Perifascial Areolar Tissue Graft for Spinal Dural Repair with Cerebrospinal Fluid Leakage: Case Report of Novel Graft Material, Radiological Assessment Technique, and Rare Postoperative Hydrocephalus

详细信息    查看全文

• 作者：Ken Matsushima¹ ; ² ; Ryo Hashimoto¹ ; Masahide Gondo³ ; Hirokazu Fukuhara¹ ; Michihiro Kohno² ; Hiroyuki Jimbo¹ ; ^{hjimbo@tokyo-med.ac.jp" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Cervical laminoplasty ; Communicating hydrocephalus ; Dural defect repair ; Duraplasty ; Incidental durotomy ; Magnetic resonance imaging ; Postoperative complication
• 刊名：World Neurosurgery
• 出版年：2016
• 出版时间：November 2016
• 年：2016
• 卷：95
• 期：Complete
• 页码：619.e5-619.e10
• 全文大小：2041 K

文摘

Incidental durotomy is a relatively common complication in spinal surgeries, and treatment of persistent cerebrospinal fluid (CSF) leakage is still challenging, especially in cases for which “watertight” suturing is inapplicable. The usefulness of a nonvascularized perifascial areolar tissue (PAT) graft recently was emphasized for plastic and skull base surgeries. Its hypervascularity allows for early engraftment and long-term survival, and its flexibility is advantageous in fixing defects of complex shapes in limited surgical spaces.

Case Description

The authors report a case of persistent CSF leakage after cervical spine surgery in which a PAT graft was used successfully for direct closure of the dural defect. The noninvasive, spin-labeled magnetic resonance imaging technique was used for postoperative assessment of CSF dynamics, not for CSF accumulation but for CSF leakage itself. In addition, some potential causes for the rare development of communicating hydrocephalus after cervical laminoplasty, as seen in this case, are discussed.

Conclusions

PAT was used successfully as an alternative free graft material for direct spinal dural closure, and its hypervascularity seemed to assist with rapid resolution of CSF leakage in our case. Spin-labeled magnetic resonance imaging may enable assessment of spinal CSF dynamics without invasion.