Lumbar surgery:

Dura repair in 10 steps

Meet-the-Expert01.12.2017

lpapavero@schoen-kliniken.delpapavero@schoen-kliniken.de

10 steps: Bird Dove, MD

1. B one removal until you see the whole dural tear

2. I ntradural look

3. R epone the fibers

4. D o an inside patch, if necessary

5. D ural closure

6. O utside patch

7. V alsalva maneuvre (PEEP 40)

8. E pidural pedicled muscle flap

9. M ultilayer closure

10. D rainage of lumbar CSF, if necessary

Dura repair: HOW… ?

• How large is it ? How shaped is it ?

hole

slit

defect

Tools 1 Micro

Tools 2 Instruments

Tools 3 Auxiliaries

62 cm

H2O

1. Bird Dove, MD

Remove the Bone

from the periphery towards the dural tear

until to see the whole border of ID

Check if the needleholder can work

Sandwich

TF1 : 1

1.9 : 1

Courtesy of Goretex, USA

OP1

Chauvet et al (2011) Study of dural watertightness: an in vitro

comparison of different sealants. Acta Neurochir 153(12) 2465-72

7.8. Bird Dove, MD

PEEP 40 cm H20 x 30 sec (Valsalva)

tension free Epidural pedicled muscle flap

Meet-the-Expert01.12.2017

Hands-on