Application of a polyethylene glycol hydrogel sealant system to prevent CSF leakage for lumbar intradural surgery: technical case report

Postoperative cerebrospinal fluid (CSF) leakage is one of the most important surgical complications in spinal surgery. Particularly in intradural spinal cord tumor surgery, it is very important to prevent CSF leakage postoperatively, as it can lead to postoperative complications such as infection and pseudomeningocele formation. Compared to the intracranial region, as the operative field is narrower and the structure of the dura mater is more fragile in the spinal region, meticulous dural suturing is sometimes impossible after intradural procedures. To prevent CSF leakage, some surgical procedures and materials have been developed in the neurosurgical field, including the recently introduced polyethylene glycol-based hydrogel sealant system. The hydrogel sealant system consists of synthetic absorbable material, which eliminates the risk of viral transmission and reduces the risk of allergic reaction. It proved to have potential for reducing postoperative CSF leakage. We used this material in intradural lumbar lesion surgery, and postoperative CSF leakage did not occur with this surgical procedure. We report our experience with dural plasty using the hydrogel sealant system in the intradural lumbar spinal lesion surgery and discuss the usefulness of this material.