Abstract / Summary
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.