دورية أكاديمية
Microsurgical Repair of Ventral Cerebrospinal Fluid Leaks in Spontaneous Intracranial Hypotension: Efficacy and Safety of Patch-Sealing Versus Suturing.
| العنوان: | Microsurgical Repair of Ventral Cerebrospinal Fluid Leaks in Spontaneous Intracranial Hypotension: Efficacy and Safety of Patch-Sealing Versus Suturing. |
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| المؤلفون: | Petutschnigg T; Department of Neurosurgery, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland., Häni L; Department of Neurosurgery, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland., Goldberg J; Department of Neurosurgery, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland., Dobrocky T; Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland., Piechowiak EI; Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland., Raabe A; Department of Neurosurgery, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland., Jesse CM; Department of Neurosurgery, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland., Schär RT; Department of Neurosurgery, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland. |
| المصدر: | Operative neurosurgery (Hagerstown, Md.) [Oper Neurosurg (Hagerstown)] 2024 Aug 12. Date of Electronic Publication: 2024 Aug 12. |
| Publication Model: | Ahead of Print |
| نوع المنشور: | Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: Lippincott Williams & Wilkins, Inc Country of Publication: United States NLM ID: 101635417 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2332-4260 (Electronic) Linking ISSN: 23324252 NLM ISO Abbreviation: Oper Neurosurg (Hagerstown) Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: 2022- : [Philadelphia] : Lippincott Williams & Wilkins, Inc. Original Publication: Hagerstown, MD: Lippincott, Williams & Wilkins, 2014- |
| مستخلص: | Background and Objectives: In patients with spontaneous intracranial hypotension (SIH), microsurgical repair is recommended in Type 1 (ventral) dural leaks, when conservative measures fail. However, there is lacking consensus on the optimal surgical technique for permanent and safe closure of ventral leaks. Methods: We performed a retrospective analysis of surgically treated SIH patients with Type 1 leaks at our institution between 2013 and 2023. Patients were analyzed according to the type of surgical technique: (1) Microsurgical suture vs (2) extradural and intradural patching (sealing technique). End points were resolution of spinal longitudinal epidural cerebrospinal fluid collection (SLEC), change in brain SIH-Score (Bern-Score), headache resolution after 3 months, surgery time, complications, and reoperation rates. Results: In total, 85 (66% women) patients with consecutive SIH (mean age 47 ± 11 years) underwent transdural microsurgical repair. The leak was sutured in 53 (62%) patients (suture group) and patch-sealed in 32 (38%) patients (sealing group). We found no significant difference in the rates of residual SLEC and resolution of headache between suture and sealing groups (13% vs 22%, P = .238 and 89% vs 94%, P = .508). No changes were found in the postoperative Bern-Score between suture and sealing groups (1.4 [±1.6] vs 1.7 [±2.1] P = 1). Mean surgery time was significantly shorter in the sealing group than in the suture group (139 ± 48 vs 169 ± 51 minutes; P = .007). Ten patients of the suture and 3 of the sealing group had a complication (23% vs 9%, P = .212), whereas 6 patients of the suture and 2 patients of the sealing group required reoperation (11% vs 6%, P = .438). Conclusion: Microsurgical suturing and patch-sealing of ventral dural leaks in patients with SIH are equally effective. Sealing alone is a significantly faster technique, requiring less spinal cord manipulation and may therefore minimize the risk of surgical complications. (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc on behalf of Congress of Neurological Surgeons.) |
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| تواريخ الأحداث: | Date Created: 20240812 Latest Revision: 20240812 |
| رمز التحديث: | 20240813 |
| DOI: | 10.1227/ons.0000000000001310 |
| PMID: | 39132996 |
| قاعدة البيانات: | MEDLINE |
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