# Regenerated Oxidized Cellulose as a Sealant and Adhesive in Endoscopic Endonasal Skull Base Reconstruction

## TL;DR

This study shows that regenerated oxidized cellulose is more effective than fibrin glue for sealing during skull base surgery.

## Contribution

ROC is introduced as a novel sealant/adhesive in endoscopic skull base surgery with superior performance compared to fibrin glue.

## Key findings

- ROC alone or with fibrin glue reduced postoperative CSF leaks to 8.3% compared to 66.6% with fibrin glue alone.
- ROC demonstrated better long-term sealing effectiveness than fibrin glue.
- Using ROC reduced postoperative CSF leak rates significantly (p=0.002).

## Abstract

Introduction
 An ideal and long-lasting adhesive and sealant is essential during endoscopic endonasal skull-base surgery to hold the reconstruction intact and prevent cerebrospinal fluid (CSF) permeation until complete healing occurs. Fibrin glue is the most common material used. Regenerated oxidized cellulose (ROC) has not been mentioned in the literature as sealant and adhesive, and, hence, we intended to study this role.

Objective
 To evaluate the role of ROC as tissue sealant and adhesive in the reconstruction of skull-base defects in endoscopic endonasal skull-base surgery.

Methods
 We retrospectively analyzed the medical records of patients who underwent endoscopic endonasal skull-base surgery with skull-base defect and intraoperative CSF leak, for which reconstruction was performed using fibrin glue or ROC, or both, as a sealant and adhesive. The type of sealant and adhesive used and postoperative CSF leak rates with different agents used were analyzed.

Results
 A total of 64 patients were investigated. Fibrin glue alone was used initially in 6 patients, of which 4 (66.6%) experienced postoperative CSF leak. Both fibrin glue and ROC were used in 26 patients, among which 2 (7.6%) exhibited postoperative CSF leak. Regenerated oxidized cellulose alone was used in 24 patients, wherein 2 (8.3%) presented with postoperative CSF leak. Fibrin glue alone was once again used later in the learning curve in 8 patients, of which 2 (25%) experienced postoperative CSF leak (
p
 = 0.002).

Conclusion
 Fibrin glue provides intraoperative watertight seal. Regenerated oxidized cellulose has better intraoperative and long-term sealant and adhesive action in endoscopic endonasal skull-base reconstruction.