Patch technique for repair of a dural tear in microendoscopic spinal surgery

2008 ◽  
Vol 90-B (8) ◽  
pp. 1066-1067 ◽  
Author(s):  
M. Shibayama ◽  
J. Mizutani ◽  
I. Takahashi ◽  
S. Nagao ◽  
H. Ohta ◽  
...  
Keyword(s):  
Spinal Surgery ◽  
Dural Tear ◽  
Patch Technique

scholarly journals Risk Factors and Options of Management for an Incidental Dural Tear in Biportal Endoscopic Spine Surgery

2020 ◽  
Vol 14 (6) ◽  
pp. 790-800
Author(s):  
Ju-Eun Kim ◽  
Dae-Jung Choi ◽  
Eugene J. Park
Keyword(s):  
Spinal Surgery ◽  
Contralateral Side ◽  
Dural Tear ◽  
Revision Operation ◽  
Dorsal Midline ◽  
Conversion To Open Surgery ◽  
Endoscopic Spine Surgery ◽  
Clear Visibility ◽  
Patch Technique ◽  
Endoscopic Spinal Surgery

Study Design: Here we perform a retrospective analysis regarding an incidental dural tear (IDT) during biportal endoscopic spinal surgery (BESS).Purpose: This study investigates the causes of IDT specifically related to technical procedures of BESS with the aim of lowering its risk during training.Overview of Literature: The incidence of dural tear is reported 0.5%–18% in open spinal surgery and 1.7%–4.3% during endoscopic spinal surgery. Because conversion to open surgery for direct repair could become necessary during endoscopic spinal surgery, prevention of this complication is essential.Methods: We have retrospectively studied IDTs by four surgeons during 1 or 2 years after starting BESS for lumbar degenerative diseases and analyzed the locations, sizes, and specific endoscopic conditions specific to each.Results: Twenty-five cases (1.6%) of IDTs among 1,551 cases of BESS occurred; 13 cases (52%) of these were within the first 6 months. The locations were dorsal midline in 12 cases, ipsilateral side in 11 cases, and contralateral side in two cases. The tear sizes were <10 mm in 20 cases and ≥10 mm in five cases. IDT commonly occurred due to injury of central dural folding during flavectomy under turbid surgical fields due to small bleeds under water. Twenty cases with IDTs of <10 mm were treated well with the patch technique. Among five cases of ≥10 mm, three underwent open repair within a few days, and two of these which failed to conservative management required a delayed revision operation due to pseudomeningocele. No cases progressed to surgical site infection or infectious spondylitis.Conclusions: IDTs of <10 mm can be successfully treated with the patch technique. To prevent IDT during the early learning period, maintaining clear visibility by securing fluent saline outflow and meticulous hemostasis of small bleeding from exposed cancellous bone and epidural vessels is essential with caution not to injure the central dural folding during midline flavectomy.

scholarly journals P.094 Spinal dural repair: a Canadian questionnaire

2017 ◽  
Vol 44 (S2) ◽  
pp. S37-S37 ◽  
Author(s):  
K Reddy ◽  
S Almenawar ◽  
M Aref ◽  
CT Oitment
Keyword(s):  
Nerve Root ◽  
Spinal Surgery ◽  
Comparative Research ◽  
Research Study ◽  
Response Rate ◽  
Bed Rest ◽  
Optimal Management ◽  
Dural Tear ◽  
Dural Repair ◽  
Dural Tears

Background: Iatrogenic dural tear a complication of spinal surgery with significant morbidity and cost to the healthcare system. The optimal management is unclear, and therefore we aimed to survey current practices among Canadian practitioners. Methods: A questionnaire was administered to members of the Canadian Neurological Surgeon’s Society designed to explore methods of closure of iatrogenic durotomy. Results: Spinal surgeons were surveyed with a 55% response rate (n=91). For pinhole sized tears there is a trend toward sealant fixation(36.7%). Medium and large sized tears are predominantly closed with sutures and sealant(67% and 80%, respectively). Anterior tears are managed using sealant alone(48%). Posterior tears are treated with a combination of sutures and sealant(73.8%). Nerve root tears are treated with either sealant alone(50%). Most respondents recommended bed rest for at least 24 hours in the setting of medium(73.2%) and large(89.1%) dural tears. Conclusions: This study elucidates the areas of uncertainty with regard to iatrogenic dural tear management. There is disagreement regarding management of anterior and nerve root tears, pin-hole sized tears in any location of the spine, and whether patients should be admitted to hospital or on bed-rest following a pin-hole sized dural tear. There is a need for a robust comparative research study of dural repair strategies.

Titanium dural clip testing

1994 ◽  
Vol 81 (6) ◽  
pp. 947-949 ◽  
Author(s):  
David I. Levy ◽  
Volker K. H. Sonntag
Keyword(s):  
Spinal Surgery ◽  
Dural Tear ◽  
Application Time ◽  
Content Type ◽  
Aneurysm Clip ◽  
Appropriate Treatment ◽  
Difficult Part ◽  
Pseudocyst Formation ◽  
Fine Print

✓ Spinal dural lacerations can be a difficult part of spinal surgery. A dural tear can result in complications that include meningitis and pseudocyst formation. Appropriate treatment for these tears is generally suturing, using 4.0, 5.0, or 6.0 suture. For successful closure of dural lacerations, the authors have collaborated in the design of a titanium clip, which resembles an aneurysm clip in appearance and is applied with standard aneurysm clip appliers. The titanium clip was tested against suture and Weck hemostatic vascular clips and found to have excellent tissue-approximating capacity and a rapid application time. It is believed that this is an appropriate device for the repair of spinal dural lacerations.

Iatrogenic dural tear in endoscopic lumbar spinal surgery: full endoscopic dural suture repair (Youn’s technique)

2018 ◽  
Vol 27 (S3) ◽  
pp. 544-548 ◽  
Author(s):  
Jong Ki Shin ◽  
Myung Soo Youn ◽  
Yoon Jae Seong ◽  
Tae Sik Goh ◽  
Jung Sub Lee
Keyword(s):  
Spinal Surgery ◽  
Suture Repair ◽  
Dural Tear ◽  
Lumbar Spinal Surgery ◽  
Lumbar Spinal ◽  
Dural Suture

scholarly journals Spinal subdural hematoma as a complication of spinal surgery: can it happen without dural tear?

2012 ◽  
Vol 22 (S3) ◽  
pp. 346-349 ◽  
Author(s):  
Harinder Gakhar ◽  
Rajendranath Bommireddy ◽  
Zdenek Klezl ◽  
Denis Calthorpe
Keyword(s):  
Subdural Hematoma ◽  
Spinal Surgery ◽  
Dural Tear ◽  
Spinal Subdural Hematoma

Remote Cerebellar Hemorrhage after a Spinal Surgery Complicated by Dural Tear: Case Report and Literature Review

2005 ◽  
Vol 57 (suppl_1) ◽  
pp. E215-E215 ◽  
Author(s):  
Oguz Karaeminogullari ◽  
Basar Atalay ◽  
Orcun Sahin ◽  
Metin Ozalay ◽  
Huseyin Demirors ◽  
...  
Keyword(s):  
Spinal Surgery ◽  
Rare Complication ◽  
Brain Parenchyma ◽  
Cerebrospinal Fluid Leakage ◽  
Decompression Surgery ◽  
Unusual Complication ◽  
Dural Tear ◽  
Cerebellar Hemorrhage ◽  
Remote Cerebellar Hemorrhage ◽  
Dural Tears

Abstract OBJECTIVE AND IMPORTANCE: This report presents a case in which cerebellar hemorrhage occurred after lumbar decompression surgery that was complicated by dural tear and prolonged cerebrospinal fluid leakage. Remote cerebellar hemorrhage after spinal surgery is extremely rare. Our objective is to describe this unusual complication, discuss the possible mechanisms of remote cerebellar hemorrhage, and review the literature. CLINICAL PRESENTATION: A 73-year-old woman underwent surgery for lumbar spinal stenosis. A dural tear occurred during decompression, and the patient developed remote cerebellar hemorrhage on postoperative Day 2. INTERVENTION: The cerebellar hemorrhage was treated surgically, and a biopsy of hemorrhagic brain parenchyma revealed an arteriovenous malformation. CONCLUSION: Although it is an extremely rare complication, remote cerebellar hemorrhage should be kept in mind as a possible complication of spinal surgery, especially in operations complicated by dural tears.

scholarly journals Positive-pressure ventilation attenuates subarachnoid-pleural fistula after thoracic spinal surgery: A report of two cases

2019 ◽  
Vol 27 (3) ◽  
pp. 230949901986547
Author(s):  
Mamoru Kono ◽  
Masao Koda ◽  
Tetsuya Abe ◽  
Kousei Miura ◽  
Katsuya Nagashima ◽  
...  
Keyword(s):  
Spine Surgery ◽  
Thoracic Spine ◽  
Spinal Surgery ◽  
Positive Pressure Ventilation ◽  
Noninvasive Positive Pressure Ventilation ◽  
Drainage Tube ◽  
Positive Pressure ◽  
Dural Tear ◽  
Thoracic Spinal ◽  
Csf Leakage

Background: Dural tear and cerebrospinal fluid (CSF) leakage is known to be a complication of anterior thoracic spine surgery. If dural tear occurs on the ventral side of dura in combination with a pleural injury, it potentially becomes a subarachnoid-pleural fistula. The pressure gradient permits continuous flow of CSF from the subarachnoid space into the cavum thorax, resulting in an intractable subarachnoid-pleural fistula. We report two cases of successfully treated subarachnoid-pleural fistula using noninvasive positive-pressure ventilation (NPPV). Methods: Two patients, a 52-year-old man and a 54-year-old woman, underwent anterior thoracic spine surgery to treat thoracic myelopathy caused by spinal tumor and ossification of the posterior longitudinal ligament. During surgery, dural tear and CSF leakage to the cavum thorax due to perforation of the dura was observed. We treated with polyglycolic acid sheet (Neovel®) in combination with fibrin glue; a suction drainage tube was placed at the subfascial level and the wound was drained with negative pressure. However, after removal of the drainage tube, subarachnoid-pleural fistula was proven. We applied NPPV to the patients. Results: We used the application of NPPV for 2 weeks in the first patient and 1 week in the second patient. In both of them, subarachnoid-pleural fistula was attenuated without apparent adverse events. Conclusion: NPPV is noninvasive and potentially useful therapy to attenuate subarachnoid-pleural fistula after thoracic spinal surgery.

scholarly journals DURAL TEAR: A FEARED COMPLICATION IN LUMBAR SPINE SURGERY

2019 ◽  
Vol 10 (4) ◽  
pp. 31-35
Author(s):  
Sohail Amir ◽  
Bilal Khan ◽  
Aurangzeb ◽  
Khaleeq-Uz-Zaman
Keyword(s):  
Lumbar Spine ◽  
Spinal Stenosis ◽  
Spinal Surgery ◽  
Lumbar Disc ◽  
Lumbar Spine Surgery ◽  
Dural Tear ◽  
Disc Disease ◽  
Lumbar Disc Disease ◽  
Cross Sectional ◽  
Female Ratio

ABSTRACT:OBJECTIVE: The objective of this study is to determine the incidence of dural tear in lumbar spine surgeries and associated risk factors. MATERIAL AND METHODS: In this descriptive cross sectional study, 117 Patients were studied in the department of Neurosurgery, Naseer Teaching Hospital Peshawar from February 2013 to December 2016. All patients with either gender or age who needed spinal surgery for lumbar disc disease, spinal stenosis, and re-do surgery were included in study while those with trauma, tumor and infection were excluded. Data was collected regarding the age of patients, co-morbid conditions, lumbar spine disease, level of involvement, type of operation, occurrence of dural tear, site of dural tear and complications were recorded on a predesigned proforma. Data was analyzed using SPSS version 20.0. RESULTS: Out of 117 patients 63(53.8%) were male and 54(46.1%) were female. Male to female ratio was 1.2:1. In our study the age of patient ranged from 16 to 80 years with mean age 38 + 2.34 years Dural tear occurred in 15(12.8%) of patients, among these 5 (4.2%) dural tear in lumbar disc prolapsed , 8(6.8%) in spinal stenosis and 2 (1.7%) in surgery for recurrent disc disease. The complication rate was 19(16.2%), among these the most common complication was cerebrospinal fluid leak (CSF) in 7(5.9%), delayed wound healing in 5(4.2%), discitis in 4(3.4%) and others in 3(2.5%) of patients. CONCLUSION: Dural tear (DT) is not uncommon complication during spinal surgery and represent a serious challenge for both surgeon and patients. Female, obese, older age, re-do surgery are the major risk factor for dural tear.

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