Dural Reconstruction with Fascia, Titanium Mesh, and Bone Screws: Technical Note

Neurosurgery ◽  
2001 ◽  
Vol 49 (3) ◽  
pp. 749-752 ◽  
Author(s):  
Laligam N. Sekhar ◽  
Sajjan Sarma ◽  
Akio Morita
Keyword(s):  
Cerebrospinal Fluid Leak ◽  
Technical Note ◽  
Dural Defect ◽  
Titanium Mesh ◽  
Temporal Fascia ◽  
Dural Closure ◽  
Titanium Screws ◽  
Abdominal Fascia ◽  
A New Technique ◽  
Fluid Leak

Abstract OBJECTIVE After the resection of cranial base tumors, there may not be enough free dural margin left for reconstruction after involved bone and dura have been removed. In such a situation, dural reconstruction becomes a problem. We propose a new technique of dural closure in such cases. METHODS A fascial graft is prepared from either fascia lata, abdominal fascia, pericranium, or temporal fascia and is trimmed to a size slightly larger than that of the dural defect. The fascial graft is placed over the dural defect and affixed to the underlying bone with a piece of titanium mesh, titanium screws, or both. The graft is then reinforced with fibrin glue. RESULTS This method of dural reconstruction has been used in five patients with basal meningiomas. Three were in the petromastoid area, and two were in the planum-ethmoid area. None of these patients experienced postoperative cerebrospinal fluid leak, and none experienced any complications related to the reconstruction. CONCLUSION This technique of dural reconstruction can be used in selected cases of basal tumors without enough free dural margin to sew into a fascial graft.

Aneurysm Clips for Durotomy Repair: Technical Note

2010 ◽  
Vol 66 (suppl_1) ◽  
pp. ons-E124-ons-E125
Author(s):  
Alexandra D. Beier ◽  
Ryan J. Barrett ◽  
Teck M. Soo
Keyword(s):  
Primary Closure ◽  
Cerebrospinal Fluid Leak ◽  
Bed Rest ◽  
Technical Note ◽  
Lumbar Spine Surgery ◽  
Aneurysm Clip ◽  
Bone Removal ◽  
Dural Closure ◽  
Fluid Leak ◽  
Primary Modality

Abstract Background: Dural injury is a common complication of lumbar spine surgery. Primary closure is the “gold standard.” Objective: This technical note describes a failed primary closure of a durotomy revised using an aneurysm clip. Methods: From 2005 to 2009, 5 patients underwent repair of a durotomy with the use of aneurysm clips. Resolution of the cerebrospinal fluid leak was seen in all patients. An 84-year-old woman underwent a laminectomy with an inadvertent dural tear that was primarily repaired with suture. On postoperative day 8, the patient presented with new incisional drainage. The wound was explored, and the dura had torn around the previous sutured closure. A curved aneurysm clip was used to obtain dural closure. Postoperatively, the patient’s incision remained dry. Results: Microsurgical closure with suture is the primary modality in durotomy repair. Difficulty arises when the dura is friable and multiple small tears are present. Suturing worsens the durotomy. Also, the durotomy is often caused along a bony edge with limited visualization, requiring additional bone removal to suture, therefore risking destabilization of the spine. Conclusion: We describe the application of an aneurysm clip to treat a recurrent durotomy where the standard practice of sutured closure failed. Aneurysm clips offer a quick, safe, and secure manner to close dura without risking spinal destabilization. They offer significant benefit to already torn, friable dura. Postoperatively, patients have no limitations and are therefore prevented from being exposed to additional risks associated with bed rest. Aneurysm clips are cost and clinically effective in the management of dural injuries.

Endoscopic Transsphenoidal Approach for Resection of Malignant Pituitary Blastoma in an 18-Month-Old Infant: A Technical Note

2014 ◽  
Vol 10 (4) ◽  
pp. 649-653 ◽  
Author(s):  
Malik Zaben ◽  
Mohsin Zafar ◽  
Shafqat Bukhari ◽  
Paul Leach ◽  
Charoline Hayhurst
Keyword(s):  
Malignant Tumor ◽  
Intraoperative Complications ◽  
Tumor Resection ◽  
Cerebrospinal Fluid Leak ◽  
Technical Note ◽  
Transsphenoidal Approach ◽  
Nasoseptal Flap ◽  
Endoscopic Endonasal ◽  
One Year ◽  
Fluid Leak

Abstract BACKGROUND: Sella and suprasellar tumors are increasingly managed via an endoscopic transsphenoidal approach, but infant endoscopic surgery has not been reported. Pituitary blastoma is a rare sellar malignant tumor that primarily occurs in infants and is managed by surgical resection (cytoreduction) followed by adjuvant therapy. OBJECTIVE: To describe the technique and feasibility of resection of a pituitary blastoma via endoscopic endonasal transsphenoidal approach in an 18-month-old infant. METHODS: Endoscopic endonasal transsphenoidal approach for resection of a pituitary malignant tumor in an infant. RESULTS: Near-total tumor resection was achieved. The skull base was reconstructed by using a nasoseptal flap with no cerebrospinal fluid leak or any other intraoperative complications. The postoperative course was uneventful. One-year follow-up showed complete resolution of the tumor. CONCLUSION: The endoscopic endonasal transsphenoidal approach with nasoseptal flap reconstruction could be used as a safe, yet minimally invasive and innovative technique for the resection of pituitary blastoma in infants.

Biologically inert synthetic dural substitutes

1990 ◽  
Vol 73 (6) ◽  
pp. 936-941 ◽  
Author(s):  
Damianos E. Sakas ◽  
Komporn Charnvises ◽  
Lawrence F. Borges ◽  
Nicholas T. Zervas
Keyword(s):  
Foreign Body ◽  
Cerebrospinal Fluid Leak ◽  
Dural Defect ◽  
Artificial Membranes ◽  
Content Type ◽  
Dural Graft ◽  
Polyurethane Film ◽  
Foreign Body Reactions ◽  
Fluid Leak ◽  
Carbonate Film

✓ Two types of artificial membranes, a medical-grade aliphatic polyurethane and a polysiloxane-carbonate block copolymer, were tested as substitutes for dura in 24 and 12 rabbits, respectively. The films were placed either epidurally, subdurally, or as dural grafts in equal subgroups of animals. The postoperative course was uneventful with no manifestations of convulsive disorder or cerebrospinal fluid leak. The animals were sacrificed 3, 6, or 9 months after implantation of the artificial membranes. Both types of artificial membranes were easily removed from the underlying nervous and the other surrounding tissues. The histological examination failed to reveal adhesions, neomembrane formations, or any type of foreign body reactions to the polyurethane film. The implantation of the polysiloxane-carbonate film caused no reaction when it was applied epidurally. As a dural graft, the polysiloxane-carbonate copolymer induced the formation of a thin neomembrane of one to two layers of fibroblasts which formed a watertight seal of the dural defect. A similar thin neomembrane was found to encase this artificial membrane in the group of animals in which it was implanted subdurally. There was no foreign body reaction to the polysiloxane-carbonate film. The authors conclude that these materials hold promise as dural substitutes or in the prevention of spinal dural scarring, and should be evaluated clinically.

scholarly journals Application of Color Doppler Ultrasound to Identify and Repair Postoperative Cerebrospinal Fluid Leak: A Technical Note

2021 ◽  
Vol 22 (1) ◽  
pp. e12-e17
Author(s):  
James L. West ◽  
Kingsley Abode-Iyamah ◽  
Selby G. Chen ◽  
W. Christopher Fox ◽  
Mohamad Bydon ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Doppler Ultrasound ◽  
Color Doppler ◽  
Cerebrospinal Fluid Leak ◽  
Color Doppler Ultrasound ◽  
Technical Note ◽  
Fluid Leak

scholarly journals Pearls & Oy-sters: Dural defect repair as treatment for refractory headache from cerebrospinal fluid leak

Neurology ◽  
2020 ◽  
Vol 95 (20) ◽  
pp. e2831-e2833
Author(s):  
Tommy Lik Hang Chan ◽  
David Dongkyung Kim ◽  
Syed Hashmi ◽  
Ian Carrol
Keyword(s):  
Cerebrospinal Fluid ◽  
Cerebrospinal Fluid Leak ◽  
Dural Defect ◽  
Refractory Headache ◽  
Defect Repair ◽  
Dural Defect Repair ◽  
Fluid Leak

Ventral spinal cerebrospinal fluid leak as the cause of persistent post–dural puncture headache in children

2013 ◽  
Vol 11 (1) ◽  
pp. 48-51 ◽  
Author(s):  
Wouter I. Schievink ◽  
M. Marcel Maya
Keyword(s):  
Cerebrospinal Fluid ◽  
Dural Puncture ◽  
Surgical Repair ◽  
Cerebrospinal Fluid Leak ◽  
Csf Leak ◽  
Dural Defect ◽  
Digital Subtraction ◽  
Post Dural Puncture Headache ◽  
Digital Subtraction Myelography ◽  
Fluid Leak

Headache occurs after dural puncture in about 1%–25% of children who undergo the procedure—a rate similar to that seen in adults. Persistence of post–dural puncture headache in spite of bed rest, increased fluid intake, and epidural blood patch treatment, however, is rare. The authors reviewed the medical records and imaging studies of all patients 19 years of age or younger who they evaluated between 2001 and 2010 for intracranial hypotension, and they identified 8 children who had persistent post–dural puncture headache despite maximal medical treatment and placement of epidural blood patches. A CSF leak could be demonstrated radiologically and treated surgically in 3 of these patients, and the authors report these 3 cases. The patients were 2 girls (ages 14 and 16 years) who had undergone lumbar puncture for evaluation of headache and fever and 1 boy (age 13 years) who had undergone placement of a lumboperitoneal shunt using a Tuohy needle for treatment of pseudotumor cerebri. The boy also had undergone a laminectomy and exploration of the posterior dural sac, but no CSF leak could be identified. All 3 patients presented with new-onset orthostatic headaches, and in all 3 cases MRI demonstrated a large ventral lumbar or thoracolumbar CSF collection. Conventional myelography or digital subtraction myelography revealed a ventral dural defect at L2–3 requiring surgical repair. Through a posterior transdural approach, the dural defect was repaired using 6-0 Prolene sutures and a dural substitute. Postoperative recovery was uneventful, with complete resolution of orthostatic headache and of the ventral cerebrospinal fluid leak on MRI. The authors conclude that persistent postdural puncture headache requiring surgical repair is rare in children. They note that the CSF leak may be located ventrally and may require conventional or digital subtraction myelography for exact localization and that transdural repair is safe and effective in eliminating the headaches.

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