title: Wound-peritoneal shunts: part of the complex management of anterior dural lacerations in patients with ossification of the posterior longitudinal ligament.
abstract: BACKGROUND
  The complex management of dural lacerations occurring after the resection of multilevel ossification of the posterior longitudinal ligament (OPLL) requires further clarification.
  
  
  METHODS
  Both preoperative MR and CT studies documented multilevel ventral cord compression attributed to OPLL with kyphosis in 82 patients requiring multilevel anterior corpectomy/fusion (ACF) (average, 2.6 levels) followed by posterior fusion (PF) (average, 6.6 levels) under the same anesthetic. The 5 patients who developed intraoperative dural lacerations/penetration demonstrated the single-layer sign (2 patients: large central mass) or the double-layer sign (3 patients: hyperdense/hypodense/hyperdense layers) on preoperative 2-dimensional CT studies. All 5 patients were managed with complex dural repair (sheep pericardial grafts, fibrin sealant, microfibrillar collagen) and had shunts placed (wound-peritoneal and lumboperitoneal).
  
  
  RESULTS
  After complex dural repair/shunting, all 5 intraoperative dural lacerations (DLs) resolved. The application of low-pressure wound-peritoneal shunts was unique to this study (Uni-Shunts, Codman, Johnson and Johnson, Dorchester, Mass). The proximal end is placed lateral/parallel to the fibula strut graft/plate complex, whereas the distal catheter is tunneled into the peritoneum in the right upper quadrant (always prepared and draped in anticipation of the need for a shunt).
  
  
  CONCLUSIONS
  Of 82 patients undergoing multilevel anterior corpectomy for OPLL/kyphosis, 5 developed intraoperative DLs successfully managed with a complex dural repair, wound-peritoneal, and lumboperitoneal shunting procedures.
authors: Neurological Surgery, The Albert Einstein College of Medicine, Bronx, NY 10461, USA. dch3@columbia.edu
authors: Nancy E
authors: NE
authors: Epstein
mesh_terms: D000328:Adult; D000368:Aged; D002557:Cerebrospinal Fluid Shunts / Q000295:instrumentation*; D004388:Dura Mater / Q000293:injuries* / Q000601:surgery; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007431:Intraoperative Complications / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D017887:Ossification of Posterior Longitudinal Ligament / Q000175:diagnosis / Q000601:surgery*; D010529:Peritoneal Cavity; D013117:Spinal Cord Compression / Q000175:diagnosis / Q000601:surgery*; D013123:Spinal Fusion; D014057:Tomography, X-Ray Computed