Cerebrospinal fluid leaks following spinal or posterior fossa surgery: use of fat grafts for prevention and repair

Abstract

<jats:p>Cerebrospinal fluid (CSF) leaks are relatively common following spinal or posterior fossa surgery. A midline dural tear in the spine is readily repaired by direct application of a suture. However, far-lateral or ventral dural tears are problematic. Fat is an ideal sealant because it is impermeable to water. In this paper the author reports his experience with using fat grafts for the prevention or repair of CSF leaks and proposes a technique in which a large sheet of fat, harvested from the patient's subcutaneous layer, is used to cover not only the dural tear(s) but all of the exposed dura and is tucked into the lateral recess. This procedure prevents CSF from seeping around the fat, which may be tacked to the dura with a few sutures. Fibrin glue is spread on the surface of the fat and is further covered with Surgicel or Gelfoam. For ventral dural tears (associated with procedures in which disc material is excised), fat is packed into the disc space to seal off the ventra1 dural leak. Leaks in the posterior fossa are managed similarly to those in the spine. Dural suture lines, following suboccipital or spinal intradural exploration, are prophylatically protected from CSF leakage in the same manner. With one exception, 27 dural tears noted during 1650 spinal procedures were successfully repaired using this technique. There was one case of postoperative CSF leakage in 150 cases in which intradural exploration for tumor or other lesions was undertaken. Both postoperative CSF leaks were controlled by applying additional skin sutures. The use of a fat graft is recommended as a rapid, effective means of prevention and repair of CSF leaks following posterior fossa and spinal surgery.</jats:p>

Bilateral subfrontal approach for tuberculum sellae meningiomas in long-term postoperative visual outcome

“…Repair of the skull base using auto fat graft has been well known in transsphenoidal surgeries and sometimes has been used in spinal and posterior fossa surgeries. 5 In addition, the frontal sinus was classically obliterated with free fat tissues in the field of otolaryngology. 14, 16,26 The effect of sealing the dural defect and preventing CSF leakage was as good as that with vascularized flap.…”

A Multicenter, Single-Blind, Prospective Randomized Trial to Evaluate the Safety of a Polyethylene Glycol Hydrogel (Duraseal Dural Sealant System) as a Dural Sealant in Cranial Surgery

“…Watertight dural closure has been achieved by augmenting primary dural closure with various methods such as supplementary suturing or applying autologous tissue grafts, including pericranium (15,28), temporalis fascia, fascia lata, ligamentum nuchae (13), muscle (18), and fat grafts (2,3). In addition, off-label biological products have been used and include fibrin glues (11,14,19,25) such as Tisseel Fibrin Sealant (Baxter Biosurgery, Inc., Deerfield, Illinois, USA; $500 per 10 mL), gelatin or collagen sponges (16,17) such as Gelfoam Sponge (Pfizer, Inc., New York, New York, USA; $20 per sponge), and DuraGen Dural Graft Matrix (Integra Lifesciences Corp., Plainsboro, New Jersey, USA; $616 per 3 ϫ 3-cm matrix).…”

Fibrin sealant augmentation with autologous pericranium for duraplasty after suboccipital decompression in Chiari 1 patients: A case series

“…[1017344045] As true watertight dural closures are often impossible to achieve, dural sealants have been developed to be applied to the sutured dural perimeter to help prevent CSF-related complications. [14] Several dural sealants are currently available for use, including trisyline amine solution and polyethylene glycol hydrogels (Dura SealTM, Covidien LLC, Mansfield, MA, USA) and fibrin sealant (TISSEEL, Baxter, Deerfield, IL, USA).…”