Novel use of nonpenetrating titanium clips for pediatric primary spinal dural closure: A technical note

Shane Shahrestani; Nolan J Brown; Joshua Loya; Neal A Patel; Julian L Gendreau; Alexander S Himstead; Noah Pierzchajlo; Rohin Singh; Ronald Sahyouni; Luis Daniel Diaz-Aguilar; Robert C Rennert; Michael L Levy

doi:10.1016/j.clineuro.2022.107422

Novel use of nonpenetrating titanium clips for pediatric primary spinal dural closure: A technical note

Clin Neurol Neurosurg. 2022 Nov:222:107422. doi: 10.1016/j.clineuro.2022.107422. Epub 2022 Sep 5.

Authors

Affiliations

¹ Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Department of Medical Engineering, California Institute of Technology, Pasadena, CA, USA.
² School of Medicine, University of California, Irvine, Orange, CA, USA. Electronic address: nolanb@uci.edu.
³ Department of Neurosurgery, University of California, La Jolla, San Diego, CA, USA.
⁴ School of Medicine, Mercer University, Columbus, GA, USA.
⁵ Department of Biomedical Engineering, Johns Hopkins Whiting School of Engineering, Baltimore, MD, USA.
⁶ School of Medicine, University of California, Irvine, Orange, CA, USA.
⁷ Department of Neurosciences and Pediatrics, University of California San Diego, San Diego, CA, USA.
⁸ Department of Neurosurgery, University of California, La Jolla, San Diego, CA, USA; Department of Neurosciences and Pediatrics, University of California San Diego, San Diego, CA, USA.

PMID: 36084429
DOI: 10.1016/j.clineuro.2022.107422

Abstract

Background: Dural closure is an important part of any pediatric spinal procedure with intradural pathology to prevent post-operative cerebrospinal fluid (CSF) egress and associated complications. Utilization of nonpenetrating titanium clips is one closure option that may have technical advantages such as ease of use and amenability to a narrow surgical corridor. No data exist on the efficacy of these clips for pediatric spinal dural closure.

Methods: A single surgeon case series of 152 pediatric patients underwent procedures involving lumbar durotomy with subsequent dural closure using the AnastoClip® nonpenetrating titanium clip closure system. Rates of infection and cerebrospinal fluid leak were measured during the follow-up period.

Results: A total of 152 pediatric patients (mean age: 6.25 ± 5.85 years, 50.7 % female) underwent intradural surgery with clip closure. The mean follow-up time was 57.0 ± 28.5 months. All patients were initially indicated for procedures involving spinal durotomy, with a majority being isolated tethered cord release (84.2 %). Others required tethered cord release and excision of a lipomyelomeningocele, spinal meningioma or arachnoid cyst (15.8 %). Post operative CSF leak occurred in two (1.32 %) patients at 11 and 18 days. Only one (0.66 %) patient was diagnosed with an infection, which was in a separate patient from those that had CSF leaks.

Conclusion: The remarkably low incidence of post-operative CSF leak and infection with nonpenetrating titanium clips suggests a strong safety and efficacy profile for this form of dural closure in a pediatric cohort. Further research evaluating this technique is required to fully demonstrate its acceptability as a cost-effective alternative to traditional suture-based closure.

Keywords: Anastoclip; Non-penetrating titanium clip; Pediatric; Primary spinal dural closure; Tethered cord release.

Publication types

Review

MeSH terms

Cerebrospinal Fluid Leak / complications
Child
Child, Preschool
Dura Mater / surgery
Female
Humans
Infant
Male
Meningeal Neoplasms* / surgery
Postoperative Complications / etiology
Surgical Instruments / adverse effects
Titanium*

Substances

Titanium