Posterior Approach and Spinal Cord Release for 360° Repair of Dural Defects in Spontaneous Intracranial Hypotension.

Beck, Jürgen; Raabe, Andreas; Schievink, Wouter I; Fung, Christian; Gralla, Jan; Piechowiak, Eike Immo; Seidel, Kathleen; Ulrich, Christian Thomas (2019). Posterior Approach and Spinal Cord Release for 360° Repair of Dural Defects in Spontaneous Intracranial Hypotension. Neurosurgery, 84(6), E345-E351. Oxford University Press 10.1093/neuros/nyy312

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BACKGROUND Spinal cerebrospinal fluid (CSF) leaks are the cause of spontaneous intracranial hypotension (SIH). OBJECTIVE To propose a surgical strategy, stratified according to anatomic location of the leak, for sealing all CSF leaks around the 360° circumference of the dura through a single tailored posterior approach. METHODS All consecutive SIH patients undergoing spinal surgery were included. The anatomic site of the leak was exactly localized. We used a tailored hemilaminotomy and intraoperative neurophysiological monitoring (IOM) for all cases. Neurological status was assessed before and up to 90 d after surgery. RESULTS Forty-seven SIH patients had an identified CSF leak between the levels C6 and L1. Leaks, anterior to the spinal cord, were approached by a transdural trajectory (n = 28). Leaks lateral to the spinal cord by a direct extradural trajectory (n = 17) and foraminal leaks by a foraminal microsurgical trajectory (n = 2). The transdural trajectory necessitated cutting the dentate ligament accompanied by elevation and rotation of the spinal cord under continuous neuromonitoring (spinal cord release maneuver, SCRM). Four patients had transient defiticts, none had permanent neurological deficits. We propose an anatomic classification of CSF leaks into I ventral (77%, anterior dural sac), II lateral (19%, including nerve root exit, lateral, and dorsal dural sac), and III foraminal (4%). CONCLUSION Safe sealing (with IOM) of all CSF leaks around the 360° surface of the dura is feasible through a single posterior approach. The exact surgical trajectory is selected according to the anatomic category of the leak.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurosurgery
04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic and Interventional Neuroradiology

UniBE Contributor:

Beck, Jürgen; Raabe, Andreas; Fung, Christian; Gralla, Jan; Piechowiak, Eike Immo; Seidel, Kathleen and Ulrich, Christian Thomas

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1524-4040

Publisher:

Oxford University Press

Language:

English

Submitter:

Martin Zbinden

Date Deposited:

06 Aug 2018 09:56

Last Modified:

24 May 2019 01:30

Publisher DOI:

10.1093/neuros/nyy312

PubMed ID:

30053151

BORIS DOI:

10.7892/boris.119044

URI:

https://boris.unibe.ch/id/eprint/119044

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