Novel dural incision and closure procedure for preventing postoperative cerebrospinal fluid leakage during the surgical removal of dumbbell-shaped spinal tumors: technical note.
The authors report on a new method for removing dumbbell-shaped spinal tumors that avoids the risk of postoperative cerebrospinal fluid (CSF) leakage. Adequate visualization of the intra- and extradural components of the tumor is achieved with the use of separate dural incisions. First, the dura mater is opened along the dural theca to provide adequate visualization of the intradural portion of the mass; then, a second incision is made along the nerve root to remove the extradural component. Meticulous suturing is essential in intradural lesion cases; however, the dura mater is usually thin and fragile in such cases. During suturing with a needle and thread, the dura mater can become lacerated proximal to the needle holes and result in CSF leakage. In the authors' technique, instead of using a needle and thread, nonpenetrating vascular clips were used to close the dural incisions. When operating on dumbbell-shaped spinal tumors, the authors found that the "separate-dural-incision method" was preferable to the conventional T-shaped dural incision method because no dural defects occurred after the intradural procedure and meticulous dural closure with vascular clips was achieved. The authors conclude that the novel separate-dural-incision method for removing dumbbell-shaped tumors and the use of nonpenetrating vascular clips permits reliable dural closure, prevents postoperative CSF leakage, and promises good postoperative clinical results.
Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan.
Kiyoshi
K
Ito
Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan.
Tatsuro
T
Aoyama
Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan.
Takuya
T
Nakamura
Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan.
Yoshiki
Y
Hanaoka
Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan.
Tetsuyoshi
T
Horiuchi
Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan.
Kazuhiro
K
Hongo
D000368:Aged; D065634:Cerebrospinal Fluid Leak / Q000517:prevention & control*; D004388:Dura Mater / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009442:Neurilemmoma / Q000000981:diagnostic imaging / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000295:instrumentation / Q000379:methods*; D011183:Postoperative Complications / Q000517:prevention & control*; D013120:Spinal Cord Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D013525:Surgical Instruments
CSF = cerebrospinal fluid; dumbbell-shaped tumor; dural incision; postoperative cerebrospinal leakage; spinal cord tumor; surgical approach; technique