Traumatic dural tears

Abstract

Traumatic dural tears are not infrequent, especially with thoracolumbar burst fractures. When diagnosed intraoperatively, they need to be promptly addressed. Primary repair should always be attempted. The authors prefer 6-0 GORE-TEX simple running suture. Dural defects can be patched using autografts like fascia lata, or a collagen matrix graft. In complex tears, we can use an onlay graft. The repair can be secured using a thin layer of a hydrogel or a fibrin sealant. The fascia and skin should be tightly closed with nonabsorbable sutures. The use of a subfascial drain is controversial. A lumbar drain is a good option in complex tears or recurrence after surgery. Every precaution should be taken to avoid overdrainage, which can lead to serious complications including subdural hematomas, herniation, and death. Good surgical technique will prevent cerebrospinal fluid (CSF) leak, promote wound healing, and avoid postoperative infections including meningitis. © 2010 Springer-Verlag Berlin Heidelberg.