Müller Simon J, Burkhardt Benedikt W, Oertel Joachim M
Department of Neurosurgery, Saarland University Medical Center and Faculty of Saarland University, Homburg-Saar, Germany.
Department of Neurosurgery, Saarland University Medical Center and Faculty of Saarland University, Homburg-Saar, Germany.
World Neurosurg. 2018 Nov;119:494-499. doi: 10.1016/j.wneu.2018.05.251. Epub 2018 Jun 12.
The incidental dural tear is a common complication in lumbar spine surgery. It has been reported that the incidence of dural tears is much greater in endoscopic procedures. Primary closure via suturing remains challenging in endoscopic procedures. The objective of this study was to conduct a literature review on the surgical technique for dural closure and repair in endoscopic spine surgery.
A systematic literature search was performed using the database PubMed. In total, 12 studies reported specifically about the surgical treatment for dural tear in percutaneous and tubular assisted endoscopic technique. The dural tear rate, the technique of dural closure, postoperative time of bed rest, postoperative symptoms related to cerebrospinal fluid fistula, and revision surgery were assessed.
The overall rate of dural tears in endoscopic spinal surgery was 2.7%, with a range from 0% to 8.6%. The incidence of a dural tear was much greater in cases with lumbar stenosis (3.7%) than in lumbar disc herniation (2.1%). The greatest rate was accompanied by resecting synovial cysts. In addition, the risk of dural tear is greater in bilateral decompression procedures via a unilateral approach. There is no consensus about the ideal technique for dural closure in endoscopic procedures. Furthermore, there is a debate whether dural tear requires surgical treatment or not.
An autologous muscle or fat graft in combination with fibrin glue or a fibrin-sealed collagen sponge seems to be a good and safe method for the management of dural tear in lumbar endoscopic spine surgery.
硬脊膜意外撕裂是腰椎手术中常见的并发症。据报道，在内镜手术中硬脊膜撕裂的发生率要高得多。在内镜手术中，通过缝合进行一期缝合仍然具有挑战性。本研究的目的是对内镜脊柱手术中硬脊膜闭合和修复的手术技术进行文献综述。
使用PubMed数据库进行系统的文献检索。共有12项研究专门报道了经皮和管状辅助内镜技术治疗硬脊膜撕裂的情况。评估了硬脊膜撕裂率、硬脊膜闭合技术、术后卧床时间、与脑脊液漏相关的术后症状以及翻修手术情况。
内镜脊柱手术中硬脊膜撕裂的总体发生率为2.7%，范围为0%至8.6%。腰椎管狭窄症患者硬脊膜撕裂的发生率（3.7%）远高于腰椎间盘突出症患者（2.1%）。切除滑膜囊肿时硬脊膜撕裂率最高。此外，经单侧入路进行双侧减压手术时硬脊膜撕裂的风险更大。在内镜手术中，对于理想的硬脊膜闭合技术尚无共识。此外，对于硬脊膜撕裂是否需要手术治疗也存在争议。
自体肌肉或脂肪移植联合纤维蛋白胶或纤维蛋白封闭的胶原海绵似乎是腰椎内镜脊柱手术中处理硬脊膜撕裂的一种良好且安全的方法。
