Black Perry
Department of Neurosurgery, MCP Hahnemann University, Philadelphia, Pennsylvania 19102, USA.
J Neurosurg. 2002 Mar;96(2 Suppl):250-2. doi: 10.3171/spi.2002.96.2.0250.
Cerebrospinal fluid (CSF) leaks are relatively common following spinal surgery. A midline dural tear in the spine is readily repaired by direct application of sutures; however, far-lateral or ventral dural tears are problematic. Fat is an ideal sealant because it is impermeable to water. In this paper the author reports his experience with using fat grafts for the prevention or repair of CSF leaks and proposes a technique in which a large sheet of fat, harvested from the patient's subcutaneous layer, is used to cover not only the dural tear(s) but all of the exposed dura and is tucked into the lateral recess. This procedure prevents CSF from seeping around the fat, which may be tacked to the dura with a few sutures. Fibrin glue is spread on the surface of the fat and is further covered with Surgicel or Gelfoam. For ventral dural tears (associated with procedures in which disc material is excised), fat is packed into the disc space to seal off the ventral dural leak. Dural suture lines following spinal intradural exploration are prophylatically protected from CSF leakage in the same manner. With one exception, 27 dural tears noted during 1650 spinal procedures were successfully repaired using this technique. There was one case of postoperative CSF leakage in 140 cases in which intradural exploration for tumor or other lesions was undertaken. Both postoperative CSF leaks were controlled by applying additional skin sutures. The use of a fat graft is recommended as a rapid, effective means of prevention and repair of CSF leaks following spinal surgery.
脊柱手术后脑脊液（CSF）漏相对常见。脊柱中的中线硬脑膜撕裂可通过直接缝合轻松修复；然而，远外侧或腹侧硬脑膜撕裂则存在问题。脂肪是一种理想的密封剂，因为它不透水。在本文中，作者报告了使用脂肪移植预防或修复脑脊液漏的经验，并提出了一种技术，即从患者皮下层获取一大片脂肪，不仅用于覆盖硬脑膜撕裂处，还用于覆盖所有暴露的硬脑膜，并将其塞入侧隐窝。此操作可防止脑脊液在脂肪周围渗漏，脂肪可用几根缝线固定在硬脑膜上。纤维蛋白胶涂抹在脂肪表面，再用外科用纱布或明胶海绵进一步覆盖。对于腹侧硬脑膜撕裂（与椎间盘材料切除手术相关），将脂肪填充到椎间盘间隙以封闭腹侧硬脑膜漏。脊柱硬脊膜内探查后的硬脑膜缝合线也以同样方式预防性地防止脑脊液渗漏。在1650例脊柱手术中发现的27处硬脑膜撕裂，除1例例外，均使用该技术成功修复。在140例进行硬脊膜内肿瘤或其他病变探查的病例中，有1例术后出现脑脊液漏。这两例术后脑脊液漏均通过额外的皮肤缝合得以控制。推荐使用脂肪移植作为脊柱手术后预防和修复脑脊液漏的一种快速、有效的方法。
