PROTECTIVE COATING OF CRANIAL NERVES WITH FIBRIN GLUE (TISSUCOL) DURING CRANIAL BASE SURGERY - TECHNICAL NOTE

OBJECTIVE: Cranial nerve deficit, either transient or permanent, is a common postoperative complication after cranial base surgery. Frequent ly, this occurs because intracranial nerves are directly involved in t he cranial base lesion. However, any cranial nerve adjacent to the les ion can be damaged because of direct or indirect manipulation during s urgery, leading to severe morbidity. We describe a new technique in wh ich the adjacent intracranial nerves are protected from surgical traum a by coating the nerves with a biological two-component fibrin glue (T issucol; Immune A.G., Vienna, Austria). SURGICAL TECHNIQUE: The techni que was performed in patients who underwent cranial base surgery for d ifferent types of lesions. After exposure of the operating field, the cranial nerves that were at risk of operative trauma were coated with a thin layer of fibrin glue using a double lumen catheter within a tra ditional suction device. RESULTS: With the application of fibrin glue, a protective layer of a rubbery consistency is formed around the nerv e. No intraoperative complications or adverse effects of the applicati on were noted. Moreover, no surgical injury of the nerves occurred and no or minimal postoperative cranial nerve deficit was noted in the co ated nerves. CONCLUSION: Although it is difficult to compare the posto perative cranial nerve deficit in the coated nerves with a control gro up, we think that this technique is a valuable method to minimize or a void intraoperative cranial nerve injury during cranial base surgery.