Novel use of nonpenetrating titanium clips for pediatric primary spinal dural closure: A technical note.

Autor: Shahrestani S; Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Department of Medical Engineering, California Institute of Technology, Pasadena, CA, USA., Brown NJ; School of Medicine, University of California, Irvine, Orange, CA, USA. Electronic address: nolanb@uci.edu., Loya J; Department of Neurosurgery, University of California, La Jolla, San Diego, CA, USA., Patel NA; School of Medicine, Mercer University, Columbus, GA, USA., Gendreau JL; Department of Biomedical Engineering, Johns Hopkins Whiting School of Engineering, Baltimore, MD, USA., Himstead AS; School of Medicine, University of California, Irvine, Orange, CA, USA., Pierzchajlo N; School of Medicine, Mercer University, Columbus, GA, USA., Singh R; School of Medicine, University of California, Irvine, Orange, CA, USA., Sahyouni R; Department of Neurosciences and Pediatrics, University of California San Diego, San Diego, CA, USA., Diaz-Aguilar LD; Department of Neurosciences and Pediatrics, University of California San Diego, San Diego, CA, USA., Rennert RC; Department of Neurosciences and Pediatrics, University of California San Diego, San Diego, CA, USA., Levy ML; Department of Neurosurgery, University of California, La Jolla, San Diego, CA, USA; Department of Neurosciences and Pediatrics, University of California San Diego, San Diego, CA, USA.
Jazyk: angličtina
Zdroj: Clinical neurology and neurosurgery [Clin Neurol Neurosurg] 2022 Nov; Vol. 222, pp. 107422. Date of Electronic Publication: 2022 Sep 05.
DOI: 10.1016/j.clineuro.2022.107422
Abstrakt: Background: Dural closure is an important part of any pediatric spinal procedure with intradural pathology to prevent post-operative cerebrospinal fluid (CSF) egress and associated complications. Utilization of nonpenetrating titanium clips is one closure option that may have technical advantages such as ease of use and amenability to a narrow surgical corridor. No data exist on the efficacy of these clips for pediatric spinal dural closure.
Methods: A single surgeon case series of 152 pediatric patients underwent procedures involving lumbar durotomy with subsequent dural closure using the AnastoClip® nonpenetrating titanium clip closure system. Rates of infection and cerebrospinal fluid leak were measured during the follow-up period.
Results: A total of 152 pediatric patients (mean age: 6.25 ± 5.85 years, 50.7 % female) underwent intradural surgery with clip closure. The mean follow-up time was 57.0 ± 28.5 months. All patients were initially indicated for procedures involving spinal durotomy, with a majority being isolated tethered cord release (84.2 %). Others required tethered cord release and excision of a lipomyelomeningocele, spinal meningioma or arachnoid cyst (15.8 %). Post operative CSF leak occurred in two (1.32 %) patients at 11 and 18 days. Only one (0.66 %) patient was diagnosed with an infection, which was in a separate patient from those that had CSF leaks.
Conclusion: The remarkably low incidence of post-operative CSF leak and infection with nonpenetrating titanium clips suggests a strong safety and efficacy profile for this form of dural closure in a pediatric cohort. Further research evaluating this technique is required to fully demonstrate its acceptability as a cost-effective alternative to traditional suture-based closure.
(Copyright © 2022 The Authors. Published by Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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