Anselmi Leonardo, Anania Carla Daniela, Ubezio Maria Cleofe, Farinaro Generoso, Creatura Donato, Ortolina Alessandro, Tomei Massimo, Baram Ali, Fornari Maurizio
Department of Neurosurgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Italy.
Department of Biomedical Sciences, Humanitas University, Via R.L Montalcini 2, 20072 Pieve Emanuele, Italy.
Brain Sci. 2024 Dec 3;14(12):1223. doi: 10.3390/brainsci14121223.
: Postoperative cerebrospinal fluid (CSF) fistulas remain a significant concern in spinal neurosurgery, particularly following dural closure. The incidence of dural tears during spinal surgery is estimated between 1.6% and 10%. While direct suturing remains the gold standard, it has a failure rate of 5-10%. Various materials and techniques have been used to enhance dural closure. This study aims to assess the effectiveness of non-penetrating titanium clips (AnastoClip) for dural closure in intradural spinal lesion surgeries. : A prospective analysis was conducted on 272 patients who were operated on for intradural spinal lesions from August 2017 to December 2023. Dural closure was performed using non-penetrating titanium clips with sealant, and, in select cases, autologous grafts. Postoperative care included early mobilization and routine MRI to assess outcomes. A comparative analysis was performed with a cohort of 81 patients treated with traditional sutures. : Among the 272 patients, postoperative CSF leaks occurred in 32 cases (11.76%), requiring various management approaches. Thirteen cases required surgical revision, while others resolved with external lumbar drainage or fluid aspiration. Compared to the suture group, which had a fistula rate of 23.46%, the titanium clip group had a significantly lower fistula rate. Logistic regression analysis did not find statistically significant associations between fistula risk and clinical factors. : Non-penetrating titanium clips provide an effective alternative to sutures for dural closure, reducing CSF leak rates. They preserve dural integrity, reduce operative time, and avoid imaging artifacts, making them a viable advancement in spinal surgery with outcomes comparable to, or better than, traditional techniques.
术后脑脊液漏仍是脊柱神经外科手术中的一个重大问题，尤其是在硬膜缝合之后。脊柱手术中硬膜撕裂的发生率估计在1.6%至10%之间。虽然直接缝合仍是金标准，但失败率为5%-10%。人们已使用各种材料和技术来加强硬膜缝合。本研究旨在评估非穿透性钛夹（AnastoClip）在硬膜内脊柱病变手术中用于硬膜缝合的有效性。
对2017年8月至2023年12月期间接受硬膜内脊柱病变手术的272例患者进行了前瞻性分析。使用带密封剂的非穿透性钛夹进行硬膜缝合，在某些情况下使用自体移植物。术后护理包括早期活动和常规MRI以评估结果。对一组81例接受传统缝合治疗的患者进行了对比分析。
在272例患者中，32例（11.76%）术后出现脑脊液漏，需要采取各种处理方法。13例需要手术修复，其他患者通过腰外引流或液体抽吸得以解决。与瘘管发生率为23.46%的缝合组相比，钛夹组的瘘管发生率显著更低。逻辑回归分析未发现瘘管风险与临床因素之间存在统计学上的显著关联。
非穿透性钛夹为硬膜缝合提供了一种有效的替代缝合的方法，可降低脑脊液漏发生率。它们保持硬膜完整性，减少手术时间，并避免成像伪影，使其成为脊柱手术中一种可行的进展，其效果与传统技术相当或更好。
