Dural closure for the treatment of superficial siderosis

2013 ◽  
Vol 18 (4) ◽  
pp. 388-393 ◽  
Author(s):  
Satoru Egawa ◽  
Toshitaka Yoshii ◽  
Kyohei Sakaki ◽  
Hiroyuki Inose ◽  
Tsuyoshi Kato ◽  
...  
Keyword(s):  
Present Report ◽  
Fluid Collection ◽  
Clinical Manifestations ◽  
Fat Grafting ◽  
Neurological Deficits ◽  
Superficial Siderosis ◽  
Dural Defect ◽  
Dural Closure ◽  
Csf Leakage ◽  
Dural Defects

Superficial siderosis (SS) of the CNS is a rare disease caused by repeated hemorrhages in the subarachnoid space. The subsequent deposition of hemosiderin in the brain and spinal cord leads to the progression of neurological deficits. The causes of bleeding include prior intradural surgery, carcinoma, arteriovenous malformation, nerve root avulsion, and dural abnormality. Recently, surgical treatment of SS associated with dural defect has been reported. The authors of the present report describe 2 surgically treated SS cases and review the literature on surgically treated SS. The patients had dural defects with fluid-filled collections in the spinal canal. In both cases, the dural defects were successfully closed, and the fluid collection was resolved postoperatively. In one case, the neurological symptoms did not progress postoperatively. In the other case, the patient had long history of SS, and the clinical manifestations partially deteriorated after surgery, despite the successful dural closure. In previously reported surgically treated cases, the dural defects were closed by sutures, patches, fibrin glue, or muscle/fat grafting. Regardless of the closing method, dural defect closure has been shown to stop CSF leakage and subarachnoid hemorrhaging. Successfully repairing the defect can halt the disease progression in most cases and may improve the symptoms that are associated with CSF hypovolemia. However, the effect of the dural closure may be limited in patients with long histories of SS because of the irreversibility of the neural tissue damage caused by hemosiderin deposition. In patients with SS, it is important to diagnose and repair the dural defect early to minimize the neurological impairments that are associated with dural defects.

scholarly journals Spinal endoscopy combined with selective CT myelography for dural closure of the spinal dural defect with superficial siderosis: technical note

2018 ◽  
Vol 28 (1) ◽  
pp. 96-102 ◽  
Author(s):  
Hidetaka Arishima ◽  
Yoshifumi Higashino ◽  
Shinsuke Yamada ◽  
Ayumi Akazawa ◽  
Hiroshi Arai ◽  
...  
Keyword(s):  
Endoscopic Examination ◽  
Technical Note ◽  
Drainage Tube ◽  
Superficial Siderosis ◽  
Dural Defect ◽  
Ct Myelography ◽  
Dural Closure ◽  
Spinal Subarachnoid Space ◽  
Csf Leakage ◽  
Dural Defects

The authors describe a new procedure to detect the tiny dural hole in patients with superficial siderosis (SS) and CSF leakage using a coronary angioscope system for spinal endoscopy and selective CT myelography using a spinal drainage tube. Under fluoroscopy, surgeons inserted the coronary angioscope into the spinal subarachnoid space, similar to the procedure of spinal drainage, and slowly advanced it to the cervical spine. The angioscope clearly showed the small dural hole and injured arachnoid membrane. One week later, the spinal drainage tube was inserted, and the tip of the drainage tube was located just below the level of the dural defect found by the spinal endoscopic examination. This selective CT myelography clarifies the location of the dural defect. During surgery, the small dural hole could be easily located, and it was securely sutured. It is sometimes difficult to detect the actual location of the small dural hole even with thin-slice MRI or dynamic CT myelography in patients with SS. The use of a coronary angioscope for the spinal endoscopy combined with selective CT myelography may provide an effective examination to assess dural closure of the spinal dural defect with SS in cases without obvious dural defects on conventional imaging.

A Diskogenic Dural Defect is the Reason for the Ventral Location of the Epidural Spinal Fluid Collection Seen in Superficial Siderosis

2021 ◽  
pp. 10.1212/CPJ.0000000000001085
Author(s):  
Neeraj Kumar
Keyword(s):  
Fluid Collection ◽  
Initial Point ◽  
Spinal Fluid ◽  
Superficial Siderosis ◽  
Low Grade ◽  
Dural Defect ◽  
Dynamic Ct ◽  
Contrast Extravasation ◽  
Recent Developments ◽  
Dural Defects

AbstractPurpose of reviewSuperficial siderosis (SS) of the nervous system is often due to a dural pathology. This review focuses on recent developments related to the management of this subgroup of SS patients.Recent findingsThe presence of an epidural ventral spinal fluid collection in patients with SS is a clue to the presence of a diskogenic dural defect. The location of the defect is ascertained by a dynamic CT-myelogram which involves placing the patient in a prone position with hips elevated. This permits gravity assisted preferential ventral localization of the contrast and active scanning during contrast injection facilitates a precise delineation of the initial point of contrast extravasation which localizes the defect.SummaryDiskogenic dural defects are commonly the underlying etiology for SS in patients with a ventral spinal fluid collection. A dynamic CT-myelogram facilitates detection and subsequent repair of these defects which arrests the continued low-grade subarachnoid bleeding.

Microsurgical anatomy and treatment of dural defects in spontaneous spinal cerebrospinal fluid leaks

2020 ◽  
pp. 1-9
Author(s):  
Ako Matsuhashi ◽  
Keisuke Takai ◽  
Makoto Taniguchi
Keyword(s):  
Dura Mater ◽  
Fat Grafting ◽  
Thoracolumbar Junction ◽  
Microsurgical Anatomy ◽  
Dural Defect ◽  
Ct Myelography ◽  
Blood Patch ◽  
Neurosurgical Treatment ◽  
Dural Defects ◽  
Csf Leaks

OBJECTIVESpontaneous spinal CSF leaks are caused by abnormalities of the spinal dura mater. Although most cases are treated conservatively or with an epidural blood patch, some intractable cases require neurosurgical treatment. However, previous reports are limited to a small number of cases. Preoperative detection and localization of spinal dural defects are difficult, and surgical repair of these defects is technically challenging. The authors present the anatomical characteristics of dural defects and surgical techniques in treating spontaneous CSF leaks.METHODSAmong the consecutive patients who were diagnosed with spontaneous CSF leaks at the authors’ institution between 2010 and 2020, those who required neurosurgical treatment were included in the study. All patients’ clinical information, radiological studies, surgical notes, and outcomes were reviewed retrospectively. Outcomes of two different procedures in repairing dural defects were compared.RESULTSAmong 77 patients diagnosed with spontaneous CSF leaks, 21 patients (15 men; mean age 57 years) underwent neurosurgery. Dural defects were detected by FIESTA MRI in 7 patients, by CT myelography in 12, by digital subtraction myelography in 1, and by dynamic CT myelography in 1. The spinal levels of the defects were localized at the cervicothoracic junction in 16 patients (76%) and thoracolumbar junction in 4 (19%). Intraoperative findings revealed that the dural defects were small, circumscribed longitudinal slits located at the ventral aspect of the dura mater. The median dural defect size was 5 × 2 mm. The presence of dural defects at the thoracolumbar junction was associated with manifestation of an altered mental status, which was an unusual manifestation of CSF leaks (p = 0.003). Eight patients were treated via the posterior transdural approach with watertight primary sutures of the ventral defects, and 13 were treated with muscle or fat grafting. Regardless of the two different procedures, postoperative MRI showed either complete disappearance or significant reduction of the extradural CSF collection. No patient experienced postoperative neurological deficits. Clinical symptoms improved or stabilized in 20 patients with a median follow-up of 12 months.CONCLUSIONSDural defects in spontaneous CSF leaks were small, circumscribed longitudinal slits located ventral to the spinal cord at either the cervicothoracic or thoracolumbar junction. Muscle/fat grafting may be an alternative treatment to watertight primary sutures of ventral dural defects with a good outcome.

Superficial siderosis: bleeding from the bone marrow after laminectomy for spinal tumor removal

2014 ◽  
Vol 21 (6) ◽  
pp. 905-908 ◽  
Author(s):  
Junichi Yokosuka ◽  
Keisuke Takai ◽  
Takashi Komori ◽  
Makoto Taniguchi
Keyword(s):  
Bone Marrow ◽  
Residual Tumor ◽  
Spinal Tumor ◽  
Neurological Deficits ◽  
Superficial Siderosis ◽  
Dural Defect ◽  
Bleeding Source ◽  
Subarachnoid Bleeding ◽  
Surgical Data ◽  
Intrathecal Space

Superficial siderosis of the CNS is a rare disease characterized by the deposition of hemosiderin in the subpial layers of the CNS as the result of chronic subarachnoid bleeding. The arrest of bleeding is important for preventing the progression of this disease; however, the exact source of bleeding remains unknown in most cases because of a lack of objective surgical data. The authors of this report have described a unique case of superficial siderosis following cervical laminectomy and autograft fusion for the removal of a spinal schwannoma; the bleeding source was verified by intraoperative and histopathological findings. The patient exhibited no obvious neurological deficits, such as hearing loss or cerebellar ataxia, when the superficial siderosis was diagnosed, although there were the social impairments associated with schizophrenia. During repair surgery, the bleeding source was revealed as the bone marrow vasculature of the remaining vertebral arch, and not the fragile vessels at the dural defect or the residual tumor. Chronic bleeding was stopped before the onset of irreversible neurological deficits in this case. Bone marrow exposed to the intrathecal space may represent a chronic bleeding source in patients with superficial siderosis following CNS surgery including laminectomy or craniotomy. The following recommendations have been proposed for superficial siderosis of the CNS from both a preventative and a therapeutic perspective: 1) During CNS surgery, neurosurgeons should make every effort to prevent exposing bone marrow to the intrathecal space to avoid the risk of chronic subarachnoid bleeding. 2) In the case of a large dural defect and pseudomeningocele following CNS surgery, bone marrow around the dural defect should be considered as the bleeding source of superficial siderosis, and such cases should undergo revision surgery before the progression of this disease.

scholarly journals Management of cerebrospinal fluid leak after surgical removal of pituitary adenomas

Medicina ◽  
2008 ◽  
Vol 44 (4) ◽  
pp. 302 ◽  
Author(s):  
Arimantas Tamašauskas ◽  
Kęstutis Šinkūnas ◽  
Wolfgang Draf ◽  
Vytenis Deltuva ◽  
Algimantas Matukevičius ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Sella Turcica ◽  
Cerebrospinal Fluid Leak ◽  
Surgical Removal ◽  
Dural Defect ◽  
Sphenoidal Sinus ◽  
Autologous Fat ◽  
Csf Leakage ◽  
Dural Defects ◽  
Fluid Leak

Objectives. The aim of the study was to evaluate the frequency and the causes of the intra- and postoperative cerebrospinal fluid (CSF) leaks and to discuss the sella closure methods. Methods. During the period from 1995 to 2005, 313 patients underwent 356 transsphenoidal operations for pituitary adenoma. Microadenoma was found in 80 (22.5%) cases, and in 276 (77.5%) cases, macroadenoma was removed. Two different methods to close the sella were used. The first one consisted packing the sella turcica and sphenoidal sinus with autologous fat and restoring the defect of sella turcica with autologous bone. In more resent practice, the regenerated oxidized cellulose (Surgicel®) and collagen sponge with human fibrin (TachoSil®) were used to cover the sella membrane defect, followed by packing the sella with autologous fat and covering the dural defect with Surgicel® and TachoSil®. Results. Adenoma was totally removed in 198 (55.6%) cases out of 356. Microadenoma was totally removed in 91.3% and macroadenoma in 45.3% of cases, respectively. Postoperative complications were noted in 40 (11.2%) patients. Two (0.6%) patients died after surgery. Intraoperative CSF leakage was observed in 58 (16.3%) cases. Postoperative CSF leakages were observed in 3 cases, when the method of packing the sella with just autologous fat was used, whereas in 29 cases when the sella fat packing was used together with Surgicel® and TachoSil® to cover the sella membrane and dural defects, no postoperative CSF leakages were observed. Conclusions. The technique of covering the sella membrane and dural defects with Surgicel® and TachoSil® in the presence of intraoperative CSF leakage appeared to be the most reliable one, as no postoperative CSF leakage applying this technique has been observed.

scholarly journals Augmentation of dural closure following cerebro-spinal surgeries using Evicel- an experience of 105 patients in India

2021 ◽  
Vol 8 (4) ◽  
pp. 1211
Author(s):  
Batuk D. Diyora ◽  
Nilesh More ◽  
Gagan Dhali
Keyword(s):  
Fibrin Sealant ◽  
Tissue Adhesive ◽  
Dural Defect ◽  
Dural Closure ◽  
Csf Leakage ◽  
Fluid Collections ◽  
Incidental Durotomy ◽  
Dural Suture ◽  
Neurological Surgery ◽  
Csf Leaks

Background: For the neurosurgeon, CSF leaks are a frustrating post-operative complication, and for the patient, it can result in unanticipated morbidity and mortality. Immediate intra-operative recognition of incidental durotomy and dural closure may avoid it. Fibrin sealant is a two-component topical hemostat, dura sealant, and tissue adhesive consisting of fibrinogen and thrombin. We conducted this study to evaluate the efficacy of fibrin sealant Evicel in the management of postoperative CSF leaks as an adjunct to dural suture in patients undergoing a variety of neurosurgical procedures.Methods: This was a retrospective, single-center clinical study conducted on 105 patients who underwent elective neurological surgery from August 2015 to May 2016 at Sion Hospital, India. The efficacy endpoint was the prevention of clinically evident and verified postoperative CSF leak.Results: In all patients, the dural defect was effectively repaired intraoperatively, indicated by the absence of CSF leakage. The success rate of using Evicel was 100% in our cohort for the durasealant efficacy. No adverse effects were reported.Conclusions: We conclude that the use of fibrin sealant Evicel was successful to manage CSF leaks and achieve predictable watertight dural closure resulting in a reduction of intraoperative and postoperative fluid collections. It possesses an acceptable safety profile, consistent with previous findings from other similar studies and studies evaluating the role of Evicel in other surgical indications.

scholarly journals Superficial siderosis of the central nervous system associated with intraspinal hemorrhage from ventral thoracic epidural veins and a ventral spinal CSF leak: case report

2017 ◽  
Vol 26 (6) ◽  
pp. 751-753 ◽  
Author(s):  
Keisuke Takai ◽  
Takashi Komori ◽  
Manabu Niimura ◽  
Makoto Taniguchi
Keyword(s):  
Csf Leak ◽  
Superficial Siderosis ◽  
Dural Defect ◽  
Bleeding Source ◽  
Thoracic Epidural ◽  
Csf Leakage ◽  
Surgical Data ◽  
Intraspinal Hemorrhage ◽  
Transdural Approach ◽  
Dural Defect Repair

In most patients with superficial siderosis of the CNS, the exact source of bleeding remains unknown because of a lack of objective surgical data. The authors herein describe the case of a 58-year-old man with superficial siderosis of the CNS. The patient also had spinal CSF leakage due to a spinal dural defect. Repair surgery for the dural defect was performed using posterior laminoplasty with a transdural approach without spinal fixation. During repair surgery, the bleeding source was found to be the epidural vein around the defect. The intraoperative and histological results of the present case suggest that epidural veins exposed to CSF represent a chronic bleeding source in patients with superficial siderosis of the CNS complicated by CSF leakage. Dural repair surgery may result in discontinuation of the CSF leaks, resolution of the epidural CSF collection, and cessation of chronic epidural bleeding.

scholarly journals A Comparative Study between Autologous Dural Closure versus Collagen Matrix (DuraGen) Closure in Decompressive Craniectomy for Trauma

2020 ◽  
Vol 17 (01) ◽  
pp. 46-49
Author(s):  
Rajesh Kumar Barooah ◽  
Basanta Kumar Baishya ◽  
Hriday Haloi ◽  
Mrinal Bhuyan ◽  
Asman Ali ◽  
...  
Keyword(s):  
Wound Infection ◽  
Decompressive Craniectomy ◽  
Operating Time ◽  
Collagen Matrix ◽  
Dural Defect ◽  
Temporalis Fascia ◽  
Dural Closure ◽  
Fascia Graft ◽  
Dural Graft ◽  
Csf Leakage

Abstract Introduction Neurosurgeons often deal with the problem of a complete and watertight dural closure after cerebral operative procedures. In decompressive craniectomy done for trauma, autologous grafts such as galea, temporalis fascia can be time consuming. Hence this study was undertaken to look into the outcome using collagen matrix graft for dural closure. Aims and Objectives To study the difference between autologous dural graft closure and collagen matrix graft with respect to the time taken for closure, cerebrospinal fluid (CSF) leakage, and wound infection. Methods This prospective study includes 30 patients who underwent decompressive craniectomy for trauma. Duraplasty with temporalis fascia graft and nonautologous collagen matrix dural patch was done by randomization. Specific time points during craniectomy and cranioplasty was calculated. Total time for the procedures and the time for dural repair and separation was calculated. Results The use of collagen matrix in decompressive craniectomy resulted in decrease in mean operative time during the first surgery by average 45 minutes (p< 0.5) as compared to the use of autologous graft. There is reduction in the operating time during second surgery (cranioplasty) by 35 minutes (p< 0.5). The patients using collagen matrix graft did not record any CSF leakage or wound infection. Excellent uptake of the collagen by the duramater was seen. Conclusion The use of collagen to cover the dural defect for decompressive craniectomy for trauma results in significant reduction in the operating time during the first surgery and also in cranioplasty. There is reduction in CSF leakage and hence duration of hospital stay and cost.

scholarly journals Fascial sling technique for dural reconstruction after translabyrinthine resection of acoustic neuroma: technical note

2012 ◽  
Vol 33 (3) ◽  
pp. E17 ◽  
Author(s):  
James K. Liu ◽  
Smruti K. Patel ◽  
Amanda J. Podolski ◽  
Robert W. Jyung
Keyword(s):  
Technical Note ◽  
Fascia Lata ◽  
Fat Graft ◽  
Reconstruction Technique ◽  
Dural Defect ◽  
Translabyrinthine Approach ◽  
Acoustic Neuromas ◽  
Fascial Sling ◽  
Csf Leakage ◽  
Dural Defects

Reconstruction of presigmoid dural defects after resection of acoustic neuromas via the translabyrinthine approach is paramount to prevent postoperative CSF leakage. However, primary dural reapproximation and achieving a watertight closure of the dural defect in this anatomical region are quite difficult. Standard closure techniques after the translabyrinthine approach often involve packing an abdominal fat graft that plugs the dural defect and mastoidectomy cavity. This technique, however, may pose the risk of direct compression of the fat graft on the facial nerve and brainstem. Nonetheless, even with the evolution in dural repair techniques, postoperative CSF leaks can still occur and provide a route for infection and meningitis. In this report, the authors describe a novel dural “sling” reconstruction technique using autologous fascia lata to repair presigmoid dural defects created after translabyrinthine resection of acoustic neuromas. The fascia lata is sewn to the edges of the presigmoid dural defect to create a sling to suspend the fat graft within the mastoidectomy defect. A titanium mesh plate embedded in porous polyethylene is secured over the mastoidectomy defect to apply pressure to the fat graft. In the authors' experience, this has been a successful technique for dural reconstruction after translabyrinthine removal of acoustic neuromas to prevent postoperative CSF leakage. There were no cases of CSF leakage in the first 8 patients treated using this technique. The operative details and preliminary results of this technique are presented.

Subdural Patch Graft Technique for Watertight Closure of Large Dural Defects in Extended Transsphenoidal Surgery

Neurosurgery ◽  
2004 ◽  
Vol 54 (3) ◽  
pp. 653-661 ◽  
Author(s):  
Masahiko Kitano ◽  
Mamoru Taneda
Keyword(s):  
Double Layer ◽  
Cranial Base ◽  
Dural Defect ◽  
Csf Rhinorrhea ◽  
Group Iii ◽  
Group I ◽  
Csf Leakage ◽  
Patch Graft ◽  
Group Ii ◽  
Dural Defects

Abstract OBJECTIVE The most common postoperative complication of the transsphenoidal approach is cerebrospinal fluid (CSF) rhinorrhea. If the dura is widely opened beyond the sellar floor and massive intraoperative CSF leakage is encountered, then the conventional packing method, in which the sella turcica is filled with pieces of fat or muscle, demonstrates a relatively high incidence of CSF rhinorrhea. For more reliable prevention of postoperative CSF leakage, we developed a method for watertight closure of large dural defects. METHODS For 34 consecutive patients with suprasellar tumors, we performed tumor resection via an extended transsphenoidal approach, in which the surgical window in the sellar floor was extended to the planum sphenoidale to expose the suprasellar cistern. The patients were retrospectively divided into three groups according to the dural defect closure technique used. Group I consisted of the first two patients, whose large dural openings were closed with a conventional fat-packing method. Group II consisted of the next 10 patients, whose large dural defects were patched with fascia and sutured with 5-0 nylon, in a watertight manner. Group III consisted of the last 22 patients, who underwent watertight dural closure with a new knot-tying technique and a double-layer patch graft, which generously covered the dural defect of the cranial base with subdural placement. In Group III, intracranial CSF compressed the patch graft against the cranial base and sealed the gap between the patch graft and the cranial base in a watertight manner. The double-layer patch graft was composed of autologous fascial membrane and a commercially available, expanded polytetrafluoroethylene dural substitute. RESULTS Postoperative CSF leakage was noted for 50% of the patients in Group I, 30% of the patients in Group II, and 9% of the patients in Group III. The time required for dural closure for Group III was approximately 50% shorter than that required for Group II (45.9 ± 12.4 min versus 93.5 ± 19.1 min, P &lt; 0.001). CONCLUSION The subdural double-layer patch graft technique is simple and reliable for the prevention of CSF rhinorrhea after transsphenoidal surgery associated with a widely opened dura.

Sign in / Sign up

Export Citation Format

Share Document