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The Paediatric EVICEL® Neuro Study

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ClinicalTrials.gov Identifier: NCT02309645
Recruitment Status : Recruiting
First Posted : December 5, 2014
Last Update Posted : July 11, 2018
Sponsor:
Information provided by (Responsible Party):
Ethicon, Inc.

Brief Summary:
The purpose of this study is to evaluate the safety and efficacy of EVICEL® when used for suture-line sealing in dura-mater closure in elective or urgent paediatric cranial neurosurgery to provide intraoperative watertight closure.

Condition or disease Intervention/treatment Phase
CSF Leak Biological: EVICEL® Fibrin Sealant Other: Sutures Only Phase 4

Detailed Description:

This is a prospective randomized, open-label, multi-center controlled study evaluating the effectiveness of EVICEL® as an adjunct to sutured dural closure compared to control to obtain an intraoperative watertight dural closure.

Paediatric subjects, undergoing elective or urgent craniotomy/craniectomy for pathological processes in the posterior fossa (such as benign or malignant tumors, vascular malformations, and Chiari 1 malformations) or in the supratentorial region and who were demonstrated to have persistent cerebrospinal fluid (CSF) leakage following a primary attempt at suture closure of the dural incision.

Paediatric subjects for this study are classified as:

  • Newborn infants (birth to 27 days. Pre-term newborn infants born ≤ 37 weeks gestation will be included within the group)
  • Infants and toddlers (28 days to <24 months)
  • Children (2 to 11 years)
  • Adolescents (12 to <18 years)

    42 paediatric subjects with intra-operative cerebrospinal fluid (CSF) leak following primary suturing of the dura will be randomized in a 2:1 allocation ratio and will be stratified by surgical procedure, posterior fossa or supratentorial to either EVICEL® Fibrin Sealant (Human) or additional dural sutures.

Subjects will be followed post-operatively through discharge and for 30 days (±3 days) post-surgery. The incidence of CSF leaks will be assessed within 5 days (± 2 days) and 30 days (±3 days) post-operatively as detected by any of the following: clinical observation, diagnostic testing or the need for surgical intervention to treat a CSF leak or pseudomeningocele.


Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 42 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: A Prospective Randomized Controlled Study Evaluating the Safety and Efficacy of EVICEL® Used for Suture-Line Sealing in Dura-Mater Closure During Paediatric Neurosurgical Cranial Procedures
Actual Study Start Date : October 1, 2014
Estimated Primary Completion Date : May 1, 2019
Estimated Study Completion Date : July 1, 2019

Resource links provided by the National Library of Medicine


Arm Intervention/treatment
Experimental: EVICEL® Fibrin Sealant
EVICEL® is a human plasma-derived fibrin sealant. EVICEL® consists of two components: a concentrate of Human Clottable Protein (referred to as Biological Component 2; BAC2) and a solution of Human Thrombin. No material of animal origin is present in the product
Biological: EVICEL® Fibrin Sealant
Subjects randomized to receive EVICEL® Fibrin Sealant (Human), a thin layer will be applied to the entire length of the suture line and the adjacent area to at least 5mm away, including all suture holes.
Other Name: EVICEL, fibrin sealant

Sutures Only
Subjects randomized to control will receive additional dural repair sutures as deemed necessary by the surgeon to attempt to achieve a watertight closure.
Other: Sutures Only
Subjects randomized to Control (Additional Sutures) will receive additional dural repair sutures applied immediately to the dural suture line after randomization as deemed necessary by the surgeon.




Primary Outcome Measures :
  1. Proportion of success (intraoperative watertight closure) in the treatment of intraoperative CSF leakage defined as no cerebrospinal (CSF) leakage from dural repair intraoperatively, during Valsalva maneuver 20-25 cm H2O for 5-10 seconds. [ Time Frame: Intraoperative ]

Secondary Outcome Measures :
  1. Incidence of CSF leakage within 5 days (± 2 days) post-operatively. [ Time Frame: Up to 5 days post-operatively ]
  2. Incidence of CSF leakage within 30 days (± 3 days) post-operatively. [ Time Frame: Up to 30 days post-operatively ]
  3. Incidence of adverse events [ Time Frame: Intaoperative through the 30-day follow-up ]
  4. Incidence of surgical site infections (SSI) according to National Healthcare Safety Network (NHSN) criteria within 30 days (± 3 days) post-operatively [ Time Frame: Intaoperative through the 30-day follow-up ]


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Ages Eligible for Study:   up to 17 Years   (Child)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Patient undergoing elective or urgent craniotomy/craniectomy for pathological processes in the posterior fossa (such as benign or malignant tumors, vascular malformation, and Chiari 1 malformations) or in the supratentorial region and who are demonstrated to have persistent CSF leakage following primary attempt at suture closure of the dural incision;
  • Administration of perioperative antibiotic prophylaxis;
  • Patients who are less than 18 years of age;
  • Patients who are able and willing to comply with the procedures required by the protocol;
  • The subject's parent/legal guardian must be willing to give permission for the subject to participate in the trial, and provide written informed consent for the subject. In addition, assent must be obtained from paediatric subjects who possess the intellectual and emotional ability to comprehend the concepts involved in the trial.
  • Surgical wound classification Class I (refer to Appendix II). Penetration of mastoid air cells during partial mastoidectomy is permitted;
  • The cuff of native dura along the craniotomy edge on each side is wide enough based on surgeon's judgment to facilitate suturing and to allow for sufficient surface area for adherence of the investigational product.

Exclusion Criteria:

  • Subjects with a dura lesion from a recent surgery that still has the potential for CSF leakage;
  • Conditions or treatments significantly compromising the immune system (such as AIDS);
  • Known hypersensitivity to the components (human fibrinogen, arginine hydrochloride, glycine, sodium chloride, sodium citrate, calcium chloride, human thrombin, human albumin, mannitol and sodium acetate) of the investigational product;
  • Hydrocephalus, except occlusive hydrocephalus caused by posterior fossa pathology to be treated.
  • Existing CSF (ventricular, etc.) drains, shunts, Cushing/Dandy cannulation or Burr holes which damage the dura;
  • Female subjects of childbearing potential with a positive urine or serum pregnancy test within 24 hours prior to surgery;
  • Female subjects who are breastfeeding or intend to become pregnant during the clinical study period;
  • Participation in another clinical trial with exposure to another investigational drug or device within 30 days prior to enrollment or expected during the study period;
  • Scheduled or foreseeable surgery within the follow-up period.
  • Dura injury during craniotomy/craniectomy that cannot be eliminated by widening the craniotomy/craniectomy to recreate the native dura cuff;
  • Use of implants made of synthetic materials coming into direct contact with dura (e.g., PTFE patches, shunts, ventricular and subdural drains);
  • Planned use of dural patches after primary suture closure of the dura;
  • Placement of Gliadel Wafers;
  • Persistent signs of increased brain turgor;
  • Patient has a gap between durotomy edges of greater than 2mm after primary dural closure.
  • Intersecting durotomy scars in the surgical path from a previous operation that cannot be completely removed by the planned dura resection;
  • Two or more separate dura defects;
  • Major intraoperative complications that require resuscitation or deviation from the planned surgical procedure.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02309645


Contacts
Contact: Leonie Rynn, MBA 908-218-2492 LRynn1@its.jnj.com

Locations
United Kingdom
Clinical Investigation Site #22 Recruiting
Leeds, England, United Kingdom
Clinical Investigation Site #21 Active, not recruiting
Liverpool, England, United Kingdom
Clinical Investigation Site #25 Recruiting
London, England, United Kingdom
Clinical Investigation Site #23 Recruiting
Manchester, England, United Kingdom
Clinical Investigation Site #24 Recruiting
Edinburgh, Scotland, United Kingdom
Clinical Investigation Site #20 Recruiting
Oxford, United Kingdom
Sponsors and Collaborators
Ethicon, Inc.
Investigators
Study Director: Richard Kocharian, MD, PhD Ethicon, Inc.

Responsible Party: Ethicon, Inc.
ClinicalTrials.gov Identifier: NCT02309645     History of Changes
Other Study ID Numbers: BIOS-13-006
2013-003558-26 ( EudraCT Number )
First Posted: December 5, 2014    Key Record Dates
Last Update Posted: July 11, 2018
Last Verified: July 2018
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: Yes

Keywords provided by Ethicon, Inc.:
fibrin sealant
CSF leak

Additional relevant MeSH terms:
Cerebrospinal Fluid Leak
Neurologic Manifestations
Nervous System Diseases
Craniocerebral Trauma
Trauma, Nervous System
Signs and Symptoms
Wounds and Injuries
Fibrin Tissue Adhesive
Hemostatics
Coagulants