Die iatrogene Duraverletzung/Liquorfistel

Zusammenfassung

Die Duraverletzung mit daraus resultierendem Verlust von Liquor cerebrospinalis ist eine der häufigsten Komplikationen bei Operationen an der Wirbelsäule bzw. am Spinalkanal. Manche Autoren sehen die Verletzung der Dura sogar als die häufigste Komplikation in der Wirbelsäulenchirurgie an. Zur Versorgung von Verletzungen der Rückenmarkshaut stehen zahlreiche erfolgversprechende Strategien und Therapieansätze zur Verfügung, dennoch gibt es bisher keine einheitlichen Richtlinien. Gute klinische Ergebnisse können mit der primären „wasserdichten“ Duranaht erzielt werden, weshalb diese auch angestrebt werden sollte. Ein der Defektgröße angepasstes intraoperatives Management zum Duraverschluss kann helfen einen persistierenden Liquorverlust und Revisionsoperationen zu vermeiden. Dennoch lässt der aktuelle Konsens in der Literatur Spielraum für individuelle Therapiemöglichkeiten und Behandlungskonzepte.

Abstract

An incidental dural tear with resulting loss of cerebrospinal fluid is one of the commonest complications of spine surgery. Some authors even consider that dural injury is the commonest complication in spinal surgery. Numerous promising strategies and therapeutic approaches are available to treat dural injuries, but there are still no uniform guidelines. Good clinical results can be achieved with primary „watertight“ dural closure, which should therefore be sought. Intraoperative management of dural closure adapted to the defect size may help to prevent persistent CSF leakage and revision surgery. Nevertheless, the current consensus in the literature leaves scope for individual therapeutic options and concepts.

Schlüsselwörter

iatrogene Durotomie - Komplikationen - Duraverletzung - Liquorleckage - Duraverschluss

Keywords

iatrogenic durotomy - complications - dural tear - cerebrospinal fluid leak - dural closure

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