Abstract
Background
An ideal dural substitute that enables watertight closure, has sufficient strength, and can be absorbed without remnant materials that induce inflammation, adhesion, and infection is not available. The purpose of this study was to evaluate the efficacy of a bioabsorbable polyglycolic acid (PGA) mesh and fibrin glue as a substitute for dural repair.
Methods
Altogether, 10 patients with noted dural tears during extradural spinal surgery and 20 patients who underwent durotomy for intradural spinal surgery were included in this study. In a series of 20 consecutive cases, dural closure was performed by suture and fibrin glue. In the subsequent 10 consecutive patients, dural closure was performed by suture and fibrin glue with the use of absorbable PGA mesh. The medical records and magnetic resonance imaging (MRI) of the surgical site were retrospectively reviewed to evaluate the presence of a cerebrospinal fluid (CSF) fistula or leakage after the surgery.
Results
A CSF fistula occurred in five patients who underwent dural repair with fibrin glue alone, and postoperative MRI showed CSF leakage in two patients with incidental dural tears after laminectomy for ossification of ligamentum flavum. No CSF fistula was present in patients who underwent dural repair using PGA mesh and fibrin glue, and no adverse effects or complications were encountered postoperatively. Follow-up MRI revealed no evidence of CSF leakage around the reconstructed dura mater.
Conclusions
The use of PGA mesh and fibrin glue for the repair of dura mater is a useful method of preventing CSF leakage in spinal surgery.
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References
FJ Eismont SW Wiesel RH Rothman (1981) ArticleTitleTreatment of dural tears associated with spinal surgery J Bone Joint Surg Am 63 1132–6 Occurrence Handle1:STN:280:DyaL38%2Fgsl2isw%3D%3D Occurrence Handle7024283
Bosacco SJ, Gardner MJ, Guille JT. Evaluation and treatment of dural tears in lumbar spine surgery: a review. Clin Orthop 2001:238–47
M Waisman Y Schweppe (1991) ArticleTitlePostoperative cerebrospinal fluid leakage after lumbar spine operations: conservative treatment Spine 16 52–3 10.1097/00007632-199101000-00010 Occurrence Handle10.1097/00007632-199101000-00010 Occurrence Handle1:STN:280:DyaK3M7msV2lsw%3D%3D Occurrence Handle2003237
JC Wang HH Bohlman KD Riew (1998) ArticleTitleDural tears secondary to operations on the lumbar spine: management and results after a two-year-minimum follow-up of eighty-eight patients J Bone Joint Surg Am 80 1728–32 10.1302/0301-620X.80B6.8966 Occurrence Handle10.1302/0301-620X.80B6.8966 Occurrence Handle1:STN:280:DyaK1M%2FptFWmug%3D%3D Occurrence Handle9875930
D Couture CL Branch SuffixJr (2003) ArticleTitleSpinal pseudomeningoceles and cerebrospinal fluid fistulas Neurosurg Focus 15 E6 Occurrence Handle10.3171/foc.2003.15.6.6 Occurrence Handle15305842
MD Smith MJ Bolesta M Leventhal HH Bohlman (1992) ArticleTitlePostoperative cerebrospinal-fluid fistula associated with erosion of the dura: findings after anterior resection of ossification of the posterior longitudinal ligament in the cervical spine J Bone Joint Surg Am 74 270–7 Occurrence Handle1:STN:280:DyaK387ns1ajsw%3D%3D Occurrence Handle1541620
P Black (2002) ArticleTitleCerebrospinal fluid leaks following spinal surgery: use of fat grafts for prevention and repair: technical note J Neurosurg 96 250–2 Occurrence Handle12450290
E Tachibana K Saito K Fukuta J Yoshida (2002) ArticleTitleEvaluation of the healing process after dural reconstruction achieved using a free fascial graft J Neurosurg 96 280–6 Occurrence Handle10.3171/jns.2002.96.2.0280 Occurrence Handle11838802
S Yamagata K Goto Y Oda H Kikuchi (1993) ArticleTitleClinical experience with expanded polytetrafluoroethylene sheet used as an artificial dura mater Neurol Med Chir (Tokyo) 33 582–5 Occurrence Handle10.2176/nmc.33.582 Occurrence Handle1:STN:280:DyaK2c%2FitVShtw%3D%3D
F San-Galli C Deminiere J Guerin M Rabaud (1996) ArticleTitleUse of a biodegradable elastin-fibrin material, Neuroplast, as a dural substitute Biomaterials 17 1081–5 10.1016/0142-9612(96)85908-4 Occurrence Handle10.1016/0142-9612(96)85908-4 Occurrence Handle1:CAS:528:DyaK28Xjtl2rsrk%3D Occurrence Handle8718967
A Laquerriere J Yun J Tiollier J Hemet M Tadie (1993) ArticleTitleExperimental evaluation of bilayered human collagen as a dural substitute J Neurosurg 78 487–91 Occurrence Handle10.3171/jns.1993.78.3.0487 Occurrence Handle1:CAS:528:DyaK3sXhvFyitr4%3D Occurrence Handle8433154
CE Nussbaum PK Maurer JV McDonald (1989) ArticleTitleVicryl (polyglactin 910) mesh as a dural substitute in the presence of pia arachnoid injury J Neurosurg 71 124–7 10.3171/jns.1989.71.1.0124 Occurrence Handle10.3171/jns.1989.71.1.0124 Occurrence Handle1:STN:280:DyaL1M3ptlajuw%3D%3D Occurrence Handle2738630
N Meddings R Scott R Bullock DA French TA Hide SD Gorham (1992) ArticleTitleCollagen vicryl — a new dural prosthesis Acta Neurochir (Wien) 117 53–8 10.1007/BF01400636 Occurrence Handle10.1007/BF01400636 Occurrence Handle1:STN:280:DyaK38zosVSrsg%3D%3D
S Terasaka K Hida Y Iwasaki (2003) ArticleTitleExperimental and clinical evaluation for the use of the bioabsorbable dural substitute Sekitsui Sekizui Journal Spine Spinal Cord 9 23–7
T Sugawara Y Itoh Y Hirano N Higashiyama Y Shimada H Kinouchi et al. (2005) ArticleTitleNovel dural closure technique using polyglactin acid sheet prevents cerebrospinal fluid leakage after spinal surgery Neurosurgery 57 290–4 10.1227/01.NEU.0000176410.65750.C0 Occurrence Handle10.1227/01.NEU.0000176410.65750.C0 Occurrence Handle16234677
V Thadani PL Penar J Partington R Kalb R Janssen LB Schonberger et al. (1988) ArticleTitleCreutzfeldt-Jakob disease probably acquired from a cadaveric dura mater graft: case report J Neurosurg 69 766–9 10.3171/jns.1988.69.5.0766 Occurrence Handle10.3171/jns.1988.69.5.0766 Occurrence Handle1:STN:280:DyaL1M%2Fjs1ersw%3D%3D Occurrence Handle3054015
S Nakagawa T Hayashi S Anegawa S Nakashima S Shimokawa Y Furukawa (2003) ArticleTitlePostoperative infection after duraplasty with expanded polytetrafluoroethylene sheet Neurol Med Chir (Tokyo) 43 120–412 10.2176/nmc.43.120 Occurrence Handle10.2176/nmc.43.120
T Nakamura Y Shimizu S Watanabe S Hitomi M Kitano J Tamada et al. (1990) ArticleTitleNew bioabsorbable pledgets and non-woven fabrics made from polyglycolide (PGA) for pulmonary surgery: clinical experience Thorac Cardiovasc Surg 38 81–5 10.1055/s-2007-1013999 Occurrence Handle10.1055/s-2007-1013999 Occurrence Handle1:STN:280:DyaK3c3ntlehtw%3D%3D Occurrence Handle2161571
DR Enzmann NJ Pelc (1991) ArticleTitleNormal flow patterns of intracranial and spinal cerebrospinal fluid defined with phase-contrast cine MR imaging Radiology 178 467–74 Occurrence Handle1:STN:280:DyaK3M7gt1amsA%3D%3D Occurrence Handle1987610
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Shimada, Y., Hongo, M., Miyakoshi, N. et al. Dural substitute with polyglycolic acid mesh and fibrin glue for dural repair: technical note and preliminary results. J Orthop Sci 11, 454–458 (2006). https://doi.org/10.1007/s00776-006-1044-7
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DOI: https://doi.org/10.1007/s00776-006-1044-7