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![]() Everting the dural edges utilizing a Penfield forceps, allows for the placement of interrupted 7-0 Gore-Tex sutures at 3-5 mm intervals the “gaps” are next filled in by medium (1.4 mm) microdural staples. As closure is performed, these retraction sutures may be flipped across the dural opening to allow the edges to come together. Deliberate opening and exposure to remove intradural pathology typically requires the sequential application of 7-0 Gore-Tex retraction sutures on the dural edges. Intentional (anticipated) opening of the dura may be required to remove intradural spinal tumors (intradural extramedullary meningiomas/neurofibromas, or intradural intramedullary tumors such as astrocytomas, ependymomas), to marsupialize arachnoid cysts, to place LP or cyst/syrinx peritoneal shunts along with other pathology. WP-Shunt Wound-Peritoneal Shunt INTRODUCTION TR/MR Relaxation Times on MR Scans (T1, T2 Weighted Studies) TLIF Transforaminal Lumbar Interbody Fusion ![]() TE/MR Echo Time: Time After Excitation Pulses: Echo Time in Magnetic Resonance Imaging SPORT Spine Patient Outcomes Research Trial OPLL Ossification Posterior Longitudinal Ligament MRSA Methicillin Resistant Staphylococcus Aureus Only rarely are lumbar drains and wound-peritoneal and/or lumboperitoneal shunts warranted.Ĭonclusion:DTs or CSF fistulas attributed to primary/secondary spinal surgery, trauma, epidural injections, OPLL, OYL, and other factors, require timely diagnosis (MRI/CT/Cisternography), and appropriate reconstruction.ĬOPD Chronic Obstructive Pulmonary DiseaseĬTM Computed Axial Tomography Myelography Closure may also include muscle patch grafts, dural patches/substitutes (bovine pericardium), microfibrillar collagen (Duragen: Integra Life Sciences Holdings Corporation, Plainsboro, NJ), and fibrin glues or dural sealants (Tisseel: Baxter Healthcare Corporation, Deerfield, IL, USA). Gore and Associates Inc., Elkton, MD, USA) sutures, as the suture itself is larger than the needle the larger suture occludes the dural puncture site. Results:DTs should be repaired utilizing interrupted 7-0 Gore-Tex (W.L. Whatever the etiology of CSF fistulas or DTs, they must be diagnosed utilizing radioisotope cisternography (RIC), magnetic resonance imaging (MRI), computed axial tomography (CT) studies, and expeditiously repaired. Other etiologies of CSF fistulas/DTs include epidural steroid injections, and resection of ossification of the posterior longitudinal ligament (OPLL) or ossification of the yellow ligament (OYL). DTs, however, may inadvertently occur during primary, but are seen more frequently during revision spinal surgery often attributed to epidural scarring. Methods:During spinal surgery, the dura may be deliberately opened to resect intradural lesions/tumors, to perform shunts, or to open/marsupialize cysts. Background:In spinal surgery, cerebrospinal fluid (CSF) fistulas attributed to deliberate dural opening (e.g., for tumors, shunts, marsupialization of cysts) or inadvertent/traumatic dural tears (DTs) need to be readily recognized, and appropriately treated.
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