Watertight Sealing Without Lumbar Drainage for Incidental Ventral Dural Defect in Transthoracic Spine Surgery

Jeon, Sang-Hyeop; Lee, Sang-Ho; Tsang, Yi Sheng; Jung, Tag-Geun; Moon, Ki-Hyoung; Choi, Gun; Dilip, Ketan D.

doi:10.1097/bsd.0000000000000249

Cited by 11 publications

(8 citation statements)

References 9 publications

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“…However in the cases of anterior cervical surgery, there are not enough muscles for coverage of cervical vertebrae, swallowing and coughing can cause CSF pressure fluctuation. So the effect is poor in anterior cervical region 16, 24…”

Section: Treatment Strategiesmentioning

confidence: 99%

“…In this review, all treatment approaches were classified into two groups based on a fluid flow mechanics: 1) stopping CSF leak by direct suture or augmented closure with dural substitute material 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 ; 2) retarding CSF leak by reducing the subarachnoid fluid pressure and/or increasing the epidural space pressure. 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 …”

Section: Treatment Strategiesmentioning

confidence: 99%

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Treatment of cerebrospinal fluid leak after spine surgery

Zhao

Tian

Jia

et al. 2017

Chinese Journal of Traumatology

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Owing to the complexity of spinal surgery, there is a great prevalence of dural tear causing cerebrospinal fluid (CSF) leakage. Many studies focused on suture repair for dural tear to stop CSF leak. Now some new treatment strategies have shown a promising effect that is listed as follows: 1) creating watertight dural closure to stop CSF leak with the help of dural substitute material; and 2) retarding CSF leak by changing pressure difference, including reducing the subarachnoid fluid pressure, increasing the epidural space pressure and both. In fact several methods mentioned above are usually combined to treat CSF leak. However, no update review summarized the relevant studies implemented in recent years. In this review, the authors would compare the effects of different dural closure techniques, and introduce the latest treatment methods and mechanisms.

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Section: Treatment Strategiesmentioning

confidence: 99%

Section: Treatment Strategiesmentioning

confidence: 99%

Treatment of cerebrospinal fluid leak after spine surgery

Zhao

Tian

Jia

et al. 2017

Chinese Journal of Traumatology

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“… 67 – 69 We and others have also shown that fibrin supports neural progenitor survival in vivo 16 , 70 , 71 and can provide physical and trophic support for nervous tissue ingrowth in neural tissue engineering models. 72 , 73 The safety and efficacy of fibrin glue (Tisseell; Baxter, Deerfield, IL) as a watertight sealant in neurosurgical applications have already been established, 74 and the potential of fibrin hydrogels as a delivery vehicle for donor neural cells and growth factors represents another advantage as a substrate for MMC repair. 75 , 76 Desirable properties for any hydrogel suitable for fetal MMC surgical repair include rapid transition from liquid to solid phase, impermeability in the aqueous in utero environment, favorable attachment to surrounding tissues, and biocompatibility with fetal neural elements.…”

Section: Discussionmentioning

confidence: 99%

Hydrogel and neural progenitor cell delivery supports organotypic fetal spinal cord development in an ex vivo model of prenatal spina bifida repair

et al. 2020

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Studying how the fetal spinal cord regenerates in an ex vivo model of spina bifida repair may provide insights into the development of new tissue engineering treatment strategies to better optimize neurologic function in affected patients. Here, we developed hydrogel surgical patches designed for prenatal repair of myelomeningocele defects and demonstrated viability of both human and rat neural progenitor donor cells within this three-dimensional scaffold microenvironment. We then established an organotypic slice culture model using transverse lumbar spinal cord slices harvested from retinoic acid–exposed fetal rats to study the effect of fibrin hydrogel patches ex vivo. Based on histology, immunohistochemistry, gene expression, and enzyme-linked immunoabsorbent assays, these experiments demonstrate the biocompatibility of fibrin hydrogel patches on the fetal spinal cord and suggest this organotypic slice culture system as a useful platform for evaluating mechanisms of damage and repair in children with neural tube defects.

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“…Previous studies did not classify the use of a fibrin sealant according to the completeness of the dural closure 3 4 6 7 13 24 25) . Frequently, the incidental durotomy margin is uneven, and a watertight dural closure could not be completed with only suture.…”

Section: Discussionmentioning

confidence: 99%

The Use Fibrin Sealant after Spinal Intradural Tumor Surgery: Is It Necessary?

et al. 2016

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ObjectiveA fibrin sealant is commonly applied after closure of an incidental or intended durotomy to reduce the complications associated with the leakage of cerebrospinal fluid. Routine usage might not be essential after closure of an intended durotomy, which has clear cut-margins. We investigated the efficacy of fibrin sealants for primary intradural spinal cord tumor surgery.MethodsA retrospective review was performed for 231 consecutive surgically treated patients with primary intradural spinal cord tumors without extradural extension. Fibrin sealants were not used for 47 patients (group I: age, 51.57±16.75 years) and were applied to 184 patients (group II: age, 48.8±14.7 years). The surgical procedures were identical except for the use of a fibrin sealant after closure of the durotomy. The primary outcome was the occurrence of complications (wound problems, hematoma collection, infection, and neurological deterioration). The covariates were age, sex, body mass index, operation time, pre-/postoperative ambulation, number of laminectomies, and type of tumor.ResultsSchwannoma was the most common pathology (n=134), followed by meningioma (n=35) and ependymoma (n=31). Complications occurred in 13 patients (3 in group I and 10 in group II, p=0.73). The postoperative ambulation status (p<0.01; odds ratio, 28.8; 95% confidence interval, 6.9-120.0) and operation time (p=0.04; cutoff, 229 minutes; sensitivity, 62%; specificity, 72%) were significant factors, whereas the use of a fibrin glue was not (p=0.47).ConclusionThe use of a fibrin sealant might not be essential to reduce complications after surgery for primary spinal intradural tumor.

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Watertight Sealing Without Lumbar Drainage for Incidental Ventral Dural Defect in Transthoracic Spine Surgery

Abstract: The established watertight closure of the dural defect using the triple layer sealing method without lumbar drainage was more effective and safe.

Cited by 11 publications

References 9 publications

Treatment of cerebrospinal fluid leak after spine surgery

Treatment of cerebrospinal fluid leak after spine surgery

Hydrogel and neural progenitor cell delivery supports organotypic fetal spinal cord development in an ex vivo model of prenatal spina bifida repair

The Use Fibrin Sealant after Spinal Intradural Tumor Surgery: Is It Necessary?

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