Dean Chou1, Vincent Y Wang, Aman Shabi Khan. 1. Department of Neurosurgery, University of California, San Francisco, San Francisco, California 94143-0350, USA. choud@neurosurg.ucsf.edu
Abstract
OBJECTIVE: Minimally invasive microdiscectomies are commonly being performed for disc herniations. Although inadvertent dural tears are not common, they do occur. Present management of many dural tears includes fibrin glue or other adhesive substances over the dura, tight closure of the fascia and skin, and possibly bedrest. Because these surgeries are usually performed through a small tube, a primary dural repair can be prohibitively difficult. One reason for the difficulty in a primary closure is that the small tube limits the use of proper opening and closing of standard dural repair instruments as well as the proper angulation of the instruments. METHODS: To circumvent this difficulty, we have improvised using commonly available instruments in the operating room for primary dural closure. RESULTS: We describe our technique and present a video demonstrating the method of primary dural closure without custom-made instruments. CONCLUSION: Primary dual repair during minimally invasive microdiscectomy can be performed using standard operation room instruments, including a standard micropituitary ronguer, 5-0 Prolene suture (Ethicon, Inc., Somerville, NJ), and a laparoscopic knot pusher.
OBJECTIVE: Minimally invasive microdiscectomies are commonly being performed for disc herniations. Although inadvertent dural tears are not common, they do occur. Present management of many dural tears includes fibrin glue or other adhesive substances over the dura, tight closure of the fascia and skin, and possibly bedrest. Because these surgeries are usually performed through a small tube, a primary dural repair can be prohibitively difficult. One reason for the difficulty in a primary closure is that the small tube limits the use of proper opening and closing of standard dural repair instruments as well as the proper angulation of the instruments. METHODS: To circumvent this difficulty, we have improvised using commonly available instruments in the operating room for primary dural closure. RESULTS: We describe our technique and present a video demonstrating the method of primary dural closure without custom-made instruments. CONCLUSION: Primary dual repair during minimally invasive microdiscectomy can be performed using standard operation room instruments, including a standard micropituitary ronguer, 5-0 Prolene suture (Ethicon, Inc., Somerville, NJ), and a laparoscopic knot pusher.
Authors: Hormuzdiyar H Dasenbrock; Stephen P Juraschek; Lonni R Schultz; Timothy F Witham; Daniel M Sciubba; Jean-Paul Wolinsky; Ziya L Gokaslan; Ali Bydon Journal: J Neurosurg Spine Date: 2012-03-09