A pivotal randomized clinical trial evaluating the safety and effectiveness of a novel hydrogel dural sealant as an adjunct to dural repair

John M. Tew, Michael J. Strong, G. Alexanderwest, Henry Woo, Daniel E. Couture, John A. Wilson, Lorenzo F. Munoz, Charles L. Rosen, Jeremy D. Greenlee, Harry R. Van Loveren, Mark Iantosca, Clinton J. Baird, Mark Smith, Matt McGirt, Jonathan Parish, Anthony L. Asher

Research output: Contribution to journalArticlepeer-review

6 Scopus citations

Abstract

BACKGROUND: A watertight dural repair is critical to minimizing the risk of postoperative complications secondary to cerebrospinal fluid (CSF) leaks. OBJECTIVE: To evaluate the safety and efficacy of a novel hydrogel, AdherusDural Sealant, when compared with control, DuraSeal Dural Sealant System, as an adjunct to standard methods of dural repair. METHODS: In this 17-center, prospective, randomized clinical trial designed as a noninferiority, single-blinded study, 124 patients received Adherus Dural Sealant (test sealant) and 126 received DuraSeal (control). The primary composite endpoint was the proportion of patients who were free of any intraoperative CSF leakage during Valsalva maneuver after dural repair, CSF leak/pseudomeningocele, and unplanned retreatment of the surgical site. Each component was then analyzed individually as a secondary endpoint. Patients were followed for 4 mo after surgery. RESULTS: The primary composite endpoint at the 120-d follow-up was achieved in 91.2% of the test sealant group compared with 90.6% of the control, thus showing that the test sealant was statistically significantly noninferior to DuraSeal (P = .0049). Post hoc analysis of the primary composite endpoint at 14 d demonstrated superiority of the test sealant over the control (P=.030). Primary endpoint failures in the control group tended to occur early in follow-up period, while a majority of test dural sealant failures were identified through protocol-required radiographic imaging at the 120-d follow-up visit. CONCLUSION: The test sealant, Adherus Dural Sealant, is a practical, safe, and effective adjunct to achieving awatertight dural closure after primary dural closure in cranial procedures.

Original languageEnglish (US)
Pages (from-to)204-212
Number of pages9
JournalOperative Neurosurgery
Volume13
Issue number2
DOIs
StatePublished - 2017

All Science Journal Classification (ASJC) codes

  • Surgery
  • Clinical Neurology

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