Research status of dural injury types and repair_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

YANG Yipeng , ZHANG Yang ,  LEI Wei

Department of Orthopedics, the First Affiliated Hospital of Air Force Medical University, Xi’an Shaanxi, 710032, P. R. China;

Corresponding author：

LEI Wei, Email: leiwei@fmmu.edu.cn

Keywords：

Spinal surgery; dural injury; cerebrospinal fluid leakage; dura sealant; artificial patch

DOI：

10.7507/1002-1892.202306064

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To evaluate the current status of classification and repair methods for dural injury caused by spinal surgery or trauma, providing new strategies and ideas for the clinical repair of dural injury and the development of related materials. Methods The literature related to dural injury both at home and abroad in recent years was thoroughly reviewed and analyzed in order to draw meaningful conclusions. Results There have been numerous retrospective studies on dural injury, but there is a scarcity of prospective and multi-center studies, resulting in a low level of evidence-based research. The incidence and risk factors of dural injury have primarily been studied in relation to common degenerative spinal diseases of the cervical and lumbar spine, with insufficient research on thoracic spine-related diseases. Currently, a universally recognized method for grading and classifying dural injury has not been established, which hampers the development of clinical guidelines for their repair. Furthermore, although there are repair materials and surgical strategies available to address clinical issues such as suture leakage and surgical repair of dural injury in complex locations, there is a lack of comprehensive clinical research and evidence-based data to validate their scientificity and reliability. Conclusion Regardless of the classification of dural injury, suture remains the most important repair method. It is important to further develop new patches or sealants that can meet clinical needs and reduce the difficulty of repair.

Citation： YANG Yipeng, ZHANG Yang, LEI Wei. Research status of dural injury types and repair. Chinese Journal of Reparative and Reconstructive Surgery, 2023, 37(9): 1177-1182. doi: 10.7507/1002-1892.202306064 Copy

1.	Nakajima K, Nakamoto H, Kato S, et al. Influence of unintended dural tears on postoperative outcomes in lumbar surgery patients: a multicenter observational study with propensity scoring. Spine J, 2020, 20(12): 1968-1975.
2.	Kaliya-Perumal AK, Tan M, Nolan CP, et al. Post-surgical thoracic spinal cord herniation following an unrepaired dural defect: a rare complication. Br J Neurosurg, 2023, 37(4): 791-794.
3.	Nielsen TH, Rasmussen MM, Thygesen MM. Incidence and risk factors for incidental durotomy in spine surgery for lumbar stenosis and herniated disc. Acta Neurochir (Wien), 2022, 164(7): 1883-1888.
4.	Sakka L, Gabrillargues J, Coll G. Anatomy of the spinal meninges. Oper Neurosurg (Hagerstown), 2016, 12(2): 168-188.
5.	Ito K, Yamada M, Horiuchi T, et al. Microanatomy of the dura mater at the craniovertebral junction and spinal region for safe and effective surgical treatment. J Neurosurg Spine, 2020.
6.	Zhuang J, Gong J, Hack GD, et al. A new concept of the fiber composition of cervical spinal dura mater: an investigation utilizing the P45 sheet plastination technique. Surg Radiol Anat, 2022, 44(6): 877-882.
7.	Shi B, Zheng X, Min S, et al. The morphology and clinical significance of the dorsal meningovertebra ligaments in the cervical epidural space. Spine J, 2014, 14(11): 2733-2739.
8.	Chen R, Shi B, Zheng X, et al. Anatomic study and clinical significance of the dorsal meningovertebral ligaments of the thoracic dura mater. Spine (Phila Pa 1976), 2015, 40(10): 692-698.
9.	Shi B, Li X, Li H, et al. The morphology and clinical significance of the dorsal meningovertebra ligaments in the lumbosacral epidural space. Spine (Phila Pa 1976), 2012, 37(18): E1093-E1098.
10.	Nicholas DS, Weller RO. The fine anatomy of the human spinal meninges. A light and scanning electron microscopy study. J Neurosurg, 1988, 69(2): 276-282.
11.	Vandenabeele F, Creemers J, Lambrichts I. Ultrastructure of the human spinal arachnoid mater and dura mater. J Anat, 1996, 189 (Pt 2): 417-430.
12.	Runza M, Pietrabissa R, Mantero S, et al. Lumbar dura mater biomechanics: experimental characterization and scanning electron microscopy observations. Anesth Analg, 1999, 88(6): 1317-1321.
13.	Protasoni M, Sangiorgi S, Cividini A, et al. The collagenic architecture of human dura mater. J Neurosurg, 2011, 114(6): 1723-1730.
14.	Patin DJ, Eckstein EC, Harum K, et al. Anatomic and biomechanical properties of human lumbar dura mater. Anesth Analg, 1993, 76(3): 535-540.
15.	Nakagawa H, Mikawa Y, Watanabe R. Elastin in the human posterior longitudinal ligament and spinal dura. A histologic and biochemical study. Spine (Phila Pa 1976), 1994, 19(19): 2164-2169.
16.	Funao H, Nakamura S, Daimon K, et al. Idiopathic dorsal spinal cord herniation perforating the lamina: a case report and review of the literature. Acta Neurochir (Wien), 2021, 163(8): 2313-2318.
17.	Yoshihara H, Yoneoka D. Incidental dural tear in lumbar spinal decompression and discectomy: analysis of a nationwide database. Arch Orthop Trauma Surg, 2013, 133(11): 1501-1508.
18.	Yoshihara H, Yoneoka D. Incidental dural tear in spine surgery: analysis of a nationwide database. Eur Spine J, 2014, 23(2): 389-394.
19.	Yoshihara H, Yoneoka D. Incidental dural tear in cervical spine surgery: analysis of a nationwide database. J Spinal Disord Tech, 2015, 28(1): 19-24.
20.	Durand WM, DePasse JM, Kuris EO, et al. Late-presenting dural tear: incidence, risk factors, and associated complications. Spine J, 2018, 18(11): 2043-2050.
21.	Mazur M, Jost GF, Schmidt MH, et al. Management of cerebrospinal fluid leaks after anterior decompression for ossification of the posterior longitudinal ligament: a review of the literature. Neurosurg Focus, 2011, 30(3): E13.
22.	Ghobrial GM, Theofanis T, Darden BV, et al. Unintended durotomy in lumbar degenerative spinal surgery: a 10-year systematic review of the literature. Neurosurg Focus, 2015, 39(4): E8.
23.	O’Neill KR, Neuman BJ, Peters C, et al. Risk factors for dural tears in the cervical spine. Spine (Phila Pa 1976), 2014, 39(17): E1015-E1020.
24.	Ramos MRD, Liu G, Tan JH, et al. Risk factors for surgical complications in the management of ossification of the posterior longitudinal ligament. Spine J, 2021, 21(7): 1176-1184.
25.	Tang J, Lu Q, Li Y, et al. Risk factors and management strategies for cerebrospinal fluid leakage following lumbar posterior surgery. BMC Surg, 2022, 22(1): 30.
26.	Takahashi Y, Sato T, Hyodo H, et al. Incidental durotomy during lumbar spine surgery: risk factors and anatomic locations: clinical article. J Neurosurg Spine, 2013, 18(2): 165-169.
27.	Müller SJ, Burkhardt BW, Oertel JM. Management of dural tears in endoscopic lumbar spinal surgery: A review of the literature. World Neurosurg, 2018, 119: 494-499.
28.	Kim HS, Raorane HD, Wu PH, et al. Incidental durotomy during endoscopic stenosis lumbar decompression: Incidence, classification, and proposed management strategies. World Neurosurg, 2020, 139: e13-e22.
29.	Hu PP, Liu XG, Yu M. Cerebrospinal fluid leakage after thoracic decompression. Chin Med J (Engl), 2016, 129(16): 1994-2000.
30.	Matsumoto M, Chiba K, Toyama Y, et al. Surgical results and related factors for ossification of posterior longitudinal ligament of the thoracic spine: a multi-institutional retrospective study. Spine (Phila Pa 1976), 2008, 33(9): 1034-1041.
31.	Sun X, Sun C, Liu X, et al. The frequency and treatment of dural tears and cerebrospinal fluid leakage in 266 patients with thoracic myelopathy caused by ossification of the ligamentum flavum. Spine (Phila Pa 1976), 2012, 37(12): E702-E707.
32.	Hu P, Yu M, Liu X, et al. Cerebrospinal fluid leakage after surgeries on the thoracic spine: A review of 362 cases. Asian Spine J, 2016, 10(3): 472-479.
33.	Luszczyk MJ, Blaisdell GY, Wiater BP, et al. Traumatic dural tears: what do we know and are they a problem? Spine J, 2014, 14(1): 49-56.
34.	Vaccaro AR, Oner C, Kepler CK, et al. AOSpine thoracolumbar spine injury classification system: fracture description, neurological status, and key modifiers. Spine (Phila Pa 1976), 2013, 38(23): 2028-2037.
35.	Xu JX, Zhou CW, Tang Q, et al. The correlation between vertical laminar fractures and the severity of associated burst fractures. World Neurosurg, 2018, 109: e829-e834.
36.	Xu JX, Zhou CW, Wang CG, et al. Risk factors for dural tears in thoracic and lumbar burst fractures associated with vertical laminar fractures. Spine (Phila Pa 1976), 2018, 43(11): 774-779.
37.	Shi X, Xiang S, Dai B, et al. Association of the presence and its types of lamina fractures with posterior dural tear and neurological deficits in traumatic thoracic and lumbar burst fractures. BMC Musculoskelet Disord, 2021, 22(1): 300.
38.	张阳德, 向忠, 彭健. 硬脊膜损伤分度及预防脑脊液漏的临床研究. 中国现代医学杂志, 2007, 17(11): 1349-1351.
39.	Galarza M, Gazzeri R, Montoya CG, et al. A proposed intention-to-treat anatomical classification of spinal dural tears, Surg Technol Int, 2019, 35: 441-446.
40.	Beck J, Raabe A, Schievink WI, et al. Posterior approach and spinal cord release for 360° repair of dural defects in spontaneous intracranial hypotension. Neurosurgery, 2019, 84(6): E345-E351.
41.	Oitment C, Aref M, Almenawar S, et al. Spinal dural repair: A Canadian questionnaire. Global Spine J, 2018, 8(4): 359-364.
42.	Galarza M, Gazzeri R, Alfaro R, et al. Evaluation and management of small dural tears in primary lumbar spinal decompression and discectomy surgery. J Clin Neurosci, 2018, 50: 177-182.
43.	Faulkner ND, Finn MA, Anderson PA. Hydrostatic comparison of nonpenetrating titanium clips versus conventional suture for repair of spinal durotomies. Spine (Phila Pa 1976), 2012, 37(9): E535-E539.
44.	Ito K, Aoyama T, Horiuchi T, et al. Utility of nonpenetrating titanium clips for dural closure during spinal surgery to prevent postoperative cerebrospinal fluid leakage. J Neurosurg Spine, 2015, 23(6): 812-819.
45.	Bi X, Liu B, Mao Z, et al. Applications of materials for dural reconstruction in pre-clinical and clinical studies: Advantages and drawbacks, efficacy, and selections. Mater Sci Eng C Mater Biol Appl, 2020, 117: 111326.
46.	Narotam PK, José S, Nathoo N, et al. Collagen matrix (DuraGen) in dural repair: analysis of a new modified technique. Spine (Phila Pa 1976), 2004, 29(24): 2861-2867.
47.	Sade B, Oya S, Lee JH. Non-watertight dural reconstruction in meningioma surgery: results in 439 consecutive patients and a review of the literature. Clinical article. J Neurosurg, 2011, 114(3): 714-718.
48.	Van Doormaal T, Germans MR, Sie M, et al. Single-arm, open-label, multicentre first in human study to e valuate the safety and performa nc e of dur al sealant patch in reducing C S F leakag e following elective cranial surgery: the ENCASE trial. BMJ Open, 2021, 11(7): e049098.
49.	Montano N, Pignotti F, Auricchio AM, et al. Results of TachoSil® associated with fibrin glue as dural sealant in a series of patients with spinal intradural tumors surgery. Technical note with a review of the literature. J Clin Neurosci, 2019, 61: 88-92.
50.	Carretta A, Epskamp M, Ledermann L, et al. Collagen-bound fibrin sealant (TachoSil®) for dural closure in cranial surgery: single-centre comparative cohort study and systematic review of the literature. Neurosurg Rev, 2022, 45(6): 3779-3788.
51.	Kim KD, Ramanathan D, Highsmith J, et al. DuraSeal exact is a safe adjunctive treatment for durotomy in spine: Postapproval study. Global Spine J, 2019, 9(3): 272-278.
52.	Zoia C, Bongetta D, Lombardi F, et al. First impressions about Adherus, a new dural sealant. J Appl Biomater Funct Mater, 2015, 13(4): e372-e375.
53.	Kinaci A, van Thoor S, Redegeld S, et al. Ex vivo evaluation of a multilayered sealant patch for watertight dural closure: cranial and spinal models. J Mater Sci Mater Med, 2021, 32(8): 85.
54.	Dafford EE, Anderson PA. Comparison of dural repair techniques. Spine J, 2015, 15(5): 1099-1105.
55.	Finn MA, Faulkner ND, Hetzel SJ, et al. Spinal duraplasty materials and hydrostasis: a biomechanical study: laboratory investigation. J Neurosurg Spine, 2011, 15(4): 422-427.
56.	Wang HR, Cao SS, Jiang YQ, et al. A comparison between “sandwich” and conventional methods of repairing spinal dura rupture. Orthop Surg, 2012, 4(4): 233-240.
57.	Choi EH, Chan AY, Brown NJ, et al. Effectiveness of repair techniques for spinal dural tears: A systematic review. World Neurosurg, 2021, 149: 140-147.
58.	Gazzeri R, Galarza M, Callovini G. Use of tissue sealant patch (TachoSil) in the management of cerebrospinal fluid leaks after anterior cervical spine discectomy and fusion. Br J Neurosurg, 2021. doi: 10.1080/02688697.2021.1881444.
59.	Nakhla J, Nasser R, de la Garza Ramos R, et al. Anterior lumbar dural tear: A transthecal route for primary closure after iatrogenic durotomy. World Neurosurg, 2017, 107: 522-525.
60.	Zhang L, Wu H, Liu Z, et al. Dural repair with fat patch for idiopathic spinal cord herniation: operative technique and a review of seven cases. Ann Transl Med, 2022, 10(16): 865.
61.	Lofrese G, Visani J, Cultrera F, et al. Anterior dural tear in thoracic and lumbar spinal fractures: Single-center experience with coating technique and literature review of the available strategies. Life (Basel), 2021, 11(9): 875.

1. Nakajima K, Nakamoto H, Kato S, et al. Influence of unintended dural tears on postoperative outcomes in lumbar surgery patients: a multicenter observational study with propensity scoring. Spine J, 2020, 20(12): 1968-1975.
2. Kaliya-Perumal AK, Tan M, Nolan CP, et al. Post-surgical thoracic spinal cord herniation following an unrepaired dural defect: a rare complication. Br J Neurosurg, 2023, 37(4): 791-794.
3. Nielsen TH, Rasmussen MM, Thygesen MM. Incidence and risk factors for incidental durotomy in spine surgery for lumbar stenosis and herniated disc. Acta Neurochir (Wien), 2022, 164(7): 1883-1888.
4. Sakka L, Gabrillargues J, Coll G. Anatomy of the spinal meninges. Oper Neurosurg (Hagerstown), 2016, 12(2): 168-188.
5. Ito K, Yamada M, Horiuchi T, et al. Microanatomy of the dura mater at the craniovertebral junction and spinal region for safe and effective surgical treatment. J Neurosurg Spine, 2020.
6. Zhuang J, Gong J, Hack GD, et al. A new concept of the fiber composition of cervical spinal dura mater: an investigation utilizing the P45 sheet plastination technique. Surg Radiol Anat, 2022, 44(6): 877-882.
7. Shi B, Zheng X, Min S, et al. The morphology and clinical significance of the dorsal meningovertebra ligaments in the cervical epidural space. Spine J, 2014, 14(11): 2733-2739.
8. Chen R, Shi B, Zheng X, et al. Anatomic study and clinical significance of the dorsal meningovertebral ligaments of the thoracic dura mater. Spine (Phila Pa 1976), 2015, 40(10): 692-698.
9. Shi B, Li X, Li H, et al. The morphology and clinical significance of the dorsal meningovertebra ligaments in the lumbosacral epidural space. Spine (Phila Pa 1976), 2012, 37(18): E1093-E1098.
10. Nicholas DS, Weller RO. The fine anatomy of the human spinal meninges. A light and scanning electron microscopy study. J Neurosurg, 1988, 69(2): 276-282.
11. Vandenabeele F, Creemers J, Lambrichts I. Ultrastructure of the human spinal arachnoid mater and dura mater. J Anat, 1996, 189 (Pt 2): 417-430.
12. Runza M, Pietrabissa R, Mantero S, et al. Lumbar dura mater biomechanics: experimental characterization and scanning electron microscopy observations. Anesth Analg, 1999, 88(6): 1317-1321.
13. Protasoni M, Sangiorgi S, Cividini A, et al. The collagenic architecture of human dura mater. J Neurosurg, 2011, 114(6): 1723-1730.
14. Patin DJ, Eckstein EC, Harum K, et al. Anatomic and biomechanical properties of human lumbar dura mater. Anesth Analg, 1993, 76(3): 535-540.
15. Nakagawa H, Mikawa Y, Watanabe R. Elastin in the human posterior longitudinal ligament and spinal dura. A histologic and biochemical study. Spine (Phila Pa 1976), 1994, 19(19): 2164-2169.
16. Funao H, Nakamura S, Daimon K, et al. Idiopathic dorsal spinal cord herniation perforating the lamina: a case report and review of the literature. Acta Neurochir (Wien), 2021, 163(8): 2313-2318.
17. Yoshihara H, Yoneoka D. Incidental dural tear in lumbar spinal decompression and discectomy: analysis of a nationwide database. Arch Orthop Trauma Surg, 2013, 133(11): 1501-1508.
18. Yoshihara H, Yoneoka D. Incidental dural tear in spine surgery: analysis of a nationwide database. Eur Spine J, 2014, 23(2): 389-394.
19. Yoshihara H, Yoneoka D. Incidental dural tear in cervical spine surgery: analysis of a nationwide database. J Spinal Disord Tech, 2015, 28(1): 19-24.
20. Durand WM, DePasse JM, Kuris EO, et al. Late-presenting dural tear: incidence, risk factors, and associated complications. Spine J, 2018, 18(11): 2043-2050.
21. Mazur M, Jost GF, Schmidt MH, et al. Management of cerebrospinal fluid leaks after anterior decompression for ossification of the posterior longitudinal ligament: a review of the literature. Neurosurg Focus, 2011, 30(3): E13.
22. Ghobrial GM, Theofanis T, Darden BV, et al. Unintended durotomy in lumbar degenerative spinal surgery: a 10-year systematic review of the literature. Neurosurg Focus, 2015, 39(4): E8.
23. O’Neill KR, Neuman BJ, Peters C, et al. Risk factors for dural tears in the cervical spine. Spine (Phila Pa 1976), 2014, 39(17): E1015-E1020.
24. Ramos MRD, Liu G, Tan JH, et al. Risk factors for surgical complications in the management of ossification of the posterior longitudinal ligament. Spine J, 2021, 21(7): 1176-1184.
25. Tang J, Lu Q, Li Y, et al. Risk factors and management strategies for cerebrospinal fluid leakage following lumbar posterior surgery. BMC Surg, 2022, 22(1): 30.
26. Takahashi Y, Sato T, Hyodo H, et al. Incidental durotomy during lumbar spine surgery: risk factors and anatomic locations: clinical article. J Neurosurg Spine, 2013, 18(2): 165-169.
27. Müller SJ, Burkhardt BW, Oertel JM. Management of dural tears in endoscopic lumbar spinal surgery: A review of the literature. World Neurosurg, 2018, 119: 494-499.
28. Kim HS, Raorane HD, Wu PH, et al. Incidental durotomy during endoscopic stenosis lumbar decompression: Incidence, classification, and proposed management strategies. World Neurosurg, 2020, 139: e13-e22.
29. Hu PP, Liu XG, Yu M. Cerebrospinal fluid leakage after thoracic decompression. Chin Med J (Engl), 2016, 129(16): 1994-2000.
30. Matsumoto M, Chiba K, Toyama Y, et al. Surgical results and related factors for ossification of posterior longitudinal ligament of the thoracic spine: a multi-institutional retrospective study. Spine (Phila Pa 1976), 2008, 33(9): 1034-1041.
31. Sun X, Sun C, Liu X, et al. The frequency and treatment of dural tears and cerebrospinal fluid leakage in 266 patients with thoracic myelopathy caused by ossification of the ligamentum flavum. Spine (Phila Pa 1976), 2012, 37(12): E702-E707.
32. Hu P, Yu M, Liu X, et al. Cerebrospinal fluid leakage after surgeries on the thoracic spine: A review of 362 cases. Asian Spine J, 2016, 10(3): 472-479.
33. Luszczyk MJ, Blaisdell GY, Wiater BP, et al. Traumatic dural tears: what do we know and are they a problem? Spine J, 2014, 14(1): 49-56.
34. Vaccaro AR, Oner C, Kepler CK, et al. AOSpine thoracolumbar spine injury classification system: fracture description, neurological status, and key modifiers. Spine (Phila Pa 1976), 2013, 38(23): 2028-2037.
35. Xu JX, Zhou CW, Tang Q, et al. The correlation between vertical laminar fractures and the severity of associated burst fractures. World Neurosurg, 2018, 109: e829-e834.
36. Xu JX, Zhou CW, Wang CG, et al. Risk factors for dural tears in thoracic and lumbar burst fractures associated with vertical laminar fractures. Spine (Phila Pa 1976), 2018, 43(11): 774-779.
37. Shi X, Xiang S, Dai B, et al. Association of the presence and its types of lamina fractures with posterior dural tear and neurological deficits in traumatic thoracic and lumbar burst fractures. BMC Musculoskelet Disord, 2021, 22(1): 300.
38. 张阳德, 向忠, 彭健. 硬脊膜损伤分度及预防脑脊液漏的临床研究. 中国现代医学杂志, 2007, 17(11): 1349-1351.
39. Galarza M, Gazzeri R, Montoya CG, et al. A proposed intention-to-treat anatomical classification of spinal dural tears, Surg Technol Int, 2019, 35: 441-446.
40. Beck J, Raabe A, Schievink WI, et al. Posterior approach and spinal cord release for 360° repair of dural defects in spontaneous intracranial hypotension. Neurosurgery, 2019, 84(6): E345-E351.
41. Oitment C, Aref M, Almenawar S, et al. Spinal dural repair: A Canadian questionnaire. Global Spine J, 2018, 8(4): 359-364.
42. Galarza M, Gazzeri R, Alfaro R, et al. Evaluation and management of small dural tears in primary lumbar spinal decompression and discectomy surgery. J Clin Neurosci, 2018, 50: 177-182.
43. Faulkner ND, Finn MA, Anderson PA. Hydrostatic comparison of nonpenetrating titanium clips versus conventional suture for repair of spinal durotomies. Spine (Phila Pa 1976), 2012, 37(9): E535-E539.
44. Ito K, Aoyama T, Horiuchi T, et al. Utility of nonpenetrating titanium clips for dural closure during spinal surgery to prevent postoperative cerebrospinal fluid leakage. J Neurosurg Spine, 2015, 23(6): 812-819.
45. Bi X, Liu B, Mao Z, et al. Applications of materials for dural reconstruction in pre-clinical and clinical studies: Advantages and drawbacks, efficacy, and selections. Mater Sci Eng C Mater Biol Appl, 2020, 117: 111326.
46. Narotam PK, José S, Nathoo N, et al. Collagen matrix (DuraGen) in dural repair: analysis of a new modified technique. Spine (Phila Pa 1976), 2004, 29(24): 2861-2867.
47. Sade B, Oya S, Lee JH. Non-watertight dural reconstruction in meningioma surgery: results in 439 consecutive patients and a review of the literature. Clinical article. J Neurosurg, 2011, 114(3): 714-718.
48. Van Doormaal T, Germans MR, Sie M, et al. Single-arm, open-label, multicentre first in human study to e valuate the safety and performa nc e of dur al sealant patch in reducing C S F leakag e following elective cranial surgery: the ENCASE trial. BMJ Open, 2021, 11(7): e049098.
49. Montano N, Pignotti F, Auricchio AM, et al. Results of TachoSil® associated with fibrin glue as dural sealant in a series of patients with spinal intradural tumors surgery. Technical note with a review of the literature. J Clin Neurosci, 2019, 61: 88-92.
50. Carretta A, Epskamp M, Ledermann L, et al. Collagen-bound fibrin sealant (TachoSil®) for dural closure in cranial surgery: single-centre comparative cohort study and systematic review of the literature. Neurosurg Rev, 2022, 45(6): 3779-3788.
51. Kim KD, Ramanathan D, Highsmith J, et al. DuraSeal exact is a safe adjunctive treatment for durotomy in spine: Postapproval study. Global Spine J, 2019, 9(3): 272-278.
52. Zoia C, Bongetta D, Lombardi F, et al. First impressions about Adherus, a new dural sealant. J Appl Biomater Funct Mater, 2015, 13(4): e372-e375.
53. Kinaci A, van Thoor S, Redegeld S, et al. Ex vivo evaluation of a multilayered sealant patch for watertight dural closure: cranial and spinal models. J Mater Sci Mater Med, 2021, 32(8): 85.
54. Dafford EE, Anderson PA. Comparison of dural repair techniques. Spine J, 2015, 15(5): 1099-1105.
55. Finn MA, Faulkner ND, Hetzel SJ, et al. Spinal duraplasty materials and hydrostasis: a biomechanical study: laboratory investigation. J Neurosurg Spine, 2011, 15(4): 422-427.
56. Wang HR, Cao SS, Jiang YQ, et al. A comparison between “sandwich” and conventional methods of repairing spinal dura rupture. Orthop Surg, 2012, 4(4): 233-240.
57. Choi EH, Chan AY, Brown NJ, et al. Effectiveness of repair techniques for spinal dural tears: A systematic review. World Neurosurg, 2021, 149: 140-147.
58. Gazzeri R, Galarza M, Callovini G. Use of tissue sealant patch (TachoSil) in the management of cerebrospinal fluid leaks after anterior cervical spine discectomy and fusion. Br J Neurosurg, 2021. doi: 10.1080/02688697.2021.1881444.
59. Nakhla J, Nasser R, de la Garza Ramos R, et al. Anterior lumbar dural tear: A transthecal route for primary closure after iatrogenic durotomy. World Neurosurg, 2017, 107: 522-525.
60. Zhang L, Wu H, Liu Z, et al. Dural repair with fat patch for idiopathic spinal cord herniation: operative technique and a review of seven cases. Ann Transl Med, 2022, 10(16): 865.
61. Lofrese G, Visani J, Cultrera F, et al. Anterior dural tear in thoracic and lumbar spinal fractures: Single-center experience with coating technique and literature review of the available strategies. Life (Basel), 2021, 11(9): 875.

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