Shields Lisa B E, Mutchnick Ian S
1Norton Neuroscience Institute, Norton Healthcare, Louisville.
2Norton Children's Hospital and Norton Children's Neuroscience Institute, Norton Healthcare, Louisville; and.
J Neurosurg Pediatr. 2025 Jan 17;35(4):391-399. doi: 10.3171/2024.10.PEDS24425. Print 2025 Apr 1.
CSF leaks are a significant source of patient morbidity following intradural spine surgeries. Watertight dural closure is crucial during these procedures to minimize the risk of a CSF leak. This study reports postoperative outcomes and changes in patient management after switching to penetrating titanium clips for dural closure in a large cohort of pediatric patients receiving a tethered cord release (TCR) or a selective dorsal rhizotomy (SDR).
An IRB-approved retrospective review was conducted of the medical charts of all patients who underwent thoracolumbar dorsal midline dural closure with the AnastoClip GC Closure System during the 7 years between May 22, 2017, and May 21, 2024. Selected data such as evidence of a CSF leak and postoperative length of stay were collected.
A total of 290 patients were treated with AnastoClips GC for dural closure. Of these patients, 232 (80.0%) underwent a TCR only, 52 (17.9%) received an SDR, and 6 (2.1%) underwent a complex TCR. The mean duration between surgery and last follow-up was 7.96 months (range 0.27-54.57 months). One patient, who received a simple TCR, experienced a transient pseudomeningocele without headache, emesis, or visible leak that resolved without surgical intervention within 8 weeks. Three (1%) patients had positional headaches without other evidence of a CSF leak, all limited to the initial 2 weeks of postoperative care. Six (2%) patients had delayed wound healing, 2 of whom underwent operative wound revisions. As of January 1, 2021, patients no longer had to lie flat postoperatively. While 60.6% of TCR patients were discharged from the hospital on POD 1 (none on POD 0) prior to this date, 87.5% of patients were discharged from the hospital on either POD 0 (3.1%) or POD 1 (84.4%) afterward. Similarly, 50% of SDR patients were discharged on POD 2 or 3 after the need for lying flat postoperatively was removed versus 21% before the protocol change.
AnastoClip GC Closure System titanium clips are safe and effective for dural closure in both TCR and SDR, with rare complications. Their efficacy has prompted us to remove flat bed rest requirements for postoperative patients, significantly reducing the length of stay, and has opened the door to making simple TCRs a same-day surgery.
脑脊液漏是硬脊膜内脊柱手术后患者发病的重要原因。在这些手术过程中，严密的硬脑膜闭合对于将脑脊液漏的风险降至最低至关重要。本研究报告了在一大群接受脊髓拴系松解术（TCR）或选择性背根切断术（SDR）的儿科患者中，改用穿透式钛夹进行硬脑膜闭合术后的结果及患者管理的变化。
对2017年5月22日至2024年5月21日这7年间所有使用AnastoClip GC闭合系统进行胸腰段背侧中线硬脑膜闭合的患者的病历进行了一项经机构审查委员会批准的回顾性研究。收集了诸如脑脊液漏的证据和术后住院时间等选定数据。
共有290例患者使用AnastoClip GC进行硬脑膜闭合。在这些患者中，232例（80.0%）仅接受了TCR，52例（17.9%）接受了SDR，6例（2.1%）接受了复杂的TCR。手术至最后一次随访的平均时长为7.96个月（范围0.27 - 54.57个月）。1例接受单纯TCR的患者出现了短暂的假性脑脊膜膨出，无头痛、呕吐或可见漏液，在8周内未经手术干预即自行消退。3例（1%）患者有体位性头痛，但无其他脑脊液漏的证据，均局限于术后护理的最初2周。6例（2%）患者伤口愈合延迟，其中2例接受了手术伤口修复。截至2021年1月1日，患者术后无需再平躺。在此日期之前，60.6%的TCR患者在术后第1天出院（术后第0天无患者出院），之后87.5%的患者在术后第0天（3.1%）或第1天（84.4%）出院。同样，在取消术后平躺要求后，50%的SDR患者在术后第2天或第3天出院，而在方案改变前这一比例为21%。
AnastoClip GC闭合系统钛夹在TCR和SDR的硬脑膜闭合中安全有效，并发症罕见。其有效性促使我们取消了术后患者平躺的要求，显著缩短了住院时间，并为将单纯TCR变为日间手术打开了大门。
