A PILOT INVESTIGATION OF POLOXAMER-407 FOR THE PREVENTION OF LEPTOMENINGEAL ADHESIONS IN THE RABBIT

Leptomeningeal adhesion formation frequently complicates operations an d diseases of the central nervous system. Chronic adhesive arachnoidit is may follow intraspinal surgery for disc, tumor, and closure of myel omeningocele. eventually producing pain and declining neurological sta tus of the patient. Reoperation for scar removal is seldom successful as the arachnoidal adhesions reform. Poloxamer 407 (P407) has been sho wn to reduce postoperative peritoneal adhesion formation in rats and g olden hamsters. In a rabbit model, we investigated the potential of P4 07 to prevent the production of arachnoidal adhesions and nerve root s carring following laminectomy and surgical meningeal injury. The lumba r spinal roots of 8 New Zealand white rabbits were surgically isolated under magnification. One root sleeve axilla was opened and immediatel y closed with 10-0 suture (control site) and a second root sleeve axil la was opened, P407 injected, and closed with 10-0 suture (treatment s ite). Five of 7 rabbits treated with P407 and followed for 7-42 days s howed no arachnoidal adhesions at the level of the nerve root. Four Ne w Zealand white rabbits had the lamina removed, and the dura over the spinal cord was opened at two sites separated by one to two lumbar seg ments. At one site P407 was inserted beneath the dura following duroto my, and the other site was opened in a similar fashion and immediately closed without the insertion of P407. There was a 50% reduction in le ptomeningeal adhesion formation with the use of P407. P407 may be usef ul in neurosurgery for the prevention of arachnoidal adhesions.