title: 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.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
authors.affiliation: Department of Neurosurgery, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan; Department of Neurosurgery, Tokyo Medical University, Tokyo, Japan.
authors.forename: Ken
authors.initials: K
authors.lastname: Matsushima
authors.affiliation: Department of Neurosurgery, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan.
authors.forename: Ryo
authors.initials: R
authors.lastname: Hashimoto
authors.affiliation: Department of Plastic and Reconstructive Surgery, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan.
authors.forename: Masahide
authors.initials: M
authors.lastname: Gondo
authors.affiliation: Department of Neurosurgery, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan.
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Fukuhara
authors.affiliation: Department of Neurosurgery, Tokyo Medical University, Tokyo, Japan.
authors.forename: Michihiro
authors.initials: M
authors.lastname: Kohno
authors.affiliation: Department of Neurosurgery, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan. Electronic address: hjimbo@tokyo-med.ac.jp.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Jimbo
mesh_terms: D000368:Aged; D065634:Cerebrospinal Fluid Leak / Q000000981:diagnostic imaging / Q000601:surgery*; D002574:Cervical Vertebrae / Q000601:surgery*; D003238:Connective Tissue / Q000637:transplantation*; D004388:Dura Mater / Q000293:injuries / Q000601:surgery*; D006801:Humans; D006849:Hydrocephalus / Q000000981:diagnostic imaging / Q000601:surgery*; D065406:Laminoplasty / Q000009:adverse effects; D008279:Magnetic Resonance Imaging; D008297:Male; D009192:Myelography; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D011843:Radiculopathy / Q000209:etiology / Q000601:surgery*; D055009:Spondylosis / Q000150:complications / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D017287:Ventriculoperitoneal Shunt
keywords: Cervical laminoplasty; Communicating hydrocephalus; Dural defect repair; Duraplasty; Incidental durotomy; Magnetic resonance imaging; Postoperative complication