Neurosurgery demands precision not just during the operation but also throughout the healing process, which plays a critical role in overall surgical outcomes. In repeat procedures especially for recurrent gliomas surgeons often encounter meningo-cerebral adhesions. Managing these adhesions can prolong surgery and increase the risk of focal cortical injury. They usually develop due to inflammation and disruption of the fragile dural border cell layer during surgery, which may ultimately affect patient survival and quality of life. ^1-3

For this reason, preventing adhesion during the first surgery is crucial. Careful technique and good haemostasis support healing, repair the dural defect and reduce adhesion risk, showing the value of supportive surgical adjuncts.^1,3

Why is prevention of meningo-cerebral adhesions important?

Meningo-cerebral adhesions are commonly seen during repeat surgeries for high-grade gliomas. When these adhesions must be separated, they can lead to several intraoperative challenges:^2,3

• Difficult and potentially risky re-entry during repeat surgery
• Longer operative time
• Challenging dural opening with pia-arachnoid disruption and cortical bleeding

Therefore, in patients who may require future neurosurgical procedures, preventing adhesion formation becomes particularly important.

A safe and effective method for preventing meningocerebral adhesions:

One effective approach is to create a barrier between the injured leptomeninges and the dura during the healing phase. A haemostatic gelatin sponge, such as SURGISPON, can serve this purpose effectively. While other collagen-based materials may offer similar benefits, gelatin sponges stand out for their ease of handling, wide availability, and cost-effectiveness.³

Let’s know about SURGISPON^®

What isSURGISPON^®?

SURGISPON^® is a gamma-sterilized, non-toxic, absorbable gelatin sponge designed to provide fast and effective bleeding control and support neurosurgical procedures. It is available in sponge, powder, and particle forms, in both normal and high-density compressed variants, and in multiple thicknesses (10 mm, 5 mm, 2 mm, 1 mm and 0.5 mm) and 1 g and 3 g powder options.

Figure 1: SURGISPON^® Absorbable Haemostatic Gelatin Sponge

What makes SURGISPON^®valuable in this setting?

SURGISPON^® is designed to control arterial, venous, and diffuse bleeding, particularly when conventional methods are insufficient.

Together, these features make SURGISPON^® a practical adjunct for effective bleeding control and improved surgical outcomes.

How does SURGISPON^® help surgeons manage such adhesion challenges?

Importantly, research shows that gelatin sponges can help reduce postoperative pain and opioid use, support haemostasis, and assist in dural repair when combined with controlled fibrin glue application.^1,4 In addition, placing a thin gelatin sponge during dural closure can create a protective barrier between the dura and brain, promoting better healing.³

How does gelatin spongehelp surgeons manage adhesion challenges?

Preventing meningocerebral adhesions mainly involves creating a barrier between the disrupted leptomeninges and the dura during healing. Gelatin sponges support this by acting as a biocompatible, nearly inert barrier made of partially fragmented connective-tissue polypeptides.³

So, what does clinical evidence say about this approach? Let’s take a closer look.

Clinical evidence:

A study conducted between February 2009 and May 2012, 902 craniotomies were performed to evaluate gelatin sponges in preventing meningo-cerebral adhesions. Compared with the control group (Group C, n = 14), gelatin sponge (Group G, n = 15) showed minimal, easily dissectible adhesions, while Group C had significantly higher adhesion scores (p < 0.001). No infections or inflammatory reactions caused by the gelatin sponge have been detected in this series of patients.³

Figure 2. (A) Exposed cortex after haemostasis during right pterional craniotomy.
(B) Thin gelatin sponge placed over the cortex to separate the dura and protect it during closure.³

Figure 3. (A) Intraoperative view via right pterional craniotomy of group G. Membrane free of attachments in the anterior two-thirds of the Sylvian fissure; asterisk marks area covered by gelatin sponge in the first surgery. Uncovered areas adhered to dura. (B) Membrane stripped with no attachments; temporal operculum visible.³

This study proves that, during the dural closure, placing a thin layer of gelatin sponge in the subdural space is a safe and effective method for preventing meningocerebral adhesions.³

Conclusion

By acting as a protective barrier and supporting clean healing, a haemostatic gelatin sponge may help make future surgeries safer and improve long-term outcomes. Placing a thin layer of SURGISPON^®in the subdural space during dural closure is a simple step that can help reduce meningo-cerebral adhesions. In neurosurgery, even a small addition can make a meaningful difference.

References

1. Nagahama Y, Li L, Takeda M, Mitsuhara T, Kurisu K, Howard III MA, Hitchon PW, Yamaguchi S. Localized controlled fibrin glue application with gelatin sponge for hemostasis and dural defect repair. Interdisciplinary Neurosurgery. 2019 Dec 1;18:100476.https://doi.org/10.1016/j.inat.2019.100476
2. Woo PY, Ng OK, Li RP, Chan KY. Reducing meningo-cerebral adhesions by implanting an interpositional subdural polyesterurethane graft after high-grade glioma resection. Acta Neurochirurgica. 2022 Aug;164(8):2057-62.https://doi.org/10.1007/s00701-022-05163-4
3. Gonzalez-Lopez P, Harput MV, Türe H, Atalay B, Türe U. Efficacy of placing a thin layer of gelatin sponge over the subdural space during dural closure in preventing meningo-cerebral adhesion. World neurosurgery. 2015 Jan 1;83(1):93-101. (Spongostan) https://doi.org/10.1016/j.wneu.2014.02.032
4. Ghabach MB, Mhanna NE, Abou Al Ezz MR, Mezher GN, Chammas MJ, Ghabach MM. Comparison of effects of hemostatic gelatin sponge impregnated with ropivacaine versus normal saline applied on the transverse process of the operated vertebrae on postoperative pain in patients undergoing spinal instrumentation surgery: a randomized clinical trial. World Neurosurgery. 2019 Aug 1;128:e1126-30.