The Dural Healing Response to the Phenytoin Sodium on Experimental Rat Cerebro-Spinal Fluid (CSF) Leakage Model

Failure of watertight dural closure after trauma or surgical interventions may result with high morbidity or even mortality for patients. Although there are various methods and techniques for adequate dural closure, the ultimate modality for watertight sealing of the dura mater is yet to be developed. This study aims to investigate the effects of phenytoin, an anti-epileptic agent which was proven to have positive effects in wound healing, on healing of the dura mater. Thirty six male Wistar rats weighing between 180 ? 220 g were used for this study. Subjects were randomized into three equal groups as control, `local phenytoin? and `systemic phenytoin?. We performed two level total laminectomies at the interscapular level and observed CSF leakage after dural incision. The control group received blood patch over the dural incision. The `local phenytoin? group received 30 mg/kg of phenytoin locally over the dural incision while the `systemic phenytoin? group received 30 mg/kg phenytoin systematically via intraperitoneal route. Six rats in each group were sacrificed at the end of the first and sixth postoperative weeks. Laminectomy sites were resected en bloc for histopathological evaluation. Hematoxylin-Eosin and Masson Trichrome staining were performed to the specimens and the slides were evaluated according to the method described by Ozisik et al. Kruskal Wallis analyzes of the results demonstrated significant difference for both between the groups sacrificed at the end of the first week and at the and of the sixth week. Intergroup analyzes regarding dural healing favored systemic application of phenytoin. There was no significant difference between the results of the animals in the control group sacrificed at the first and the sixth weeks after post hoc analyzes with Wilcoxon Test. similarly there were no significant difference in the `local phenytoin? group. On the other hand, evaluation of the data gathered at the end of the first and sixth weeks from the rats in the `systemic phenytoin? group demonstrated significant difference. Dural healing was most prominent in the `systemic phenytoin? group. As a result, the positive effects of phenytoin on wound healing as well as dural healing were proven by the results of our study. However, further studies are required for clinical implementation.