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Vol. 30. Issue 4.
Pages 173-178 (July - August 2019)
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Vol. 30. Issue 4.
Pages 173-178 (July - August 2019)
Special article
DOI: 10.1016/j.neucie.2018.12.001
Spinal dural closure without suture: Minimizing the risk of CSF leakage with a flat non-penetrating titanium U-clip
Cierre dural espinal sin sutura: minimizando el riesgo de fístula de LCR con U-Clip® de titanio no penetrante plano
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Francisco M. Marin Laut
Corresponding author
miguel.laut@uca.es

Corresponding author.
, Efraim A. Gómez Cárdenas, Jesús Riqué Dormido, Nicolás Moliz Molina, Jose A. López López
Department of Neurosurgery, University Hospital of Puerta de Mar, Cádiz, Spain
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Table 1. Etiological distribution by regions with laminectomy rate.
Abstract
Background

The classic surgical spinal dural closure technique in surgery on intradural lesions is performed with continuous suture or loose stitches using 4-0 to 6-0 polypropylene monofilament or nylon suture. Dural closure with suture causes irritant damage to the dural/arachnoid interface. The penetrating suture causes new dural holes. Even the needle of the suture can cause harm to the patient and the surgeon. For these reasons, other non-penetrating techniques for dural closure have been sought.

Objective

The purpose of this review was to show the efficacy of using the titanium clip (U-clip) (Ligaclip-MCA of Ethicon Endo-Surgery, LLC, Medical GmbH, Norderstedt, Germany) with a flat internal surface in spinal neurosurgical procedures, and to evaluate the effects of its use on post-operative magnetic resonance imaging (MRI).

Methods

We performed a retrospective analysis of a cohort of 50 consecutive patients who underwent intradural spinal surgeries for intradural spinal lesions in the neurosurgery department of our institution between 2013 and 2018.

Results

The mean follow-up period was 27 months. No patient developed a post-operative cerebrospinal fluid (CSF) dural-cutaneous fistula. CSF leakage was not observed in the control MRIs at 6 weeks.

Conclusions

We describe, for the first time, the use of this type of U-clip with a flat inner side. The non-penetrating titanium U-clip facilitates effective and rapid dural closure at all spinal levels due to its flat internal face when closed. The U-clips did not cause significant artefacts or distortions on the magnetic resonance imaging.

Keywords:
Spinal dural closure
Non-penetrating titanium clips
Postoperative cerebrospinal leakage
Anastomotic clips
Resumen
Introducción

La técnica quirúrgica clásica de cierre de la duramadre espinal en cirugía en lesiones intradurales se realiza con sutura continua o puntos sueltos usando monofilamento de polipropileno 4-0 a 6-0 o sutura de nylon. El cierre dural con sutura causa daño irritante a la interfaz dural/aracnoidea. La sutura penetrante causa nuevos agujeros durales. Incluso la aguja de la sutura puede causar daño al paciente y al cirujano. Por estas razones, se han buscado otras técnicas no penetrantes para el cierre de la duramadre.

Objetivo

El propósito de esta revisión fue mostrar la eficacia del uso del clip de titanio (U-Clip®) (Ligaclip MCA de Ethicon Endo-Surgery, LLC, Medical GmbH, Norderstedt, Alemania) con una superficie interna plana en procedimientos neuroquirúrgicos espinales, y para evaluar los efectos de su uso en los controles de resonancia magnética (RM) postoperatoria.

Métodos

Se realizó un análisis retrospectivo de una cohorte de 50 pacientes consecutivos que se sometieron a cirugías intradurales espinales en el departamento de neurocirugía de nuestra institución entre 2013 y 2018.

Resultados

El período medio de seguimiento fue de 27 meses. Ningún paciente desarrolló fístula dural-cutánea del líquido cefalorraquídeo (LCR) postoperatoria. No se observó fuga del LCR en las RM de control a las 6 semanas.

Conclusiones

Describimos, por primera vez, el uso de este tipo U-Clip® con un lado interior plano. El U-Clip® de titanio no penetrante facilita el cierre dural efectivo y rápido en todos los niveles espinales debido a su cara interna plana cuando está cerrado. Los U-Clip® no causaron artefactos o distorsiones significativas en la RM.

Palabras clave:
Cierre dural espinal
Clips de titanio no penetrantes
Fístula postoperatoria del líquido cefalorraquídeo
Clip de anastomosis

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