DuraSeal-hematoma: concealed hematoma causing spinal cord compression.

STUDY
DESIGN: Case description.
OBJECTIVE: To present a case report which highlights a complication following the use of Duraseal in posterior cervical surgery. SUMMARY OF BACKGROUND DATA: Duraseal is increasingly used to repair cranial and spinal dural defects to prevent cerebrospinal fluid leakage. Although it is well established that the hydrogel expands after implantation and may result in compressive effects, the phenomenon of Duraseal-entrapped hematoma has not previously been reported.
METHODS: The authors report a 80-year-old woman who presented with cervical myelopathy secondary to canal stenosis. The patient underwent decompressive cervical laminectomies. The surgery was complicated by an unintended durotomy. A thin layer of Duraseal was applied over the dural surface and a suction drain placed before wound closure. The patient awoke from surgery without any new neurologic deficits but experienced delayed functional deterioration. Urgent magnetic resonance imaging demonstrated an extradural hematoma with severe cord compression.
RESULTS: The patient underwent urgent surgery. Intraoperatively, the Duraseal was found to have formed a restrictive layer, completely entrapping the extradural hematoma with resultant spinal cord compression. Minimal blood clot was found external to the hydrogel layer.
CONCLUSION: Although Duraseal can provide an effective and water-tight dural repair, it also has the potential to "entrap" extradural bleeding which otherwise may have been evacuated by a wound drain placed under suction. Our experience has shown that Duraseal should be used judiciously with recognition of this potential complication.