Ito Kiyoshi, Yanagawa Takao, Horiuchi Tetsuyoshi, Sakai Keiichi, Hongo Kazuhiro
Department of Neurosurgery, Shinshu University School of Medicine, Asahi, Matsumoto, Japan.
No Shinkei Geka. 2010 Dec;38(12):1127-31.
Postoperative cerebrospinal fluid (CSF) leakage is one of the most important surgical complications in spinal surgery. Particularly in intradural spinal cord tumor surgery, it is very important to prevent CSF leakage postoperatively, as it can lead to postoperative complications such as infection and pseudomeningocele formation. Compared to the intracranial region, as the operative field is narrower and the structure of the dura mater is more fragile in the spinal region, meticulous dural suturing is sometimes impossible after intradural procedures. To prevent CSF leakage, some surgical procedures and materials have been developed in the neurosurgical field, including the recently introduced polyethylene glycol-based hydrogel sealant system. The hydrogel sealant system consists of synthetic absorbable material, which eliminates the risk of viral transmission and reduces the risk of allergic reaction. It proved to have potential for reducing postoperative CSF leakage. We used this material in intradural lumbar lesion surgery, and postoperative CSF leakage did not occur with this surgical procedure. We report our experience with dural plasty using the hydrogel sealant system in the intradural lumbar spinal lesion surgery and discuss the usefulness of this material.
术后脑脊液漏是脊柱手术中最重要的手术并发症之一。特别是在硬脊膜内脊髓肿瘤手术中,术后预防脑脊液漏非常重要,因为它可能导致术后感染和假性脑脊膜膨出形成等并发症。与颅内区域相比,由于脊柱区域的手术视野更窄且硬脑膜结构更脆弱,硬脊膜内手术后有时无法进行细致的硬脑膜缝合。为了预防脑脊液漏,神经外科领域已经开发了一些手术方法和材料,包括最近引入的聚乙二醇基水凝胶密封剂系统。该水凝胶密封剂系统由合成可吸收材料组成,消除了病毒传播风险并降低了过敏反应风险。事实证明它有减少术后脑脊液漏的潜力。我们在硬脊膜内腰椎病变手术中使用了这种材料,采用该手术方法术后未发生脑脊液漏。我们报告在硬脊膜内腰椎脊柱病变手术中使用水凝胶密封剂系统进行硬脑膜成形术的经验,并讨论这种材料的实用性。