Role of intraoperative abdominal fat augmented duroplasty in spinal intradural tumors for prevention of CSF related complications
European Journal of Molecular & Clinical Medicine,
2022, Volume 9, Issue 3, Pages 10184-10189
AbstractAim: To evaluate the role of intraoperative abdominal fat augmented duroplasty in
spinal intradural tumors for prevention of CSF related complications.
Material and methods: The present prospective interventional study was conducted
among 20 patients with an IST were operated, who attended Bangur Institute of
Neurosciences, IPGME & R and SSKM Hospital, Kolkata during February 2021 to
April 2022.After endotracheal intubation and line placement inthe supine patient, the
left paraumbilical area is prepared and draped. Fat was harvested though a 2
cmparaumbilical incision. The harvested fat isplaced in antibiotic saline in a sterile cup
until neededfor closure.All patients had neurophysiologic monitoring throughoutthe
operation. Once the tumor was resected, the durawas closed with 5-0 Prolen stitches in a
running fashion.Any evidence of a CSFleak or pseudomeningocele was evaluated
prospectively. The fat-tissue dynamics on postoperative MRIs were also assessed.
Results: The hospital stay lasted anywhere from 2 to 11 days (on average 5 days), with
follow-up lasting anywhere from 1 to 12 months. Despite postoperative irradiation and
treatment, one patient, a lady in her mid-40s with a grade III conus/cauda astrocytoma,
died 1 year later as a result of disease progression and CSF seeding throughout her
neuraxis. During follow-up, no evidence of tumour recurrence was seen in any other
patient.No sign of a CSF leak or a pseudomeningocele was seen on physical examination
or neuroradiologic follow-up.
Conclusion: The use of autologous fat grafting in the future enables a watertight dural
closure and eliminates the dead space generated by surgical exposure, muscle dissection,
and bone removal.
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