CSF-Related Complications After Intradural Spinal Tumor Surgery: Utility of an Autologous Fat Graft

Abstract

Object:The incidence of cerebrospinal fluid (CSF)-related complications after intradural spinal tumor (IST) surgery is high and reported in up to 18% of patients. However, no efficient way to prevent those complications has been reported so far. Treating these complications may require prolonged bed rest, re-exploration, external lumbar drain, use of antibiotics, and possible precipitation of other complications. To alleviate the risk of CSF-related complications, we prospectively adopted the intraoperative use of autologous fat grafting after IST surgery.Methods:This is a perspective analysis of 37 cases (out of 40 cases series) that a prospective use of abdominal fat autograft was applied during dural closure. After the tumor was resected and the dura closed, we used the Valsalva maneuver to ensure watertight closure. CSF leak was prevented with the enforcement of suture with a fat autograft as necessary. In addition a thin layer of fat tissue was then placed over the dura to obliterate any dead space. Fibrin glue was then applied over the graft. Filling the dead space with the fat graft prevented a low-pressure space in which CSF could pool and form a pseudomeningocele.Results:After adopting the fat autograft technique, we did not observe any post-surgery CSF-related complications in any of these patients.Conclusions:The prospective use of autologous fat grafting can ensure watertight dural closure and obliterate the dead space created during surgical exposure and bone removal. This technique significantly reduces, and may completely eliminate, postoperative CSF-related complications in patients with ISTs.

Spinal Dumbbell Epidural Hemangioma: Two Stage/Same Sitting/Same Position Posterior Microsurgical and Transthoracic Endoscopic Resection – Case Report and Review of the Literature

“…The intraspinal epidural portion of the tumor was completely resected. A fat pad, harvested at the beginning of surgery via a paraumbilical incision ( 5 ), was placed into the foramen as a marker for the extent of resection during the later thoracoscopic procedure. The second stage surgery included video-assisted left thoracoscopic resection of the extraforaminal intrathoracic part of the tumor.…”

Durotomy Surrogate and Seals for Intradural Spinal Cord Stimulators: Apparatus and Review of Clinical Methods and Materials

“…Early and contemporary reviews of the material properties and findings in clinical use are available elsewhere. Although this market is seemingly oversupplied with artificial sealants and substitutes that are purportedly superior to local, autologous tissue, the use of fat or other tissues harvested locally may still have a role .…”

Repair of Postoperative Cervical Pseudomeningocele with the Use of Bone Morphogenetic Protein

“…BMPs are signaling molecules that belong to a superfamily of proteins known as transforming growth factor-β (TGF-β) that are mostly involved in osteogenesis [7,8]. When used in high quantities BMPs were associated with complications such as ectopic bone growth, osteolysis, and systemic neoplasm [9]. We sought to demonstrate that BMPs could be used in the repair of recurrent CSF leak and pseudomeningocele without long-term complications.…”