Role of Novel RADA16 Hydrogel in Endoscopic Skull Base Surgery
Study Details
Study Description
Brief Summary
The purpose of this study is to specifically evaluate the effectiveness of Puragel, a RADA16 polypeptide hydrogel, in expediting post-operative healing and re-mucosalization of the nasoseptal flap harvest site during endoscopic skull base surgery and the impact on patient and sinonasal morbidity.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
|
N/A |
Detailed Description
Briefly, multiple agents exist and have been long-studied in endoscopic sinus and septal surgery, which include non-absorbable agents and biodegradabale, absorbable synthetic agents including extracellular matrix (ECM) based compounds and synthetic biopolymers. The goal of these agents has often been to reduce sinonasal crusting, postoperative bleeding, and synechia formation. With advancements in postoperative adjuncts, many options now exist for postoperative sinonasal packing including medicated products such as steroid-impregnated stents and chitosan-based absorbable packs.
Lastly, with respect to intra-operative adjuncts designed to foster healing in the postoperative period, PuraGelTM, a RADA16 polypeptide hydrogel, was identified as an ECM-based solution, which aids in wound healing, adhesion prevention, and hemostasis at the completion of the case. In hydrogel format, this agent forms a synthetic matrix that serves as a scaffold for mucosal healing while serving as a mechanical barrier on tissue surfaces, thereby limiting scarring. To date, there have been no studies evaluating the role of this gel-based compound in the postoperative period in endoscopic skull base surgery.
Thus, amongst all of these agents that have been previously studied to some degree in patients undergoing endoscopic sinus surgery, there has been limited study on their role in endoscopic skull base surgery and utility in reducing sinonasal morbidity in the postoperative setting. Therefore, our goal was to investigate and compare the impact of varying sinonasal agents in the nasal cavity following endoscopic skull base surgery. We hypothesize that the absorbable, ECM-based gel compound (PuraGel TM) demonstrates an improvement on postoperative healing rate and sinonasal crusting with reduced patient morbidity and improved patient comfort when compared to non-absorbable agents.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Active Comparator: PuraGel (RADA16) Hydrogel Participant will have PuraGel (RADA16) Hydrogel applied to the nasoseptal flap harvest site following endoscopic skull base surgery |
Device: PuraGel (RADA16) Hydrogel
Participant will have PuraGel (RADA16) Hydrogel applied to the nasoseptal flap harvest site
|
| Active Comparator: Non-absorbable Packing (Silastic Splint) Participant will have a silastic splint (Non-Absorbable Packing) applied to the nasoseptal flap harvest site following endoscopic skull base surgery with no additional packing or agent |
Device: Non-Absorbable Packing (Silastic Splint)
Participant will have silastic splint applied to nasoseptal flap harvest site
|
Outcome Measures
Primary Outcome Measures
- Change in Modified Lund-Kennedy nasal endoscopy score [1 week, 4 weeks, and 12 weeks following surgery.]
Modified Lund-Kennedy nasal endoscopy score to rate mucosal edema, nasal crusting, and scarring. This will be double blinded (video endoscopy will be performed and scoring will be performed by non-operative surgeon, blinded to the intervention group). This scoring will address wound healing, adhesion formations. Scoring will be performed at 1 week, 4 weeks, and 12 weeks following surgery. The timing of these assessments is based on the routine postoperative follow-up schedule. No additional appointments will be made for the purposes of this study. We will be looking at the change in this score over time.
Secondary Outcome Measures
- Patient-reported pain [1 week, 4 weeks, and 12 weeks following surgery.]
Patient-reported pain visual analog scale during postoperative debridement of the main nasal cavity. Minimum score is 1 (reflecting no pain) and the maximum score is 10 (reflecting extreme amount of pain).
- subjective QOL score [1 week, 4 weeks, and 12 weeks following surgery.]
Postoperative, subjective QOL score with the validated Anterior Skull Base Nasal Inventory-12 (ASK-12) at 1 week, 4 weeks, and 12 weeks postoperatively.
- Endoscopic grading of mucosalization [1 week, 4 weeks, and 12 weeks following surgery.]
Likert scale of mucosalization of the nasal septum graded by blinded reviewer via nasal endoscopy video
Eligibility Criteria
Criteria
Inclusion Criteria:
-
Patient is 18 years of age or older
-
Patient is undergoing endoscopic endonasal approach for the management of a skull base tumor or CSF leak. Nasoseptal Flap must be harvested.
-
Patient is undergoing surgery via bi-nostril approach requiring bilateral surgical dissection of the nasal cavity in approach to the skull base
Exclusion Criteria:
-
Patient has evidence of radiographic baseline sinus disease consistent with acute or chronic rhinosinusitis (including nasal polyposis, prior septal perforation) on pre-operative CT sinus
-
Patient has had prior sinonasal surgery or has undergone sinonasal radiation treatment
-
Patient has a known coagulation disorder or immune deficiency.
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | Indiana University | Indianapolis | Indiana | United States | 46202 |
Sponsors and Collaborators
- Indiana University
- 3-D Matrix Medical Technology
Investigators
None specified.Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- 14045