Repair of a spinal pseudomeningocele in a delayed postsurgical cerebrospinal fluid leak using titanium U-clips: Technical note

Introduction: Chronic cerebrospinal fluid leak (CCFL) represents a possible event following spine surgery, with an incidence rate ranging from 5 to 18%. In literature have been reported few modification techniques that involved the use of titanium U-clips with the aim to reduce dural traumatism during its closure but only after non-accidental durotomy. Case illustration: We report the case of a 47-year-old female with history of L5-S1 microsurgical discectomy. After one year the patient was admitted to our unit because she presented progressive skin swelling in the lumbar region, intermittent headache and recurrent episodes of lipothymia. One-year MRI showed a voluminous subcutaneous cerebrospinal fluid (CSF)-like intensity collection in the T2-weighted sequences and communicating with the right L5-S1 interlaminar space. A second surgery revealed pseudomeningocele and a 5 mm dural defect is identified. At first, a tobacco pouch was created, and a suture with Prolene 6–0, a non-absorbable, synthetic monofilament, is made on the previously dissected tissue. In a second step, 2 medium/short non-penetrating titanium U-clips are applied with a multi-clip applier. There was no sign of recurrent pseudomeningocele in the 2-year follow-up. Conclusion: The authors presented a novel use of titanium U-clips to manage an insidious and complex case of pseudomeningocele in a CCFL. U-clips represent a safe and effective tool in CCFL repair