A Novel Dural Reconstruction Method Following Spinal Tumor Resection

Objective:This report describes a new method for reducing the risk of postoperative obliteration of the subdural space and spinal cord tethering that frequently occurs following resection of intradural spinal tumors. Methods:A 66-year-old patient underwent resection of a T1 to T2 intradural meningioma. A duraplasty procedure was performed to reconstruct the thecal sac and create a capacious cerebrospinal fluid (CSF)-filled space around the spinal cord. To prevent subsequent inward compression of the thecal sac from dorsally located soft tissue, a titanium strap was fashioned to span the laminectomy defect. Dural tack-up stitches were secured to the titanium strap and the laminoplasty construct was secured in place using standard bone screws. Results:The combined duraplasty-titanium laminoplasty procedure was technically straightforward and there were no complications following surgery. Postoperative MR imaging 6 weeks following surgery demonstrated that the goal of creating a capacious CSF-filled space around the spinal cord, without inward compression of the thecal sac by scar tissue, was achieved. MR images of the spinal cord and dura were not degraded by the presence of the overlying titanium strap. Conclusions:This simple method that combines a duraplasty and titanium laminoplasty procedure seems to be a safe and effective approach to achieving the objective of maintaining a capacious CSF-filled space surrounding the spinal cord following intradural surgery.