Dural Sealants and Cerebrospinal Fluid Leak Management

The dura mater serves as a critical barrier enclosing the central nervous system and maintaining cerebrospinal fluid (CSF) homeostasis. Surgical interventions involving dural incisions, whether in cranial or spinal procedures, carry a risk of postoperative CSF leakage, which can lead to infection, pseudomeningocele formation, intracranial hypotension and prolonged hospital stay. To mitigate these complications, adjunctive dural sealants have been developed to reinforce sutured closures or to provide sutureless, watertight barriers. These materials span a spectrum from synthetic hydrogels and polyethylene glycol (PEG) formulations to biologically derived fibrin and collagen matrices. Advances in sealant chemistry and delivery systems have sought to optimise adhesive strength, minimise swelling in confined neural spaces and incorporate antimicrobial or regenerative properties. Effective sealants must balance biocompatibility, mechanical resilience against physiological pressures and controlled biodegradation to support tissue healing without inducing fibrosis or nerve compression.

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Dural Sealants and Cerebrospinal Fluid Leak Management publication trend

The graph below shows the total number of articles in dural sealants and cerebrospinal fluid leak management across all publications each year (not limited to Nature Index journals).

Technical terms

Dura mater: The outermost fibrous membrane enveloping the brain and spinal cord, providing mechanical protection and containing cerebrospinal fluid.

Cerebrospinal fluid leak: The escape of CSF through a dural defect, which can lead to complications such as intracranial hypotension, infection and pseudomeningocele.

Hydrogel sealant: A network of hydrophilic polymers that forms a gel upon contact with tissue, designed to adhere to the dura and create a watertight closure.

Burst pressure: The maximal internal fluid pressure a sealant or repair construct can withstand before leakage occurs, typically measured in mmHg or cmH₂O.

Pseudomeningocele: A fluid-filled cavity between the dura mater and surrounding tissues resulting from persistent CSF leakage post-surgery.

References

1. A low-swelling hydrogel as a multirole sealant for efficient dural defect sealing and prevention of postoperative adhesion. National Science Review (2024).
2. Janus adhesive bio-patches with targeted drug delivery enabled anti-bacteria and pro-angiogenesis for dura mater repair. Materials Today Bio (2025).
3. Ex vivo evaluation of a multilayered sealant patch for watertight dural closure: cranial and spinal models. Journal of Materials Science: Materials in Medicine (2021).