Autologous Fibrin Glue in Microvascular Decompression for Trigeminal Neuralgia and Hemifacial Spasm.

Abstract

Adhesive materials are widely used in microvascular decompression for treating neurovascular compression syndromes. They play an important role in the critical step of vessel fixation. Recently, completely autologous fibrin glue produced solely from a patient's own plasma was developed. It can theoretically reduce the risks of viral or prion transmission and allergic reactions, while potentially providing more stable long-term adhesion. This study reports our initial experience with completely autologous fibrin glue in microvascular decompression and evaluates its efficacy and safety. Twenty-seven consecutive patients (12 with trigeminal neuralgia and 15 with hemifacial spasm) underwent microvascular decompression using autologous fibrin glue, including 8 trigeminal neuralgia treated using a fully endoscopic supracerebellar infratentorial approach. Autologous cryoprecipitate and thrombin were prepared (average: 4.8 mL each) from preoperative blood collection (average: 388.9 mL) without adverse events. All offending arteries, including 5 vertebral arteries, were securely transposed using polytetrafluoroethylene and autologous fibrin glue. The fibrin glue was also used to support dural closure with a collagen matrix. All patients experienced complete symptom relief, with no need for postoperative medication, except for 1 patient with mild recurrence despite maintained vascular fixation confirmed on magnetic resonance imaging. No new permanent neurological deficits, cerebrospinal fluid leakage, infections, allergic reactions, or systemic complications were observed. These findings suggest that completely autologous fibrin glue is safe and effective for both vessel fixation and dural sealing in microvascular decompression, without complications related to its use.