Epstein N E, Hollingsworth R
Department of Surgery, North Shore University Hospital, Manhasset, New York, USA.
Surg Neurol. 1999 Nov;52(5):511-4. doi: 10.1016/s0090-3019(99)00135-4.
Cerebrospinal fluid (CSF) fistulas may occur during anterior cervical surgery performed for the resection of ossification of the posterior longitudinal ligament (OPLL), as OPLL occasionally erodes to and through the dura. These fistulas have been variously managed with gelfoam, dural substitutes sutured in place, fibrin glue, lumbar drains, and lumboperitoneal shunts. However, more adequate dural repair is now feasible with the 1.4-mm microdural titanium stapler.
A 59-year-old female with OPLL and moderate to severe myelopathy (Nurick Grade IV) had a C3-C7 anterior corpectomy with fusion using Orion plates followed by a C3-T1 posterior wiring and fusion with halo application. During the anterior approach, a 5-mm CSF fistula at C4-C5 was directly repaired under the operating microscope using a 1.4-mm microdural stapler, bovine pericardial graft, and fibrin glue. Immediately postoperatively, a lumboperitoneal shunt was also placed.
Postoperatively, her myelopathy improved to a mild to moderate level (Nurick Grade II). Her acute left deltoid plegia resolved within 3 months.
The 1.4-mm microdural stapler makes "watertight" closure of anterior cervical CSF fistulas more feasible.
在为切除后纵韧带骨化症（OPLL）而进行的颈椎前路手术中可能会发生脑脊液（CSF）瘘，因为OPLL偶尔会侵蚀并穿透硬脑膜。这些瘘管已经通过明胶海绵、原位缝合的硬脑膜替代物、纤维蛋白胶、腰大池引流管和腰大池腹腔分流术等多种方法进行处理。然而，现在使用1.4毫米微型硬脑膜钛钉可以实现更充分的硬脑膜修复。
一名59岁患有OPLL且伴有中度至重度脊髓病（努里克分级IV级）的女性患者，接受了C3 - C7前路椎体次全切除并使用Orion钢板融合，随后进行了C3 - T1后路钢丝固定及融合并应用头环。在前路手术过程中，在手术显微镜下使用1.4毫米微型硬脑膜钛钉、牛心包移植物和纤维蛋白胶直接修复了C4 - C5处5毫米的脑脊液瘘。术后立即还放置了腰大池腹腔分流管。
术后，她的脊髓病改善至轻度至中度水平（努里克分级II级）。她急性左侧三角肌麻痹在3个月内得到缓解。
1.4毫米微型硬脑膜钛钉使颈椎前路脑脊液瘘的“水密”闭合更可行。
