Lopes M, Faillot T
Service de neurochirurgie, clinique d'Argonay, 385, route de Menthonnex, 74370 Argonay, France.
Service de neurochirurgie, hôpital Beaujon, 100, boulevard du Général-Leclerc, 92118 Clichy cedex, France.
Neurochirurgie. 2015 Oct;61(5):329-32. doi: 10.1016/j.neuchi.2015.06.005. Epub 2015 Sep 26.
Dural tears are a dreaded surgical incident because they are difficult to anticipate and may lead to serious complications.
The French College of Neurosurgery analyzed 100 cases of dural tears declared on the physicians accreditation website from the Haute Autorité de santé (Regional Health Authority). A questionnaire on drainage, type of dural repair and bed rest duration was sent to 87 French neurosurgeons.
Thirty-six percent of patients with dural tears had a history of previous spinal surgery and the most common cause of tear was surgical fibrosis into the operative field for 30% of cases. Sixty-four percent had no history of spinal surgery and, in 33% of cases, the dural tear occurred during a surgery for herniated disc. Drainage was proposed case by case in 76% of cases, the patient was allowed to stand up at day 1 in 48% of cases. The treatment of dural tears combined different techniques including in situ injection of biological glue in 86% of cases. The most common complication was the need of wound repair procedure in 59.5% of cases, which was complicated by meningitis in 21.5% of cases.
This study shows the lack of formal consensus about the procedure of repair, the method of drainage or the need to keep the patient bed ridden. This study highlights a relatively high frequency of dural tears, its potentially serious complications and stresses the need for prospective studies in order to define the appropriate action to undertake when faced with this type of incident.
