Spontaneous intracranial hypotension (SIH) is caused by CSF leakage through the skull base or, more commonly, the spine. In the spine, the CSF might leak into either the epidural space or a paraspinal vein in patients with a CSF-venous fistula. Nonoperative management, including caffeine, abdominal binders, oral fluids, and bed rest, is typically appropriate, although it yields unsatisfactory results for some patients.

The authors illustrate the surgical repair of a ventral, cervical CSF leak through a single-level anterior cervical discectomy and fusion (ACDF) without corpectomy in a 25-year-old patient with SIH. MRI and CT revealed a longitudinally extensive ventral epidural CSF collection and a calcified disc bulge at C5-6. Myelography showed no alternative source of leak. While a prior report describes repair via corpectomy, this article describes the technique for repair via ACDF only, with the use of a device designed for dural repair in minimally invasive spine surgery (DuraStat). This approach was particularly appealing in a young patient, and the dural defect was successfully repaired.

The ability to perform repair of a ventral cervical CSF leak through a single-level ACDF might allow for the resolution of this challenging-to-treat condition while minimizing surgical morbidity. https://thejns.org/doi/10.3171/CASE24770.

Training in delicate spinal dura mater suturing techniques poses significant challenges due to patient safety and medicolegal concerns, driving the need for alternative training methods beyond traditional mentorship models. This study aimed to introduce and validate a training model for orthopaedic residents using perfusion-based porcine spines to simulate intraoperative durotomy and subsequent repair.

Nine junior orthopaedic residents were invited to participate. Three attending orthopaedic spine surgeons were included in the control group. Fresh porcine spines were used for the simulation, and a perfusion-based system was implemented to replicate cerebrospinal fluid circulation and apply hydrostatic pressure to the dura. Durotomies were made and mended with 6-0 prolene sutures, and the participants' performance was assessed across six trials for repair speed and leakage pressure. Additionally, the self-confidence levels of the residents were analyzed before and after the training.

While attending surgeons showed consistent performance across trials, residents demonstrated a 70% reduction in mean total time and a 62% increase in mean leakage pressure after training. Residents showed significant improvements in repair speed from Trial 4 and in repair quality from Trial 3 compared with Trial 1 as the baseline. The difference compared with attending surgeons became insignificant in repair speed from Trial 4 and in repair quality from Trial 2, indicating that the residents' performance approached that of the attending surgeons. Residents' self-confidence increased significantly from a mean pre-training score of 1.1 to a mean post-training score of 4.3.

This simulation model, which utilizes fresh porcine spines and a perfusion-based system, is an accessible, cost-effective, and high-fidelity training method for dural repair during spinal surgery.

Historically, the use of subfascial drains for the management of durotomies was avoided due to concerns about the creation of cerebrospinal fluid (CSF) fistulas. Currently, there are limited series utilizing subfascial drainage for CSF leak management, many of which utilize suction drainage. We report our experience with the use of subfascial passive drainage in the management of such leaks.

To demonstrate the efficacy of a passive subfascial bile bag for diversion of CSF post-operatively in concert with a post-operative head of bed (HOB) protocol for the management of durotomies in spine surgery.

We performed a retrospective chart review of patients who underwent spinal surgery at a single institution performed by one surgeon. Cases utilizing a passive subfascial bile bag for durotomies were identified. A total of 1,882 consecutive surgeries were reviewed, and 108 met the inclusion criteria. The primary outcome was return to the operating room (OR) and/or the need for lumbar drain placement. Patient sociodemographic information and pre-, intra-, and post-operative clinical characteristics were reviewed.

A total of 108 patients underwent subfascial bile bag CSF diversion after intra-operative durotomy. Four patients (3.7%) experienced post-operative CSF leakage requiring lumbar drain placement, while only two (1.9%) patients required a return to the OR. One patient returned to the OR for symptomatic pseudomeningocele and the other for ongoing CSF drainage from their wound.

 Durotomies are known to increase complication rates, including reoperation. The use of subfascial passive bile bag drainage in concert with a post-operative HOB protocol is a safe and effective manner to manage durotomies while minimizing the need for reoperation.

Dural defects are common in spinal and cranial neurosurgery. A series of complications, such as cerebrospinal fluid leakage, occur after rupture of the dura. Therefore, treatment strategies are necessary to reduce or avoid complications. This review comprehensively summarizes the common causes, risk factors, clinical complications, and repair methods of dural defects. The latest research progress on dural repair methods and materials is summarized, including direct sutures, grafts, biomaterials, non-biomaterial materials, and composites formed by different materials. The characteristics and efficacy of these dural substitutes are reviewed, and these materials and methods are systematically evaluated. Finally, the best methods for dural repair and the challenges and future prospects of new dural repair materials are discussed.