Hydrostatic Comparison of Nonpenetrating Titanium Clips Versus Conventional Suture for Repair of Spinal Durotomies

Faulkner, Nathan D.; Finn, Michael A.; Anderson, Paul A.

doi:10.1097/brs.0b013e31824cf756

Cited by 27 publications

(8 citation statements)

References 13 publications

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“…In fact, hydrostatic pressure studies in bovine spines have no difference in CSF leak rates among braided sutures, monofilament sutures, and microclips. 23 Lastly, concerns were initially expressed that the titanium clip artifact may disturb CT or MRI interpretation in the postoperative setting. However, it has been demonstrated that this is not the case on multiple reports.…”

Section: Discussionmentioning

confidence: 99%

Primary Repair of Posteriorly Located Anterior Skull Base Dural Defects Using Nonpenetrating Titanium Clips in Cranial Trauma

Milton

Andrews

Baker

et al. 2020

J Neurol Surg B Skull Base

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Objective Primary repair of posteriorly located anterior skull base (ASB) dural defects following cranial trauma is made difficult by narrow operative corridors and adherent dura mater. Inadequate closure may result in continued cerebrospinal fluid (CSF) leak and infectious sequelae. Here, we report surgical outcomes following the use of nonpenetrating titanium microclips as an adjunctive repair technique in traumatic anterior skull base dural defects extending from the olfactory groove to the tuberculum sellae. Methods All trauma patients who underwent a bifrontal craniotomy from January 2013 to October 2019 were retrospectively reviewed. Patients with ASB defects located at posterior to the olfactory groove were analyzed. Patients with isolated frontal sinus fractures were excluded. All patients presented with CSF leak or radiographic signs of dural compromise. Patients were divided according to posterior extent of injury. Patient characteristics, imaging, surgical technique, and outcomes are reported. Results A total of 19 patients who underwent a bifrontal craniotomy for repair of posteriorly located ASB dural defects using nonpenetrating titanium microclips were included. Defects were divided by location: olfactory groove (10/19), planum sphenoidale (6/19), and tuberculum sellae (3/19). No patients demonstrated a postoperative CSF leak. No complications related to the microclip technique was observed. Clip artifact did not compromise postoperative imaging interpretation. Conclusion Primary repair of posteriorly located ASB dural defects is challenging due to narrow working angles and thin dura mater. Use of nonpenetrating titanium microclips for primary repair of posteriorly located dural defects is a reasonable adjunctive repair technique and was associated with no postoperative CSF leaks in this cohort.

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Section: Discussionmentioning

confidence: 99%

Primary Repair of Posteriorly Located Anterior Skull Base Dural Defects Using Nonpenetrating Titanium Clips in Cranial Trauma

Milton

Andrews

Baker

et al. 2020

J Neurol Surg B Skull Base

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“…[31][32][33][34] It has demonstrated efficacy for use in major vascular injuries in skull base surgery and has recently been approved for dural reconstruction for its potential in preventing postoperative CSF leaks. 6,35 Thus far, there is evidence that the clips can be used to repair leaks in the spinal dura, [36][37][38][39] as well as one case report that demonstrated the use of titanium clips in repairing a CSF leak at the skull base. 40 Skull base repairs often fail at the leading edge of the graft.…”

Section: Discussionmentioning

confidence: 99%

Failure Pressures of Dural Repairs in a Porcine Ex Vivo Model: Novel Use of Titanium Clips Versus Tissue Glue

Chorath

Krysinski

Bunegin

et al. 2019

Allergy�Rhinol (Providence)

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ObjectiveEndoscopic skull base surgery is advancing, and it is important to have reliable methods to repair the resulting defect. The objective of this study was to determine the failure pressures of 2 commonly used methods to repair large dural defects: collagen matrix underlay with fibrin glue and collagen matrix underlay with polyethylene glue, as well as a novel repair method: fascia lata with nonpenetrating titanium vascular clips.MethodsThe failure pressure of the 3 dural repairs was determined in a closed testing apparatus. Defects in porcine dura were created and collagen matrix grafts were used as an underlay followed by either fibrin glue (FG/CMG) or polyethylene glycol glue (PEG/CMG). A third condition using a segment of fascia lata was positioned flush with the edges of the dural defect and secured with titanium clips (TC/FL). Saline was infused to simulate increasing intracranial pressure (ICP) applied to the undersurface of the grafts until the repairs failed.ResultsThe mean failure pressure of the PEG/CMG repair was 34.506 ± 14.822 cm H2O, FG/CMG was 12.413 ± 5.114 cm H2O, and TC/FL was 8.330 ± 3.483 cm H2O. There were statistically significant differences in mean failure pressures among the 3 repair methods.ConclusionIn this ex vivo model comparing skull base repairs’ ability to withstand cerebrospinal fluid leak, the repairs that utilized PEG/CMG tolerated the greatest amount of pressure and was the only repair that exceeded normal physiologic ICP’s. Repair methods utilizing glues generally tolerated higher pressures compared to the novel repair using clips alone.

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“…Faulkner et al . [3] reported that the dura closure with nonpenetrating titanium clips provides immediate hydrostatic strength similar to intact dura. In conclusion of the previous studies revealed that nonpenetrating titanium clips have the benefits of being technically easy to use, reduced durotomy repair time, decreased bed rest due to related medical complications, superior postoperation with immediate hydrostatic strength, and better reapproximation if it fails to clip successfully.…”

Section: Discussionmentioning

confidence: 99%

Durotomy repair in minimally invasive transforaminal lumbar interbody fusion by nonpenetrating clips

et al. 2014

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Background:Closure of the dura defect may be easy to perform in open lumbar surgery but could be difficult in minimally invasive transforaminal lumbar interbody fusions (MIS-TLIF) since MIS-TLIF was done through a small tube, which limited the use of standard dural repair instruments. We used nonpenetrating titanium clips that were originally designed for the vascular anastomoses to repair the dura defect, which is never described in the literature.Methods:We presented a case of spinal stenosis with incidental durotomy while performing MIS-TLIF. We closed the dura laceration with three medium-sized nonpenetrating titanium clips (AnastoClip Vessel Closure System, LeMaitre Vascular, Inc., Burlington, MA).Results:Nonpenetrating titanium clips have the benefits of being technically easy to use, reduced durotomy repair time, decreased bed rest due to related medical complications, superior postoperation with immediate hydrostatic strength, and better reapproximation if it fails to clip successfully. As for the postoperation follow up, clips are tiny and reveal no obvious artifact, especially in cases where the pedicle screws are already causing much artifact.Conclusion:Primary dural closure during MIS-TLIF with clips is an effective way in cases that involve limited tubular space.

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Hydrostatic Comparison of Nonpenetrating Titanium Clips Versus Conventional Suture for Repair of Spinal Durotomies

Abstract: Nonpenetrating titanium clips provide a durotomy closure with immediate hydrostatic strength similar to intact dura whereas suture repair with either suture was significantly less robust. The use of titanium clips was more rapid than that of suture repair.

Cited by 27 publications

References 13 publications

Primary Repair of Posteriorly Located Anterior Skull Base Dural Defects Using Nonpenetrating Titanium Clips in Cranial Trauma

Primary Repair of Posteriorly Located Anterior Skull Base Dural Defects Using Nonpenetrating Titanium Clips in Cranial Trauma

Failure Pressures of Dural Repairs in a Porcine Ex Vivo Model: Novel Use of Titanium Clips Versus Tissue Glue

Durotomy repair in minimally invasive transforaminal lumbar interbody fusion by nonpenetrating clips

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