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The following is a summary of “Periventricular gliomas. Evaluation of the risks associated with ventricular opening in two cohorts—one prospective with TachoSil® for ventricular sealing and the other without it retrospective,” published in the February 2025 issue of European Journal of Surgical Oncology by Pilar et al.
Ventricular opening (VO) during glioma resection, particularly in high-grade periventricular gliomas, has long been associated with an increased risk of postoperative complications, including cerebrospinal fluid (CSF) leaks, pseudo meningocele, infection, hydrocephalus, and leptomeningeal spread (LMS). Despite this known risk, there remains a lack of specific, clinically tested products aimed at sealing the ventricle during such procedures. TachoSil®, a hemostatic agent commonly used for dura mater sealing, has gained attention as a potential solution to address the challenges posed by VO. However, its effectiveness and safety in the context of glioma surgery with VO remain under-explored. The aim of this study was to assess the safety and effectiveness of TachoSil® as a ventricular sealant in patients undergoing surgery for periventricular gliomas with VO.
A single-center, analytical, and observational study was conducted to compare two cohorts of patients with gliomas and VO: a prospective cohort treated with TachoSil® between 2020 and 2024 and a retrospective control cohort that did not receive TachoSil® between 2017 and 2023. A range of epidemiological, clinical, radiological, and surgical variables were recorded, focusing particularly on complications attributable to VO, such as CSF leaks, pseudo meningocele, infection, hydrocephalus, and LMS. In total, 68 patients were included in the study: 37 in the prospective cohort treated with TachoSil® and 31 in the retrospective control cohort. The two cohorts exhibited statistically similar demographic, clinical, and radiological characteristics, suggesting homogeneity between groups.
The results revealed that the use of TachoSil® for ventricular sealing led to significantly wider resections, with a smaller residual tumor volume in the treatment group (1.54 cm3 ± 1.92) compared to the control group (3.71 cm3 ± 5.64, P = 0.032). Furthermore, the incidence of postoperative complications related to VO was significantly lower in the TachoSil® cohort, with only two patients experiencing complications compared to nine in the control group (p = 0.008). These findings suggest that TachoSil® is a safe and effective adjunct for sealing the ventricle in patients with glioma, potentially reducing complications related to VO, improving the extent of tumor resection, and decreasing the need for readmissions or reinterventions due to VO-related issues. Despite these promising results, a randomized clinical trial is necessary to further validate the findings and establish definitive guidelines for the use of TachoSil® in this setting.
Source: ejso.com/article/S0748-7983(25)00098-8/abstract
