TachoSil® as a ventricular sealant after glioma resection: A single-center retrospective cohort study

Abstract Ventricular entry during resection of periventricular gliomas may increase the risk of cerebrospinal fluid (CSF)-related complications, while optimal management of ependymal defects remains uncertain. We evaluated the feasibility, short-term safety, and postoperative imaging characteristics of onlay TachoSil® ventricular sealing after supratentorial high-grade glioma resection, supported by a focused synthesis of the available neurosurgical literature. We retrospectively reviewed 32 consecutive adult patients undergoing WHO grade 3–4 glioma resection between January 2024 and January 2026 in whom an intraoperative ventricular opening was sealed with a TachoSil® patch placed over the ependymal defect. CSF-related subcutaneous collection or wound leakage occurred in 5/32 patients (15.6%) within 30 days; four were managed conservatively and one required temporary lumbar drainage. No patient developed meningitis or ventriculitis, shunt-dependent hydrocephalus, early patch-related obstruction requiring reoperation, or need for permanent CSF diversion. Serial MRI through 3 months demonstrated a thin laminar interface centered at the ventricular repair site, with predominantly preserved CSF-like intraventricular signal and no patch displacement, free intraventricular material, CSF-pathway obstruction, progressive ventriculomegaly, or definite radiological migration. These findings support the technical feasibility and short-term safety of onlay TachoSil® ventricular sealing and suggest that the patch may provide a stable neomembrane-like interface between the resection cavity and ventricular system. However, the absence of a control group, the 15.6% rate of CSF-related collections, and limited follow-up preclude conclusions regarding comparative efficacy or rare delayed complications. Prospective multicenter studies with standardized closure endpoints and longer follow-up are warranted.