Moon Jung Hyeon, Lee Sungjoon, Chung Chun Kee, Kim Chi Heon, Heo Won
Department of Neurosurgery, Seoul National University College of Medicine, Seoul, South Korea; Neuroscience Research Institute, Seoul National University Medical Research Center, Seoul, South Korea; Clinical Research Institute, Seoul National University Hospital, Seoul, South Korea.
Department of Neurosurgery, Haeundae Paik Hospital, Busan, South Korea.
J Clin Neurosci. 2017 Nov;45:172-179. doi: 10.1016/j.jocn.2017.05.028. Epub 2017 Jun 16.
Primary dural repair in ossification of posterior longitudinal ligament (OPLL) surgery via anterior is challenging because of limited space. Based on several years of our experiences, we present our concept for addressing cerebrospinal fluid (CSF) leakage following dural tear during anterior OPLL surgery.
We reviewed the medical records of 65 patients who underwent anterior OPLL surgery from 2003 to 2014. We included 7 patients whose operation records described dural tear followed by CSF leakage. Primary dural repair could not be performed in 6 patients because of ragged tear and limited space. We managed them with our own strategy: simple cover with an artificial dura, collagen sponge and/or fibrin glue on defect site; anatomical layer-by-layer repair without either subfascial or CSF drain, and early ambulation.
Of 7 patients, wound problems developed in 2 patients. Wound aspiration and antibiotic treatment was done without wound compression in one patient, and simple irrigation followed by anatomical layer-by-layer re-closure was done in the other patient without either bed rest or lumbar drainage. Pseudomeningoceles were detected in 4 patients, including 2 patients who had wound problems. However, all pseudomeningoceles were absorbed spontaneously or stabilized on follow-up images without interventions such as bed rest, lumbar drain or wound compression.
Without interference of pressure equilibrium between intradural and extradural space, the defect site would heal and close. After that, the isolated pseudomeningocele would be spontaneously absorbed after certain period of time.
由于空间有限，经前路行后纵韧带骨化症（OPLL）手术时进行原发性硬脊膜修复具有挑战性。基于我们多年的经验，我们提出了在经前路OPLL手术中处理硬脊膜撕裂后脑脊液（CSF）漏的理念。
我们回顾了2003年至2014年接受经前路OPLL手术的65例患者的病历。我们纳入了7例手术记录描述有硬脊膜撕裂并伴有脑脊液漏的患者。6例患者因撕裂边缘不整齐和空间有限无法进行原发性硬脊膜修复。我们采用自己的策略对他们进行处理：在缺损部位用人工硬脊膜、胶原海绵和/或纤维蛋白胶简单覆盖；进行解剖学上的逐层修复，不放置筋膜下引流或脑脊液引流管，并早期活动。
7例患者中，2例出现伤口问题。1例患者在未进行伤口加压的情况下进行了伤口抽吸和抗生素治疗，另1例患者在未卧床休息或进行腰大池引流的情况下，简单冲洗后进行了解剖学上的逐层重新缝合。4例患者检测到假性硬脊膜膨出，其中2例有伤口问题。然而，所有假性硬脊膜膨出均在随访影像中自行吸收或稳定，未进行诸如卧床休息、腰大池引流或伤口加压等干预措施。
在不干扰硬膜内和硬膜外空间压力平衡的情况下，缺损部位会愈合和闭合。在此之后，孤立的假性硬脊膜膨出在一段时间后会自行吸收。
