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.

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 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.

scholarly journals Novel dural incision and closure procedure for preventing postoperative cerebrospinal fluid leakage during the surgical removal of dumbbell-shaped spinal tumors: technical note

2016 ◽  
Vol 25 (5) ◽  
pp. 620-625 ◽  
Author(s):  
Kiyoshi Ito ◽  
Tatsuro Aoyama ◽  
Takuya Nakamura ◽  
Yoshiki Hanaoka ◽  
Tetsuyoshi Horiuchi ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Dura Mater ◽  
Clinical Results ◽  
Technical Note ◽  
Spinal Tumors ◽  
Cerebrospinal Fluid Leakage ◽  
Surgical Removal ◽  
Dural Closure ◽  
Csf Leakage ◽  
Dural Defects

The authors report on a new method for removing dumbbell-shaped spinal tumors that avoids the risk of postoperative cerebrospinal fluid (CSF) leakage. Adequate visualization of the intra- and extradural components of the tumor is achieved with the use of separate dural incisions. First, the dura mater is opened along the dural theca to provide adequate visualization of the intradural portion of the mass; then, a second incision is made along the nerve root to remove the extradural component. Meticulous suturing is essential in intradural lesion cases; however, the dura mater is usually thin and fragile in such cases. During suturing with a needle and thread, the dura mater can become lacerated proximal to the needle holes and result in CSF leakage. In the authors' technique, instead of using a needle and thread, nonpenetrating vascular clips were used to close the dural incisions. When operating on dumbbell-shaped spinal tumors, the authors found that the “separate-dural-incision method” was preferable to the conventional T-shaped dural incision method because no dural defects occurred after the intradural procedure and meticulous dural closure with vascular clips was achieved. The authors conclude that the novel separate-dural-incision method for removing dumbbell-shaped tumors and the use of nonpenetrating vascular clips permits reliable dural closure, prevents postoperative CSF leakage, and promises good postoperative clinical results.

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.

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.

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.

Recurrent subdural hematoma caused by cerebrospinal fluid leakage

2006 ◽  
Vol 4 (2) ◽  
pp. 183-185 ◽  
Author(s):  
Junichi Mizuno ◽  
Praveen V. Mummaneni ◽  
Gerald E. Rodts ◽  
Daniel L. Barrow
Keyword(s):  
Cerebrospinal Fluid ◽  
Computerized Tomography ◽  
Subdural Hematoma ◽  
Nerve Root ◽  
Csf Leak ◽  
Cerebrospinal Fluid Leakage ◽  
Dural Defect ◽  
Ct Myelography ◽  
Csf Fistula ◽  
Csf Leakage

✓The authors report a case of a recurrent subdural hematoma (SDH) that was caused by a persistent cerebrospinal fluid (CSF) leak from an L1–2 fistula. A 34-year-old man experienced severe headaches due to SDH, and he underwent aspiration of subdural fluid four times due to recurrent collections. Further evaluation with computerized tomography (CT) myelography demonstrated extradural extravasation of contrast through an L1–2 fistula. The patient underwent an L1–2 laminectomy; a small dural defect with CSF leakage at the left nerve root sleeve was found and was repaired. Following the repair, the patient had no further recurrence of SDH. Recurrent SDH, caused by spontaneous CSF leakage through a lumbar CSF fistula, is extremely rare. In cases of recurrent SDH, radiographic workup with spinal CT myelography should be considered.

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.

Spinal extradural meningeal cyst: correct radiological and histopathological diagnosis

2002 ◽  
Vol 13 (4) ◽  
pp. 1-4 ◽  
Author(s):  
Kimiaki Sato ◽  
Kensei Nagata ◽  
Yasuo Sugita
Keyword(s):  
Cell Layer ◽  
Histopathological Examination ◽  
Histopathological Diagnosis ◽  
Ct Myelography ◽  
Meningeal Cyst ◽  
Spinal Subarachnoid Space ◽  
Male Patients ◽  
Meningeal Cysts ◽  
Dural Defects ◽  
Cyst Cavity

Object Spinal extradural meningeal cysts are uncommon and rarely cause neural compression. The clinical, radiological, and histopathological characteristics of the lesions are discussed and previous reports reviewed. Methods The authors describe five cases of a spinal extradural meningeal cyst (three female and two male patients, with a mean age of 47 years (range 14–75 years). Four of the cysts were located at the thoracolumbar level, the fifth at the sacral level. Radiological and neuroimaging-based diagnosis was made using a combination of magnetic resonance imaging, myelography, and/or computerized tomography (CT) myelography. A connection between the spinal subarachnoid space and the cyst cavity was demonstrated on myelography and/or CT myelography in all cases, and dural defects were confirmed visually intraoperatively. In all cases histopathological examination confirmed that the cyst wall was formed by nonspecific fibrous connective tissue without a single-cell layer of inner arachnoid lining. Conclusions A diagnosis of spinal extradural meningeal cyst is difficult to make based solely on histopathological examination. It is essential that the final characterization and diagnosis be based on intraoperative inspection combined with radiological and histopathological findings.

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