Spinal dural closure without suture: Minimizing the risk of CSF leakage with a flat non-penetrating titanium U-clip / Cierre dural espinal sin sutura: minimizando el riesgo de fístula de LCR con U-Clip(R) de titanio no penetrante plano

Background: The classic surgical spinal dural closure technique in surgery on intradural lesions is performed with continuous suture or loose stitches using 4-0 to 6-0 polypropylene monofilament or nylon suture. Dural closure with suture causes irritant damage to the dural/arachnoid interface. The penetrating suture causes new dural holes. Even the needle of the suture can cause harm to the patient and the surgeon. For these reasons, other non-penetrating techniques for dural closure have been sought. Objective: The purpose of this review was to show the efficacy of using the titanium clip (U-clip) (Ligaclip-MCA of Ethicon Endo-Surgery, LLC, Medical GmbH, Norderstedt, Germany) with a flat internal surface in spinal neurosurgical procedures, and to evaluate the effects of its use on post-operative magnetic resonance imaging (MRI). Methods: We performed a retrospective analysis of a cohort of 50 consecutive patients who underwent intradural spinal surgeries for intradural spinal lesions in the neurosurgery department of our institution between 2013 and 2018. Results: The mean follow-up period was 27 months. No patient developed a post-operative cerebrospinal fluid (CSF) dural-cutaneous fistula. CSF leakage was not observed in the control MRIs at 6 weeks. Conclusions: We describe, for the first time, the use of this type of U-clip with a flat inner side. The non-penetrating titanium U-clip facilitates effective and rapid dural closure at all spinal levels due to its flat internal face when closed. The U-clips did not cause significant artefacts or distortions on the magnetic resonance imaging

Introducción: La técnica quirúrgica clásica de cierre de la duramadre espinal en cirugía en lesiones intradurales se realiza con sutura continua o puntos sueltos usando monofilamento de polipropileno 4-0 a 6-0 o sutura de nylon. El cierre dural con sutura causa daño irritante a la interfaz dural/aracnoidea. La sutura penetrante causa nuevos agujeros durales. Incluso la aguja de la sutura puede causar daño al paciente y al cirujano. Por estas razones, se han buscado otras técnicas no penetrantes para el cierre de la duramadre. Objetivo: El propósito de esta revisión fue mostrar la eficacia del uso del clip de titanio (U-Clip(R)) (Ligaclip MCA de Ethicon Endo-Surgery, LLC, Medical GmbH, Norderstedt, Alemania) con una superficie interna plana en procedimientos neuroquirúrgicos espinales, y para evaluar los efectos de su uso en los controles de resonancia magnética (RM) postoperatoria. Métodos: Se realizó un análisis retrospectivo de una cohorte de 50 pacientes consecutivos que se sometieron a cirugías intradurales espinales en el departamento de neurocirugía de nuestra institución entre 2013 y 2018. Resultados: El período medio de seguimiento fue de 27 meses. Ningún paciente desarrolló fístula dural-cutánea del líquido cefalorraquídeo (LCR) postoperatoria. No se observó fuga del LCR en las RM de control a las 6 semanas. Conclusiones: Describimos, por primera vez, el uso de este tipo U-Clip(R) con un lado interior plano. El U-Clip(R) de titanio no penetrante facilita el cierre dural efectivo y rápido en todos los niveles espinales debido a su cara interna plana cuando está cerrado. Los U-Clip(R) no causaron artefactos o distorsiones significativas en la RM

Spinal dural closure without suture: Minimizing the risk of CSF leakage with a flat non-penetrating titanium U-clip.

BACKGROUND: The classic surgical spinal dural closure technique in surgery on intradural lesions is performed with continuous suture or loose stitches using 4-0 to 6-0 polypropylene monofilament or nylon suture. Dural closure with suture causes irritant damage to the dural/arachnoid interface. The penetrating suture causes new dural holes. Even the needle of the suture can cause harm to the patient and the surgeon. For these reasons, other non-penetrating techniques for dural closure have been sought. OBJECTIVE: The purpose of this review was to show the efficacy of using the titanium clip (U-clip) (Ligaclip-MCA of Ethicon Endo-Surgery, LLC, Medical GmbH, Norderstedt, Germany) with a flat internal surface in spinal neurosurgical procedures, and to evaluate the effects of its use on post-operative magnetic resonance imaging (MRI). METHODS: We performed a retrospective analysis of a cohort of 50 consecutive patients who underwent intradural spinal surgeries for intradural spinal lesions in the neurosurgery department of our institution between 2013 and 2018. RESULTS: The mean follow-up period was 27 months. No patient developed a post-operative cerebrospinal fluid (CSF) dural-cutaneous fistula. CSF leakage was not observed in the control MRIs at 6 weeks. CONCLUSIONS: We describe, for the first time, the use of this type of U-clip with a flat inner side. The non-penetrating titanium U-clip facilitates effective and rapid dural closure at all spinal levels due to its flat internal face when closed. The U-clips did not cause significant artefacts or distortions on the magnetic resonance imaging.