Hyun-Jin Park1, Seung-Kook Kim2, Su-Chan Lee3, Wanseok Kim4, Sangho Han4, Sang-Soo Kang5. 1. Department of Spine Center, Orthopaedic Surgery, Hallym University Kangnam Sacred Heart Hospital, Seoul, South Korea. 2. Himchan UHS Spine and Joint Centre, Department of Neurosurgery, University Hospital Sharjah, Sharjah, United Arab Emirates; Joint and Arthritis Research, Department of Orthopaedic Surgery, Himchan Hospital, Seoul, South Korea; Department of Pharmaceutical Medicine and Regulatory Sciences, College of Medicine and Pharmacy, Yonsei University, Incheon, South Korea. Electronic address: hyunipapa@yonsei.ac.kr. 3. Joint and Arthritis Research, Department of Orthopaedic Surgery, Himchan Hospital, Seoul, South Korea. 4. Department of Spine Center, Department of Orthopaedic Surgery, Daechan Hospital, Incheon, South Korea. 5. Spine Center, Department of Orthopaedic Surgery, Leaders Hospital, Seoul, South Korea.
Abstract
OBJECTIVE: To determine the rate and anatomical location of dural tears associated with spinal surgery using a percutaneous biportal endoscopic surgery (PBES) technique. We investigated the relationship between dural tears and the type of procedure and type of instrument used. METHODS: We retrospectively analyzed 643 PBES cases by reviewing the medical records, operative records, and operative videos. Incidental durotomy was identified in 29 cases. We analyzed the size and anatomical location of the dural tears, the surgical instrument that caused the tear, and the technique used to seal the tear. RESULTS: The dural tear incidence was 4.5% (29 of 643 cases). Tears in the exiting nerve area (2 cases; 6.9%) had mainly been caused by curettage, tears in the thecal sac area (18 cases; 62.1%) were associated with electric drill and forceps use; and tears in the traversing nerve area were associated with the use of a Kerrison punch (9 cases; 31%). Of the 29 cases of dural tear, 12 were treated with in-hospital monitoring and bed rest, 14 were treated with a fibrin sealant, 2 were treated with a nonpenetrating titanium clip, and 1 was converted to microscopic surgery. One case of postoperative meningocele after conservative treatment required endoscopic revision surgery to close the dural tear. CONCLUSIONS: Most cases of incidental dural tear during PBES were treated with an endoscopic procedure. The incidence of dural tear was no greater than that associated with microscopic surgery. Our management strategy for incidental dural tears during PBES has been shown to be safe and effective.
OBJECTIVE: To determine the rate and anatomical location of dural tears associated with spinal surgery using a percutaneous biportal endoscopic surgery (PBES) technique. We investigated the relationship between dural tears and the type of procedure and type of instrument used. METHODS: We retrospectively analyzed 643 PBES cases by reviewing the medical records, operative records, and operative videos. Incidental durotomy was identified in 29 cases. We analyzed the size and anatomical location of the dural tears, the surgical instrument that caused the tear, and the technique used to seal the tear. RESULTS: The dural tear incidence was 4.5% (29 of 643 cases). Tears in the exiting nerve area (2 cases; 6.9%) had mainly been caused by curettage, tears in the thecal sac area (18 cases; 62.1%) were associated with electric drill and forceps use; and tears in the traversing nerve area were associated with the use of a Kerrison punch (9 cases; 31%). Of the 29 cases of dural tear, 12 were treated with in-hospital monitoring and bed rest, 14 were treated with a fibrin sealant, 2 were treated with a nonpenetrating titanium clip, and 1 was converted to microscopic surgery. One case of postoperative meningocele after conservative treatment required endoscopic revision surgery to close the dural tear. CONCLUSIONS: Most cases of incidental dural tear during PBES were treated with an endoscopic procedure. The incidence of dural tear was no greater than that associated with microscopic surgery. Our management strategy for incidental dural tears during PBES has been shown to be safe and effective.
Authors: Maxim N Kravtsov; Vadim A Manukovsky; Saidmirze D Mirzametov; Olga V Malysheva; Dmitry A Averyanov; Dmitry V Svistov Journal: Front Surg Date: 2022-04-29
Authors: Pang Hung Wu; Hyeun Sung Kim; Yeon Jin Lee; Dae Hwan Kim; Jun Hyung Lee; Jun Bok Jeon; Harshavardhan Dilip Raorane; Il-Tae Jang Journal: Brain Sci Date: 2020-06-15