Kramer Dallas E, Kaye Brandon, Sandoval-Consuegra Jose, Jeong Seung W, Woodhouse Cody, Yu Alexander
1Department of Neurosurgery, Allegheny Health Network, Pittsburgh, Pennsylvania; and.
2Nova Southeastern University Dr. Kiran C. Patel College of Allopathic Medicine, Davie, Florida.
Neurosurg Focus. 2025 Feb 1;58(2):E16. doi: 10.3171/2024.11.FOCUS24721.
Persistent CSF leakage and symptomatic pseudomeningocele formation are a primary concern following intradural posterior fossa and spinal surgeries, with rates approaching 23.7% and 10%, respectively. These complications occur at a higher rate in cases in which a watertight primary closure cannot be attained. In such cases, various dural substitutes and sealants are at the surgeon's disposal and often require suturing a dural substitute to the existing dura. Herein, the authors describe a novel sutureless inlay-onlay fibrin-coated collagen fleece (TachoSil) "sandwich" closure technique for dural reconstruction and closure.
The authors retrospectively reviewed posterior fossa and intradural spinal cases performed by the senior author from January 1, 2021, to August 30, 2024, which used the described novel closure technique when primary closure without expansion could not be attained. Primary outcomes were rates of postoperative CSF leakage, symptomatic pseudomeningocele formation, CSF diversion, infection, and revision surgery.
A total of 13 patients (8 craniotomies, 2 craniectomies, and 3 spinal cases) were identified with a mean age of 61.3 ± 14.0 years. Surgical indications included intra-axial and extra-axial tumors, acute cerebellar infarcts, an unruptured aneurysm, and a ruptured arteriovenous malformation. One patient (7.7%) who underwent emergency craniectomy for acute cerebellar infarct developed a postoperative CSF leak and symptomatic pseudomeningocele with suspicion of pseudotumor cerebri, ultimately requiring CSF diversion. There were no complications among patients receiving craniotomy or intradural spinal surgery. No postoperative infections or revision surgeries occurred.
The TachoSil sandwich technique represents an effective means of cranial and spinal dural reconstruction and closure in cases in which watertight primary dural closure cannot be achieved.
持续性脑脊液漏和有症状的假性脑膜膨出形成是后颅窝硬膜内和脊柱手术后的主要问题，发生率分别接近23.7%和10%。在无法实现水密性一期缝合的情况下，这些并发症的发生率更高。在这种情况下，外科医生可使用各种硬脑膜替代物和密封剂，并且通常需要将硬脑膜替代物缝合到现有的硬脑膜上。在此，作者描述了一种用于硬脑膜重建和闭合的新型无缝合镶嵌-覆盖纤维蛋白涂层胶原绒（速即纱）“三明治”闭合技术。
作者回顾性分析了资深作者在2021年1月1日至2024年8月30日期间进行的后颅窝和硬膜内脊柱手术病例，这些病例在无法实现无扩张的一期闭合时使用了所描述的新型闭合技术。主要结局指标为术后脑脊液漏、有症状的假性脑膜膨出形成、脑脊液分流、感染和翻修手术的发生率。
共确定了13例患者（8例开颅手术、2例颅骨切除术和3例脊柱手术），平均年龄为61.3±14.0岁。手术适应证包括轴内和轴外肿瘤、急性小脑梗死、未破裂动脉瘤和破裂的动静脉畸形。1例因急性小脑梗死接受急诊颅骨切除术的患者出现术后脑脊液漏和有症状的假性脑膜膨出，怀疑为假性脑瘤，最终需要进行脑脊液分流。接受开颅手术或硬膜内脊柱手术的患者未出现并发症。未发生术后感染或翻修手术。
在无法实现水密性一期硬脑膜闭合的情况下，速即纱三明治技术是一种有效的颅骨和脊柱硬脑膜重建及闭合方法。
