Multiple-Layer Lumbosacral Pseudomeningocele Repair with Bilateral Paraspinous Muscle Flaps and Literature Review

Banerjee, Christopher; Cross, Brandy N.; Rumley, Jacob; DeVine, John G.; Ritter, Edmond F.; Vender, John R.

doi:10.1016/j.wneu.2020.09.038

Cited by 5 publications

(4 citation statements)

References 44 publications

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“…39 Of note, during the paraspinal muscle flap mobilization, the lateral lumbar perforators should be preserved and the flaps should be loosely sutured together to avoid muscle necrosis. 38,39 This increases the resistance against CSF drainage and decreases the rate of CSF tracking out through the incision and ultimately wound breakdown. Next, a subfascial drain is placed underneath the muscle repair layers.…”

Section: Discussionmentioning

confidence: 99%

“…Next, a subfascial drain is placed underneath the muscle repair layers. 38 The fascial layer is then closed tightly above the muscle flap. Another drain, such as a JP drain, may be placed superficially above the fascial layer to further decrease any fluid, seroma, or CSF, that could accumulate at this layer.…”

Section: Discussionmentioning

confidence: 99%

“…The muscles are then brought together in an overlapping manner and closed using 3-0 polydioxanone sutures medially through both flaps simultaneously. 38 This technique allows the bulk of the paraspinal musculature to layer within the surgical cavity, reducing the dead space that typically follows a lumbar spine surgery. 39 Of note, during the paraspinal muscle flap mobilization, the lateral lumbar perforators should be preserved and the flaps should be loosely sutured together to avoid muscle necrosis.…”

Section: Paraspinal Muscle Flapsmentioning

confidence: 99%

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Incidental Durotomy Repair in Lumbar Spine Surgery: Institutional Experience and Review of Literature

Albayar

Spadola

Blue

et al. 2022

Global Spine Journal

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Study Design : Retrospective Chart Review. Objectives Incidental durotomies (IDs) are common spine surgery complications. In this study, we present a review on the most commonly utilized management strategies, report our institutional experience with case examples, and describe a stepwise management algorithm. Methods A retrospective review was performed of the electronic medical records of all patients who underwent a thoracolumbar or lumbar spine surgery between March 2017 and September 2019. Additionally, a literature review of the current management approaches to treat IDs and persistent postoperative CSF leaks following lumbar spine surgeries was performed. Results We looked at 1133 patients that underwent posterior thoracolumbar spine surgery. There was intraoperative evidence of ID in 116 cases. Based on our cohort and the current literature, we developed a progressive treatment algorithm for IDs that begins with a primary repair, which can be bolstered by dural sealants or a muscle patch. If this fails, the primary repair can be followed by a paraspinal muscle flap, as well as a lumbar drain. If the patient cannot be weaned from temporary CSF diversion, the final step in controlling postoperative leak is longterm CSF diversion via a lumboperitoneal shunt. In our experience, these shunts can be weaned once the patient has no further clinical or radiographic signs of CSF leak. Conclusions There is no standardized management approach of IDs and CSF leaks in the literature. This article intends to provide a progressive treatment algorithm and contribute to the development process of a treatment consensus.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Paraspinal Muscle Flapsmentioning

confidence: 99%

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Incidental Durotomy Repair in Lumbar Spine Surgery: Institutional Experience and Review of Literature

Albayar

Spadola

Blue

et al. 2022

Global Spine Journal

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“…13 Banerjee at al described a technique of lumbosacral pseudomeningocele repair involving a two-layer pants-over-vest closure of the pseudomeningocele coupled with mobilization of bilateral paraspinal musculature to create a Z-plasty, or a Z-shaped flap. 14 And this report including 10 patients demonstrated a high success rate without recurrence. Previous retrospective study reported that 19 patients of SEAC underwent complete or partial excision of cyst with dural repair and none of them showed recurrence or clinical deterioration.…”

Section: Discussionmentioning

confidence: 53%

Gluteus Maximus Muscle Flap in Tongue in Groove and Wrap Around Pattern for Refractory CSF Leakage in Extradural Cyst Patient

et al. 2022

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Spinal extradural arachnoid cyst (SEAC) is a rare disease and has surgical challenges because of the critical surrounding anatomy. We describe the rare case of a 58-year-old woman who underwent extradural cyst total excision with dural repair and presented with refractory cerebrospinal fluid (CSF) leakage even though two consecutive surgeries including dural defect re-repair and lumbar-peritoneal shunt were performed. The authors covered the sacral defect using bilateral gluteus maximus muscle flap in tongue in groove and wrap around pattern for protection of visible sacral nerve roots and blockage of CSF leakage point. With the flap coverage, the disappearance of cyst and fluid collection was confirmed in the postoperative radiological finding, and the clinical symptoms were significantly improved. By protecting the sacral nerve roots and covering the base of sacral defect, we can minimize the risk of complication and resolve the refractory fluid collection. Our results suggest that the gluteus muscle flap can be a safe and effective option for sacral defect and CSF leakage in extradural cyst or other conditions.

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Spinal pseudomeningocele closure: capsulofascial interposition technique

Blum²,

Cho³

et al. 2023

Childs Nerv Syst

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Multiple-Layer Lumbosacral Pseudomeningocele Repair with Bilateral Paraspinous Muscle Flaps and Literature Review

Cited by 5 publications

References 44 publications

Incidental Durotomy Repair in Lumbar Spine Surgery: Institutional Experience and Review of Literature

Incidental Durotomy Repair in Lumbar Spine Surgery: Institutional Experience and Review of Literature

Gluteus Maximus Muscle Flap in Tongue in Groove and Wrap Around Pattern for Refractory CSF Leakage in Extradural Cyst Patient

Spinal pseudomeningocele closure: capsulofascial interposition technique

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