Abstract

Objective: Fibrin sealants have become integral in neurosurgical practice, offering both hemostatic and tissue-sealing benefits across diverse intracranial procedures. Despite widespread use, evidence regarding their efficacy and safety remains inconsistent. This review aims to synthesize current applications, outcomes and reported complications in intracranial neurosurgery.
Methods: A narrative literature review with systematic search methods was conducted in accordance with key PRISMA 2020 principles. PubMed database was searched from inception using combinations of MeSH terms and keywords related to “fibrin sealant,” “neurosurgery,” “intracranial hemostasis” and “dural closure.” Eligible studies included Randomized Controlled Trials (RCTs), cohort studies, case series and reviews reporting clinical outcomes of fibrin sealant use in intracranial procedures. Data were extracted regarding application type, efficacy and complications. Due to heterogeneity among studies, results were synthesized narratively.
Results: A total of 22 studies met the inclusion criteria. Fibrin sealants were useful for dural closure, reduction of Cerebrospinal Fluid (CSF) leakage and hemostasis during tumor and vascular surgeries. Meta-analyses revealed inconsistent results on preventing postoperative CSF leaks, with some reporting benefit and others no difference from standard closure. In skull base and vascular procedures, sealants improved operative visualization and decreased bleeding. Reported complications included postoperative mass effect, adhesion formation, inflammation and allergic or thromboembolic events.
Conclusion: Fibrin sealants remain valuable adjuncts in neurosurgery, enhancing hemostasis and facilitating watertight dural closure. However, variability in formulation and expansion properties can lead to rare but severe complications. Current evidence is based on small series and heterogeneous studies, underscoring the need for high-quality RCTs to establish guidelines for their safe and effective use.

Keywords: Cerebrospinal fluid; Complications; Fibrin sealants; Hemostatic agents; Neurosurgery

Abbreviations: CSF: Cerebrospinal Fluid; RCTs: Randomized Controlled Trials; MVD: Microvascular Decompression; DESS: DuraSeal Exact Spine Sealant