Fibrin-coated collagen fleece "sandwich" closure technique for cranial and spinal dural reconstruction and closure.

Abstract

Objective: Persistent CSF leakage and symptomatic pseudomeningocele formation are a primary concern following intradural posterior fossa and spinal surgeries, with rates approaching 23.7% and 10%, respectively. These complications occur at a higher rate in cases in which a watertight primary closure cannot be attained. In such cases, various dural substitutes and sealants are at the surgeon's disposal and often require suturing a dural substitute to the existing dura. Herein, the authors describe a novel sutureless inlay-onlay fibrin-coated collagen fleece (TachoSil) "sandwich" closure technique for dural reconstruction and closure.

Methods: The authors retrospectively reviewed posterior fossa and intradural spinal cases performed by the senior author from January 1, 2021, to August 30, 2024, which used the described novel closure technique when primary closure without expansion could not be attained. Primary outcomes were rates of postoperative CSF leakage, symptomatic pseudomeningocele formation, CSF diversion, infection, and revision surgery.

Results: A total of 13 patients (8 craniotomies, 2 craniectomies, and 3 spinal cases) were identified with a mean age of 61.3 ± 14.0 years. Surgical indications included intra-axial and extra-axial tumors, acute cerebellar infarcts, an unruptured aneurysm, and a ruptured arteriovenous malformation. One patient (7.7%) who underwent emergency craniectomy for acute cerebellar infarct developed a postoperative CSF leak and symptomatic pseudomeningocele with suspicion of pseudotumor cerebri, ultimately requiring CSF diversion. There were no complications among patients receiving craniotomy or intradural spinal surgery. No postoperative infections or revision surgeries occurred.

Conclusions: The TachoSil sandwich technique represents an effective means of cranial and spinal dural reconstruction and closure in cases in which watertight primary dural closure cannot be achieved.