Factors Associated With “Sterile Cystic Formation” Following the Application of BioGlue® in Brain Surgery and Review of Literature

Introduction BioGlue® (CryoLife, Inc, Kennesaw, GA), despite being claimed to be a safe and harmless sealant, reportedly has several adverse effects including surgical wound dehiscence. This study aimed to examine the factors that may contribute to this unfavorable outcome in cranial surgery. Methods A retrospective cross-sectional analysis was conducted on patients who underwent brain surgery with the use of BioGlue® between January 2015 and December 2022. One hundred and two individuals were enrolled and classified into two categories based on the incidence of surgical wound complications. The patients' demography, operative details, and the nature of their surgical wound problems were evaluated. Results Out of 102 individuals, 15 experienced postoperative wound complications. Fluid resembling pus was noted; however, laboratory cultures yielded negative results. Complications were significantly more prevalent (seven times higher) among individuals utilizing BioGlue® in proximity to titanium plates for skull defect correction. Patients using the 5 mL pre-filled BioGlue® device had a 2.8 times higher likelihood of complications than the 2 mL version. Using the patient's cranial bone as a barrier during surgery reduced the risk of complications. Conclusions Neurosurgeons should note possible adverse reactions of using a sealant for cranial surgery that include inflammation and wound separation. Treatment should include thorough cleansing and complete removal of BioGlue®. Two prevalent risk factors were the close proximity (direct contact) of BioGlue® to the adjacent titanium plate used for covering skull defect and the volume of sealant used (5 mL or 2 mL).