フィブリン糊スプレーによる髄液漏に対するSealing効果の検討

Sealing Effect of Fibrin Glue Spray on the Protection of Cerebrospinal-fluid Leakage through the Dura Mata

I．はじめに

　脳神経外科の手術におけるフィブリン糊の使用頻度は年々増加傾向にあり，その使用目的は主として髄液漏防止である．実際，硬膜の修復が困難で，術後髄液漏が問題となる経蝶形骨洞手術や後頭蓋窩手術に多用され，その有効性については数多くの報告が認められる^{1,4,5,7,8，11）}．しかしながらフィブリン糊が実際どの程度まで，硬膜・くも膜欠損部あるいは縫合部からの髄液漏防止に有用であるかを，詳細に検討した実験報告は未だ認められていない．また，近年，従来の塗布方法である重曹法・二液混合法に加えてスプレー法が開発され，今後その応用範囲はさらに拡大するものと予想される．

　われわれは，加圧シリンジとマノメーターを用いた実験系を作製し，（1）フィブリン糊の塗布方法とsealing効果，（2）不全硬膜縫合に対するsealing効果，（3）硬膜欠損部位に対するsealing効果の基礎実験を行ったので報告する．

Fibrin glue, a biologic adhesive, is made with highly concentrated human fibrinogen and clotting factors. It has become used frequently in neurosurgical proce-dures, in particular in the closure of the dura mata to prevent cerebrospinal fluid leakage. This report evalu-ates sealing effects of the fibrin glue on cerebrospinal fluid leakage through the dura.

(1) Three manipulations for application of fibrin glue were used ; i.e., layer, mixture and spray methods. These methods were compared to estimate their sealing effects on water leakage through a 1.2mm pore in an artificial dura. The burst pressure was significantly higher when the spray method was used than when the other two methods were used. (2) Dural incision was made and then sutured at intervals of 2mm, 3mm, 4mm, 6mm, and 8mm. Fibrin glue was applied by a spray method on the sutured dura. The burst pressure of the fibrin plate was over 80cmH₂O on every interval of du-ral suture. (3) Dural defects 2mm, 4mm, 6mm, and 8mm in diameter were made, and then spray of fibrin glue was used to shield the defects. The fibrin clot spreading to the inner and outer surfaces of the pore defect was plug-shaped. The fibrin plug tolerated water pressure over 200cmH₂O, in every size of pore.In conclusion, the optimal method for using fibrin glue on the surface of the dura was a spray method. Fibrin plate/clot made by the spray method sealed the dural tear or pore so well that it sustained a water pressure of over 80cmH₂O, which is far higher than normal pressure of the intracranial cerebrospinal fluid.