During the period of 1990-1998, we applied EC glue produced by Guangzhou Baiyun Medical Glue Company to a variety of diseases in neurosurgery and achieved satisfactory results.
Clinical data
There were 1086 cases in this group, aged from 2 to 87 years old, with an average of 35,6 years old. The distribution of disease types is shown in Table 1.
The amount of EC glue should be used according to the lesion, generally 0.5~1.0ml (1~2 pieces). If the lesion is widely involved and the arterial or venous sinus bleeding is more violent, the dosage should be increased appropriately.
1.Craniotomy for cranial tumor
Including meningioma, glioblastoma, vascular reticulocytoma, chordoma, teratoma, osteoma, etc. It is mainly used to stop the bleeding in the tumor bed and surrounding areas which are difficult to control during surgery.
2.Cranio-cerebral trauma
It is mostly used for the bonding and repair of cerebrovascular damage, craniofacial and skull base bone defects, skull crushing and repositioning of depressed fractures. In the case of repairing cerebrovascular damage, gelatin sponge is firstly used to fill in the broken blood vessel, and then the repair piece coated with EC glue is applied to it in order to play the role of reinforcement.
3.Saddle area lesion transsphenoidal surgery
At the end of the operation, the muscle, gelatin sponge and bone pieces are glued together with EC glue to repair the saddle base to prevent cerebrospinal fluid leakage. For many years, we have used transsphenoidal surgery to treat large pituitary adenoma of suprasellar extension, and if there is rupture of saddle septum after adenoma removal and cerebrospinal fluid leakage occurs, we have used EC glue to repair the saddle base with good effect, and there is no case of cerebrospinal fluid nasal leakage.
4.Cranial defect repair
Such as the bonding of free bone flap, cranial-orbital-nasal joint surgery of the channel mucosal plugging, in the CT brain stereotactic open surgery, need to use EC glue to bond the ring-type bone flap fixed.
5.Repair of cerebrospinal fluid ear (nasal) leakage
For patients with traumatic or spontaneous cerebrospinal fluid ear (nasal) leak, after searching for the leak, a rough surface is created around the leak with surgical instruments, and a fascia, dura mater or muscle block slightly larger than the leak is taken and coated with EC glue and applied to the leak, and another layer of glue is applied above the repair and covered with gelatin sponge, which can often achieve the purpose of very tight repair. In the present group of 58 cases of cerebrospinal fluid ear (nasal) leaks repaired with EC glue, all of them were successful in one operation, and none of them had releakage after the operation.
6.Brain (spinal cord) hemangioma or AVM surgery
In order to prevent the patient from bleeding due to the increase of blood pressure after the surgery, a small piece of muscle or gelatin sponge coated with EC glue can be wrapped around the clamped aneurysm or the severed thick AVM supply artery in order to prevent the patient from bleeding due to the increase of blood pressure caused by some reasons. This method is also suitable for isolated surgery of those broad-based cerebral aneurysms that cannot be clamped.
7.Surgery for abnormal proliferation of bone fibers
This disease is rare. Due to the abnormal proliferation of bones in the craniofacial and skull base, it can cause a variety of clinical symptoms, such as visual and hearing impairment, eye protrusion, and craniofacial deformity. Surgical treatment is mainly to amputate the abnormally proliferated bones, perform thorough neurovascular decompression, and perform cranial and skull base reconstruction at the same time. During the operation, reconstruction and reconstruction of the removed skull, orbital roof, brow arch and nasal bridge are performed. Therefore, the application of EC glue and its adhesive effect is very important.
8.Craniocervical and vertebroplasty
Many craniocervical area and spinal canal diseases (including tumors, arachnoid cysts, disc prolapse, atlanto-occipital deformity, spinal stenosis, etc.), after surgical treatment, the cut craniocervical bone and spinal plate reset, the implementation of molding, in order to maintain the integrity of the spinal canal after surgery. For example, atlanto-occipital fusion and laminectomy “back door” surgery after craniocervical surgery are good indications for EC glue application.
Discussion
1.For the bonding of bone flap or bone defect, the bone powder from the cranial drilling is often not filled in the bone flap sawing, and then the EC glue is dripped into the bone flap, which can make it bond more firmly.
2, the use of EC glue environment, required in the surgery for the need to bond the site and tissue, should be cleared of blood or liquid components, to maintain local cleanliness and dryness, to enable it to play a strong bonding performance.
3, with EC glue on the blood vessels and nerves for bonding and hemostasis, first coated with EC glue on the gelatin sponge or muscle sheet, and then attached to the glue site, do not apply directly to the tissue.
4. When applying EC glue during deep brain surgery (e.g. surgery of saddle area lesion via oral-nasal-pteryx approach), it is necessary to inject the glue into the site with a syringe containing a long needle. Since the gel is often polymerized in the syringe within a short time after being withdrawn from the ampoule, it should be used quickly to avoid blockage of the syringe (use thick needles and disposable plastic syringes).