Online ISSN: 2515-8260

Role of intraoperative abdominal fat augmented duroplasty in spinal intradural tumors for prevention of CSF related complications

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1Dr. Priya Ranjan Mandal, 2Dr. Gitanjali Datta

Abstract

Aim: 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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