Management of Spinal Dural Tear
Mohamed Tawfik Mahdy Elgebely;
Abstract
Dura mater is the outermost of the three layers of the meninges surrounding the brain and spinal cord.
It is responsible for protection of the brain and spinal cord, containing the c.s.f., correct development of the C.N.S. & Different cell populations has been described in meninges as stem cells which activated by spinal cord injury and brain stroke.
Dural tears one of the most serious complications that spinal surgeons may face it.
It must be treated efficiency & carefully to avoid its complication either intra operatively or postoperative.
Even tiny holes in the dura will cause marked C.S.F. leak but unfortunately not all tears are recognized intraopertivly.
The evolution of spinal procedures, skills of the surgeon, redundant dura & the recurrent operations is the most important risk factors in the occurrence of the dural tear.
Although the presences of dural sealing materials like (Fibrin glue, Gel foam, Surgicel, Gelatin sponge, dura seal, collagen matrix) &autogenous graft (fat &fascia) primary repair with sutures is still the treatment of choice for intraoperative treatment of the dural tear.
Closed sub arachnoid drainage by insertion of a catheter in the sub arachnoid space to relieve C.S.F. Pressure on the tear is another choice in treatment of dural tear.
The goal of successful management of the dural tear associated with C.S.F. leak is to produce an adequate seal that can withstand C.S.F pressure during healing period.
When there is asmall leak which is not treated properly it may lead to a serious complication like (intra cranial hypotension,infection,meningitis,pseudomeningeocele, fistula, superficial sedrosis , chronic headache& adhesive arachidonitis if methyl prednisolone or local anesthetics injected directly on breached dura).
It is responsible for protection of the brain and spinal cord, containing the c.s.f., correct development of the C.N.S. & Different cell populations has been described in meninges as stem cells which activated by spinal cord injury and brain stroke.
Dural tears one of the most serious complications that spinal surgeons may face it.
It must be treated efficiency & carefully to avoid its complication either intra operatively or postoperative.
Even tiny holes in the dura will cause marked C.S.F. leak but unfortunately not all tears are recognized intraopertivly.
The evolution of spinal procedures, skills of the surgeon, redundant dura & the recurrent operations is the most important risk factors in the occurrence of the dural tear.
Although the presences of dural sealing materials like (Fibrin glue, Gel foam, Surgicel, Gelatin sponge, dura seal, collagen matrix) &autogenous graft (fat &fascia) primary repair with sutures is still the treatment of choice for intraoperative treatment of the dural tear.
Closed sub arachnoid drainage by insertion of a catheter in the sub arachnoid space to relieve C.S.F. Pressure on the tear is another choice in treatment of dural tear.
The goal of successful management of the dural tear associated with C.S.F. leak is to produce an adequate seal that can withstand C.S.F pressure during healing period.
When there is asmall leak which is not treated properly it may lead to a serious complication like (intra cranial hypotension,infection,meningitis,pseudomeningeocele, fistula, superficial sedrosis , chronic headache& adhesive arachidonitis if methyl prednisolone or local anesthetics injected directly on breached dura).
Other data
| Title | Management of Spinal Dural Tear | Other Titles | معالجة قطع طبقة الأم الجافية المحيطة بالحبل الشوكي | Authors | Mohamed Tawfik Mahdy Elgebely | Issue Date | 2014 |
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