伤口-腹膜分流术:后纵韧带骨化患者硬脑膜前裂伤复杂处理的一部分

Nancy E. Epstein MD
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引用次数: 15

摘要

背景:后纵韧带多节段骨化切除术后发生的硬膜撕裂伤的复杂处理需要进一步澄清。方法术前MR和CT研究均记录了82例在相同麻醉条件下需要多节段前椎体切除术/融合(ACF)(平均2.6个节段)然后进行后椎体融合(PF)(平均6.6个节段)的OPLL伴后凸的多节段腹侧脊髓压迫。术中出现硬膜撕裂/穿透的5例患者术前二维CT表现为单层征象(2例:中央大肿块)或双层征象(3例:高密度/低密度/高密度层)。所有5例患者均行复杂硬脑膜修复术(羊心包移植、纤维蛋白密封胶、微纤维胶原蛋白),并放置分流术(伤口-腹膜和腰腹膜)。结果5例术中硬脑膜撕裂(DLs)均经复杂的硬脑膜修复/分流后痊愈。低压伤口-腹膜分流的应用在本研究中是独一无二的(uni -分流,Codman, Johnson and Johnson, Dorchester, Mass)。近端放置在腓骨支架移植物/钢板复合物的外侧/平行位置,而远端导管则在右上象限隧道进入腹膜(总是在需要分流时准备和覆盖)。结论82例接受多节段前椎体切除术治疗后凸/后凸的患者中,5例发生术中损伤,并通过复杂的硬脑膜修复、伤口-腹膜和腰腹膜分流手术成功处理。
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Wound-peritoneal shunts: part of the complex management of anterior dural lacerations in patients with ossification of the posterior longitudinal ligament

Background

The complex management of dural lacerations occurring after the resection of multilevel ossification of the posterior longitudinal ligament (OPLL) requires further clarification.

Methods

Both preoperative MR and CT studies documented multilevel ventral cord compression attributed to OPLL with kyphosis in 82 patients requiring multilevel anterior corpectomy/fusion (ACF) (average, 2.6 levels) followed by posterior fusion (PF) (average, 6.6 levels) under the same anesthetic. The 5 patients who developed intraoperative dural lacerations/penetration demonstrated the single-layer sign (2 patients: large central mass) or the double-layer sign (3 patients: hyperdense/hypodense/hyperdense layers) on preoperative 2-dimensional CT studies. All 5 patients were managed with complex dural repair (sheep pericardial grafts, fibrin sealant, microfibrillar collagen) and had shunts placed (wound-peritoneal and lumboperitoneal).

Results

After complex dural repair/shunting, all 5 intraoperative dural lacerations (DLs) resolved. The application of low-pressure wound-peritoneal shunts was unique to this study (Uni-Shunts, Codman, Johnson and Johnson, Dorchester, Mass). The proximal end is placed lateral/parallel to the fibula strut graft/plate complex, whereas the distal catheter is tunneled into the peritoneum in the right upper quadrant (always prepared and draped in anticipation of the need for a shunt).

Conclusions

Of 82 patients undergoing multilevel anterior corpectomy for OPLL/kyphosis, 5 developed intraoperative DLs successfully managed with a complex dural repair, wound-peritoneal, and lumboperitoneal shunting procedures.

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Surgical Neurology
Surgical Neurology 医学-临床神经学
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