we included 58 patients, mean age 46 years , 65% female, with the diagnosis of SIH. We treated 38 ventral leaks, 17 dorsal/lateral leaks, 2 CSF-venous fistulas. In all but two patients (96.6%) the leak could be approached, identified and closed via the tubular retractor. Leaks were visualized via a transdural approach, after cutting the dentate ligament and lateralization of the ventral dura. Microspurs were removed and leaks were closed by sandwich patch using a fibrin sealant patch (ventral leaks) or clipping of the respective nerve root (lateral leaks, CSF-venous fistula). At a median follow up of 21.5 months (IQR 16-28), eight patients were lost to follow up and 45 reported a benefit from surgery with respect to orthostatic symptoms. Mild permanent neurologic deficits occurred in 1.7%, the revision rate due to persisting or recurring leak was 3.4% and the overall revisioin rate was 10.3%.CONCLUSIONS: Minimally invasive surgery using tubular retractors of 18-20mm diameter can be safely and effectively performed for closure of spinal dural CSF-leaks in specialized centers.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.