Dural Repair by Direct Continuous Locking Sutures and Concomitant Insertion of Subfascial Tube in Planned Intradural Spinal Cord Tumor Surgery
Author(s): Ramadan Shamseldein
Background: Durotomy induced cerebrospinal fluid (CSF) leakage is a terrible complication in spine surgery that could be occurred even with expertise. The estimated rate of CSF leakage in intentional durotomies varies from 5 to 13% in intradural spinal tumor resection to even higher rate for surgeries for tethered cord syndrome or Chiari I malformation. Different treatment modalities are utilized as conservative measures, direct sutures, autograft, dural substitutes and sealant agents to overcome this complication.
Patient and method: This is a retrospective descriptive study of thirty patients were operated upon at neurosurgery department of Elsahil teaching hospital from November 2014 to November 2019. They were operated for intradural spinal cord tumor excision followed by primary direct sutural repair of the durotomy site augmented with autograft and concomitant insertion of subfascial tube as a drainage tube for seven to ten days.
Aim: To evaluate the results of primary direct dural repair with continuous locking sutures and on lay gel foam layer augmented with autograft (fat or muscle) without sealant agents. With concomitant insertion of subfascial tube closed system as drainage in planned intradural surgery.
Results: After subfascial tube removal three cases (10%) show persistent leakage that managed conservatively with tapering cessation within three weeks till complete cessation of the CSF leakage occur. One of the three cases developed pseudomeningocele (3.3%) after complete wound closure and cessation of the leakage.
Conclusion: Direct sutural repair of the durotomy site with continuous locking sutural closure and on lay gel foam layer and fat or muscle graft without any sealant agents, and concomitant insertion of subfascial tube closed system as a drainage tube for seven to ten days, is effective and safe economic method for dural repair.