectif:

Le but de l’étude était de comparer le coût de la colle DuraSeal et de la colle Tisseel lors de la chirurgie pituitaire endoscopique.

Méthodes:

Une analyse des coûts a été effectuée basée sur des cas de chirurgie pituitaire endoscopique opérés dans notre institution de soins tertiaires. Nous avons déterminé directement les coûts pour la salle d’opération, l’hospitalisation et le scellant chirurgical et nous avons estimé le temps de guérison et le taux de fuites postopératoires de LCR à partir de valeurs consensus rapportées dans la littérature. Nous rapportons les résultats pour différents scénarios cliniques possibles d’utilisation du scellant.

Résultats:

Dans un modèle où le scellent chirurgical est utilisé uniquement chez les cas à haut risque, l’utilisation du DuraSeal permet d’épargner au moins $4486,72. Si le scellent chirurgical est utilisé chez tous les cas, l’utilisation régulière de DuraSeal plutôt que de Tisseel réduit peu les coûts annuels ou les augmente de $7619,25 au maximum, selon le volume de cas et le taux estimé de fuites postopératoires de LCR.

Conclusion:

Dans la plupart des scénarios cliniques, l’utilisation de DuraSeal pour la chirurgie pituitaire endoscopique peut réduire les coûts hospitaliers annuels totaux par rapport au Tisseel.

Type
Original Article
Information
Canadian Journal of Neurological Sciences , Volume 37 , Issue 5 , September 2010 , pp. 650 - 655
Copyright
Copyright © The Canadian Journal of Neurological 2010

References

1. Casler, JD, Doolittle, AM, Mair, EA. Endoscopic surgery of the anterior skull base. Laryngoscope. 2005; 115:16–24.CrossRefGoogle ScholarPubMed
2. Sudhakar, N, Ray, A, Vafidis, JA. Complications after transsphenoidal surgery: our experience and a review of the literature. Br J Neurosurg. 2004; 18:507–12.Google Scholar
3. Rabadan, AT, Hernandez, D, Ruggeri, CS. Pituitary tumors: our experience in the prevention of postoperative cerebrospinal fluid leaks after transsphenoidal surgery. J Neurooncol.2009; 93: 127–31.CrossRefGoogle ScholarPubMed
4. Shiley, SG, Limonadi, F, Delashaw, JB, Barnwell, SL, Andersen, PE, Hwang, PH, et al. Incidence, etiology, and management of cerebrospinal fluid leaks following trans-sphenoidal surgery. Laryngoscope. 2003; 113:1283–8.Google Scholar
5. Dusick, JR, Mattozo, CA, Esposito, F, Kelly, DF. BioGlue for prevention of postoperative cerebrospinal fluid leaks in transsphenoidal surgery: a case series. Surg Neurol.2006; 66: 371–6; discussion 376.CrossRefGoogle ScholarPubMed
6. Welch, KC, Palmer, JN. Intraoperative emergencies during endoscopic sinus surgery: CSF leak and orbital hematoma. Otolaryngol Clin North Am. 2008; 41:581–96, ix-x.Google Scholar
7. Har-El, G. Endoscopic transnasal transsphenoidal pituitary surgery-comparison with the traditional sublabial transseptal approach. Otolaryngol Clin North Am. 2005; 38:723–35.Google Scholar
8. Kerr, JT, Chu, FW, Bayles, SW. Cerebrospinal fluid rhinorrhea: diagnosis and management. Otolaryngol Clin North Am. 2005; 38:597–611.CrossRefGoogle ScholarPubMed
9. Kuroki, A, Kayama, T. Endoscopic approach to the pituitary lesions: contemporary method and review of the literature. Biomed Pharmacother.2002; 56 Suppl 1:158s–64s.Google Scholar
10. Martin, TJ, Loehrl, TA. Endoscopic CSF leak repair. Curr Opin Otolaryngol Head Neck Surg. 2007; 15:35–9.Google Scholar
11. Cappabianca, P, Cavallo, LM, de Divitiis, E. Endoscopic endonasal transsphenoidal surgery. Neurosurgery. 2004; 55:933–40; discussion 940-1.CrossRefGoogle ScholarPubMed
12. Leng, LZ, Brown, S, Anand, VK, Schwartz, TH. “Gasket-seal” watertight closure in minimal-access endoscopic cranial base surgery. Neurosurgery.2008; 62:ONSE342-3; discussion ONSE343.Google ScholarPubMed
13. Grotenhuis, JA. Costs of postoperative cerebrospinal fluid leakage: 1-year, retrospective analysis of 412 consecutive nontrauma cases. Surg Neurol. 2005; 64:490–3, discussion 493–4.Google Scholar
14. Preul, MC, Bichard, WD, Spetzler, RF. Toward optimal tissue sealants for neurosurgery: use of a novel hydrogel sealant in a canine durotomy repair model. Neurosurgery. 2003; 53:1189–98; discussion 1198–9.CrossRefGoogle Scholar
15. Kacher, DF, Frerichs, K, Pettit, J, Campbell, PK, Meunch, T, Norbash, AM. DuraSeal magnetic resonance and computed tomography imaging: evaluation in a canine craniotomy model. Neurosurgery.2006; 58:ONS140-7; discussion ONS-147.Google Scholar
16. Cosgrove, GR, Delashaw, JB, Grotenhuis, JA, Tew, JM, Van Loveren, H, Spetzler, RF, et al. Safety and efficacy of a novel polyethylene glycol hydrogel sealant for watertight dural repair. J Neurosurg. 2007; 106:52–8.Google Scholar
17. Boogaarts, JD, Grotenhuis, JA, Bartels, RH, Beems, T. Use of a novel absorbable hydrogel for augmentation of dural repair: results of a preliminary clinical study. Neurosurgery. 2005; 57:146–51; discussion 151.Google ScholarPubMed
18. Canadian Pharmacists Association. Compendium of Pharmaceuticals and Specialties (CPS). Ottawa: The Association; 2009:2936.Google Scholar
19. Abuzayed, B, Kafadar, AM, Oguzoglu, SA, Canbaz, B, Kaynar, MY. Duraplasty using autologous fascia lata reenforced by on-site pedicled muscle flap: technical note. J Craniofac Surg. 2009; 20:435–8.CrossRefGoogle ScholarPubMed
20. Shah, AR, Pearlman, AN, O’Grady, KM, Bhattacharyya, TK, Toriumi, DM. Combined use of fibrin tissue adhesive and acellular dermis in dural repair. Am J Rhinol. 2007; 21:619–21.Google Scholar
21. Yano, S, Tsuiki, H, Kudo, M, Kai, Y, Morioka, M, Takeshima, H, et al. Sellar repair with resorbable polyglactin acid sheet and fibrin glue in endoscopic endonasal transsphenoidal surgery. Surg Neurol. 2007; 67:59–64; discussionCrossRefGoogle ScholarPubMed
22. Black, P. Cerebrospinal fluid leaks following spinal surgery: use of fat grafts for prevention and repair. Technical note. J Neurosurg. 2002; 96:250–2.Google ScholarPubMed
23. Weber, R, Keerl, R, Draf, W, Schick, B, Mosler, P, Saha, A. Management of dural lesions occurring during endonasal sinus surgery. Arch Otolaryngol Head Neck Surg. 1996; 122:732–6.Google Scholar
24. United States Food and Drug Administration. Approved drug products with therapeutic equivalence vvaluations (Orange Book). Rockville: U. S. Department of Heath and Human Services; 2009:1160.Google Scholar
25. Than, KD, Baird, CJ, Olivi, A. Polyethylene glycol hydrogel dural sealant may reduce incisional cerebrospinal fluid leak after posterior fossa surgery. Neurosurgery.2008; 63:ONS182-6; discussion ONS186-7.Google Scholar
26. Seiler, RW, Mariani, L. Sellar reconstruction with resorbable vicryl patches, gelatin foam, and fibrin glue in transsphenoidal surgery: a 10-year experience with 376 patients. J Neurosurg.2000; 93: 762–5.Google Scholar
27. Ciric, I, Ragin, A, Baumgartner, C, Pierce, D. Complications of transsphenoidal surgery: results of a national survey, review of the literature, and personal experience. Neurosurgery.1997; 40: 225–36; discussion 236-7.Google Scholar
28. Black, PM, Zervas, NT, Candia, GL. Incidence and management of complications of transsphenoidal operation for pituitary adenomas. Neurosurgery. 1987; 20:920–4.Google Scholar
29. Koltai, PJ, Goufman, DB, Parnes, SM, Steiniger, JR. Transsphenoidal hypophysectomy through the external rhinoplasty approach. Otolaryngol Head Neck Surg. 1994; 111:197–200.Google Scholar
30. Jho, HD. Endoscopic transsphenoidal surgery. J Neurooncol. 2001; 54:187–95.CrossRefGoogle ScholarPubMed
31. Han, ZL, He, DS, Mao, ZG, Wang, HJ. Cerebrospinal fluid rhinorrhea following trans-sphenoidal pituitary macroadenoma surgery: experience from 592 patients. Clin Neurol Neurosurg.2008; 110: 570–9.Google Scholar
32. Sanai, N, Quinones-Hinojosa, A, Narvid, J, Kunwar, S. Safety and efficacy of the direct endonasal transsphenoidal approach for challenging sellar tumors. J Neurooncol. 2008; 87:317–25.Google Scholar
33. Nishioka, H, Izawa, H, Ikeda, Y, Namatame, H, Fukami, S, Haraoka, J. Dural suturing for repair of cerebrospinal fluid leak in transnasal transsphenoidal surgery. Acta Neurochir (Wien).2009; 151: 1427–30.Google Scholar
34. Senior, BA, Ebert, CS, Bednarski, KK, Bassim, MK, Younes, M, Sigounas, D, et al. Minimally invasive pituitary surgery. Laryngoscope. 2008; 118:1842–55.Google Scholar
35. Tamasauskas, A, Sinkunas, K, Draf, W, Deltuva, V, Matukevicius, A, Rastenyte, D, et al. Management of cerebrospinal fluid leak after surgical removal of pituitary adenomas. Medicina (Kaunas). 2008; 44:302–7.Google Scholar
36. Sherman, JH, Pouratian, N, Okonkwo, DO, Jane, JA Jr., Laws, ER. Reconstruction of the sellar dura in transsphenoidal surgery using an expanded polytetrafluoroethylene dural substitute. Surg Neurol. 2008; 69:73–6; discussion 76.Google Scholar
37. Charalampaki, P, Reisch, R, Ayad, A, Welschehold, S, Conrad, J, Wuster, C. Image-guided endonasal transsphenoidal microsurgical treatment of recurrent microadenomas of the pituitary gland. Minim Invasive Neurosurg. 2006; 49:93–7.CrossRefGoogle ScholarPubMed
38. Cappabianca, P, Esposito, F, Cavallo, LM, Messina, A, Solari, D, di Somma, LG, et al. Use of equine collagen foil as dura mater substitute in endoscopic endonasal transsphenoidal surgery. Surg Neurol. 2006; 65:144–8; discussion 149.Google Scholar
39. Rudnik, A, Zawadzki, T, Wojtacha, M, Bazowski, P, Gamrot, J, Galuszka-Ignasiak, B, et al. Endoscopic transnasal transsphenoidal treatment of pathology of the sellar region. Minim Invasive Neurosurg. 2005; 48:101–7.Google Scholar
40. Sonnenburg, RE, White, D, Ewend, MG, Senior, B. Sellar reconstruction: is it necessary? Am J Rhinol. 2003; 17:343–6.Google Scholar
41. Kelly, DF, Oskouian, RJ, Fineman, I. Collagen sponge repair of small cerebrospinal fluid leaks obviates tissue grafts and cerebrospinal fluid diversion after pituitary surgery. Neurosurgery.2001; 49: 885–9; discussion 889-90.Google Scholar
42. Chee, GH, Mathias, DB, James, RA, Kendall-Taylor, P. Transsphenoidal pituitary surgery in Cushing’s disease: can we predict outcome? Clin Endocrinol (Oxf). 2001; 54:617–26.Google Scholar
43. Citardi, MJ, Cox, AJ, 3rd, Bucholz, RD. Acellular dermal allograft for sellar reconstruction after transsphenoidal hypophysectomy. Am J Rhinol. 2000; 14:69–73.CrossRefGoogle ScholarPubMed
44. Kelley, TF, Stankiewicz, JA, Chow, JM, Origitano, TC. Endoscopic transsphenoidal biopsy of the sphenoid and clival mass. Am J Rhinol. 1999; 13:17–21.Google Scholar
45. Yoshimoto, T, Sawamura, Y, Houkin, K, Abe, H. Effectiveness of fibrin glue for preventing postoperative extradural fluid leakage. Neurol Med Chir (Tokyo). 1997; 37:886–9; discussion 889-90.Google Scholar
46. Horowitz, B, Busch, M. Estimating the pathogen safety of manufactured human plasma products: application to fibrin sealants and to thrombin. Transfusion. 2008; 48:1739–53.Google Scholar
47. Mitsuhata, H, Horiguchi, Y, Saitoh, J, Saitoh, K, Fukuda, H, Hirabayasi, Y, et al. An anaphylactic reaction to topical fibrin glue. Anesthesiology. 1994; 81:1074–7.Google Scholar
48. Berguer, R, Staerkel, RL, Moore, EE, Moore, FA, Galloway, WB, Mockus, MB. Warning: fatal reaction to the use of fibrin glue in deep hepatic wounds. Case reports. J Trauma. 1991; 31:408–11.Google Scholar
49. Krishnan, LK, Vijayan Lal, A, Uma Shankar, PR, Mohanty, M. Fibrinolysis inhibitors adversely affect remodeling of tissues sealed with fibrin glue. Biomaterials. 2003; 24:321–7.CrossRefGoogle ScholarPubMed
50. Yamaoka, T, Tabata, Y, Ikada, Y. Fate of water-soluble polymers administered via different routes. J Pharm Sci. 1995; 84:349–54.Google Scholar
51. Bhatki, AM, Carrau, RL, Snyderman, CH, Prevedello, DM, Gardner, PA, Kassam, AB. Endonasal surgery of the ventral skull base-endoscopic transcranial surgery. Oral Maxillofac Surg Clin North Am. 2010; 22:157–68.CrossRefGoogle ScholarPubMed
52. Weinstein, JS, Liu, KC, Delashaw, JB Jr., Burchiel, KJ, van Loveren, HR, Vale, FL, et al. The safety and effectiveness of a dural sealant system for use with nonautologous duraplasty materials. J Neurosurg. 2010; 112:428–33.Google Scholar
53. Nishioka, H, Haraoka, J, Ikeda, Y. Risk factors of cerebrospinal fluid rhinorrhea following transsphenoidal surgery. Acta Neurochir (Wien). 2005; 147:1163–6; discussion 1166.Google Scholar