Dural substitute with polyglycolic acid mesh and fibrin glue for dural repair: technical note and preliminary results
Dural substitute with polyglycolic acid mesh and fibrin glue for dural repair: technical note and preliminary results
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DOI：
10.1007/s00776-006-1044-7
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发表时间：
2006-09-01
影响因子：
1.7
通讯作者：
Itoi, Eiji
中科院分区：
文献类型：
--
作者：
Shimada, Yoichi;Hongo, Michio;Itoi, Eiji
背景。目前还没有一种理想的硬脑膜替代品能够实现水密闭合、具有足够的强度、并且可以被吸收而不残留引起炎症、粘连和感染的材料。本研究的目的是评估生物可吸收聚乙醇酸 (PGA) 网和纤维蛋白胶作为硬脑膜修复替代品的功效。方法。本研究总共纳入了 10 名在硬膜外脊柱手术期间出现明显硬膜撕裂的患者和 20 名因硬膜内脊柱手术而接受硬膜切开术的患者。在一系列连续 20 例病例中，通过缝合和纤维蛋白胶进行硬脑膜闭合。在随后的连续 10 名患者中，使用可吸收的 PGA 网通过缝合和纤维蛋白胶进行硬脑膜闭合。回顾性审查手术部位的医疗记录和磁共振成像（MRI），以评估手术后是否存在脑脊液（CSF）瘘或渗漏。结果。 5 名仅用纤维蛋白胶修复硬脑膜的患者出现了脑脊液瘘，术后 MRI 显示 2 名患者因黄韧带骨化而进行椎板切除术后偶发硬脑膜撕裂，出现脑脊液渗漏。使用PGA网和纤维蛋白胶进行硬脑膜修复的患者没有出现脑脊液瘘，术后也没有出现不良反应或并发症。后续 MRI 显示重建硬脑膜周围没有脑脊液渗漏的证据。结论。使用PGA网片和纤维蛋白胶修复硬脑膜是脊柱手术中预防脑脊液漏的有效方法。
Background. An ideal dural substitute that enables watertight closure, has sufficient strength, and can be absorbed without remnant materials that induce inflammation, adhesion, and infection is not available. The purpose of this study was to evaluate the efficacy of a bioabsorbable polyglycolic acid (PGA) mesh and fibrin glue as a substitute for dural repair.Methods. Altogether, 10 patients with noted dural tears during extradural spinal surgery and 20 patients who underwent durotomy for intradural spinal surgery were included in this study. In a series of 20 consecutive cases, dural closure was performed by suture and fibrin glue. In the subsequent 10 consecutive patients, dural closure was performed by suture and fibrin glue with the use of absorbable PGA mesh. The medical records and magnetic resonance imaging (MRI) of the surgical site were retrospectively reviewed to evaluate the presence of a cerebrospinal fluid (CSF) fistula or leakage after the surgery.Results. A CSF fistula occurred in five patients who underwent dural repair with fibrin glue alone, and postoperative MRI showed CSF leakage in two patients with incidental dural tears after laminectomy for ossification of ligamentum flavum. No CSF fistula was present in patients who underwent dural repair using PGA mesh and fibrin glue, and no adverse effects or complications were encountered postoperatively. Follow-up MRI revealed no evidence of CSF leakage around the reconstructed dura mater.Conclusions. The use of PGA mesh and fibrin glue for the repair of dura mater is a useful method of preventing CSF leakage in spinal surgery.