Research status of dural injury types and repair / 中国修复重建外科杂志

OBJECTIVE@#To evaluate the current status of classification and repair methods for dural injury caused by spinal surgery or trauma, providing new strategies and ideas for the clinical repair of dural injury and the development of related materials.@*METHODS@#The literature related to dural injury both at home and abroad in recent years was thoroughly reviewed and analyzed in order to draw meaningful conclusions.@*RESULTS@#There have been numerous retrospective studies on dural injury, but there is a scarcity of prospective and multi-center studies, resulting in a low level of evidence-based research. The incidence and risk factors of dural injury have primarily been studied in relation to common degenerative spinal diseases of the cervical and lumbar spine, with insufficient research on thoracic spine-related diseases. Currently, a universally recognized method for grading and classifying dural injury has not been established, which hampers the development of clinical guidelines for their repair. Furthermore, although there are repair materials and surgical strategies available to address clinical issues such as suture leakage and surgical repair of dural injury in complex locations, there is a lack of comprehensive clinical research and evidence-based data to validate their scientificity and reliability.@*CONCLUSION@#Regardless of the classification of dural injury, suture remains the most important repair method. It is important to further develop new patches or sealants that can meet clinical needs and reduce the difficulty of repair.

A Rare Extradural Spinal Meningioma with Nocturnal Chest Pain: A Case Report

STUDY DESIGN: Case report. OBJECTIVES: To report a rare case of a spinal extradural meningioma in a patient with longstanding nonspecific thoracic nocturnal pain. SUMMARY OF LITERATURE REVIEW: Meningioma is a frequent intradural extramedullary tumor that is associated with pain, sensory/motor deficits, and sphincter weakness. Spinal meningiomas most commonly occur in the thoracic spine, although they can also be found at other locations. MATERIALS AND METHODS: A 65-year-old woman first visited the cardiac and gastrointestinal departments of our institution due to chest pain 2 years previously. No explanation for the complaint could be found in the heart or other organs. On a computed tomography scan of the thorax, a spinal mass was found a few months before the diagnosis. On magnetic resonance imaging, an extramedullary and extradural mass was observed at T7/8. RESULTS: We performed surgery and found an extradural spinal meningioma upon the histological diagnosis. Postoperatively, the patient could adequately move both legs and feet and the nocturnal chest pain disappeared after surgery without any complications. CONCLUSIONS: Awareness of the rarity and nonspecific symptoms of extradural spinal meningiomas will be beneficial for their accurate diagnosis and proper treatment.

Comparison of therapeutic effect of different treatments for cerebrospinal fluid leakage induced by surgical operation of spinal fracture combined with dural injury / 中华创伤杂志

Objective To compare the therapeutic effect of three treatments for cerebrospinal fluid leakage induced by surgical operation of spinal fracture combined with dural injury.Methods From June 2005 to June 2010,64 patients with cerebrospinal fluid leakage after surgery to spinal fracture combined with dural injury were analyzed.Patients were treated with positioning adjustment and incision pressure dressing (Group A,n =21),with cerebrospinal fluid leakage drainage via a lumbar percutaneous subarachnoid catheter (Group B,n =21),and with continuous wound drainage followed by catheter removing and wound closure when wound is completely healed (Group C,n =22).Time to stop cerebrospinal fluid leaking from a surgical incision,wound healing time,success rate in the primary intervention and postoperative complications were reviewed among these groups.Results In Group A,the incisional cerebrospinal fluid leakage disappeared at (19.0 ±3.9)days,with healing time of (25.0 ± 4.6)days.The primary wound healing was achieved in 13 patients but failure to the primary intervention occurred in 8 patients,of whom 6 patients presented complications which were then cured.In Group B,the incisional cerebrospinal fluid leakage disappeared at (3.0 ± 1.0) days,with healing time of (16.0 ± 2.6) days.There were 15 patients with primary wound healing but 6 patients got healing after further treatment,with no complications occurred.In Group C,there was no incisonal cerebrospinal fluid leakage or complications and all patients presented primary wound healing in a period of (13.0± 1.0)days.Healing time was shorter and success rate in the primary intervention in Group C was higher than those in Groups A and B (P ＜ 0.05).Conclusions Continuous wound drainage till catheter removal and wound closure on complete wound healing is a good choice for treating cerebrospinal fluid leakage induced by surgical operation of spinal fracture combined with dural injury,for it has advantages of good incisional healing,high success rate and few complications in the primary treatment.

The curative effect of medical clue jointed muscle flap for the treatment of spinal dural injury with cerebro-spinal fluid leakage during the spinal operation process / 中国基层医药

Objective To report a method of handling dural injury with cerebrospinal fluid leakage during the spinal operation process and analyze its effect,to comparatively analyze with the existing methods and to find a better way processing this problem.Methods A total of 36 patients with dural injury and cerebrospinal fluid leakage during the spinal operation process were collected.Among these clinical cases,there were 15 males,21 females,age ranged from 26 to 78 years old,average 58 years old.During the spinal operation process,the injured dura was sutured or repaired.After that,the dural wound was glued with a piece of muscle or fascia by a kind of medical glue named KangPaiTe.After the operation,broad -spectrum antibiotics and timely fresh dressing changing for the wound were applied.The nature and volume of the drainage fluid was documented and analyzed.When the volume of the drainage fluid was below 50mL per day,the drainage tube was pulled away,and the incision of the drainage tube was sutured again.Results The cerebrospinal fluid leakage lasted from 0 day to 4 days,average 1.5 days;the drainage tube was placed from 1 day to 5 days,average 2 days;no wound infection and other complications occurred among all the clini-cal cases included in this study.Conclusion After the injured dura was sutured or repaired,gluing the dural wound with a slice of muscle or fascia by a kind of medical glue named Kangpaite is a better method of handling dural injury with cerebrospinal fluid leakage.

Remote Cerebellar Hemorrhage after Intradural Disc Surgery

We report a rare case of remote cerebellar hemorrhage after intradural disc surgery at the L1-2 level. Two days after the spine surgery, patient complained unexpected headache, dizziness, nausea and vomiting. From the urgently conducted brain CT, it was reported that the patient had cerebellar hemorrhage. Occipital craniotomy and hematoma evacuation was performed, and hemorrhagic lesion on the right cerebellum was effectively removed. After occipital craniotomy, the patient showed signs of improvement on headache, dizziness, nausea and vomiting. He was able to leave the hospital after two weeks of initial operation without any neurological deficit. Remote cerebellar hemorrhage following spinal surgery is extremely rare, but may occur from dural damage of spinal surgery, accompanied with cerebrospinal fluid leakage. Early diagnosis is particularly important for the optimal treatment of remote cerebellar hemorrhage.