AnastoClip Dural Closure in Minimally Invasive, Intradural Spine Surgery

Introduction: AnastoClips are a nonpenetrating titanium clip originally designed for vascular anastomosis which can be applied for dural closure. Using AnastoClips to repair spinal dura is a viable option after minimally invasive, intradural spine surgery (MIISS). We aimed to assess the rate of postoperative cerebrospinal fluid (CSF) leak after AnastoClips repair of spinal dura following MIISS.

Methods: The Neurosurgery patient database at our hospital was reviewed for all patients who underwent MIISS from 1/1/2010 to 4/30/2023, using a tubular-based Mast Quadrant™ Retractor System (Medtronic Sofamor Danek USA, Inc., Memphis, TN, USA) and 26 patients were identified that underwent AnastoClip GC® Closure System (LeMaitre Vascular ULC, Vaughan, Ontario, Canada) dural closure after intentional intraoperative durotomy. Variables collected by retrospective case review include age, gender, surgery performed, spinal region (i.e. cervical, thoracic, or lumbar), dural graft usage, dural sealant usage, pathology, postoperative CSF leak, and other postoperative complications.

Results: 26 adult male (53.8%, n=14) and female (46.2%, n=12) patients ages 28-81 years underwent minimally invasive intradural laminotomies (19.2%, n=5), laminectomies (77%, n=20), and hemilaminectomies (3.8%, n=1), all with intentional dural opening. 53.8% received DuraGen onlay graft (Integra LifeSciences Corporation, Plainsboro, NJ, USA), while the rest received no dural graft. DuraSeal® Spine Sealant System (Integra Life Sciences, Plainsboro, NJ, USA) was used as a dural sealant in 30.8% (n=8), while Adherus® AutoSpray ET Dural Sealant (Stryker, Durham, NC, USA) was used in 7.7% (n=1). The most common pathology was tumor (61.5%, n=16) followed by syringomyelia (15.4%, n=4), cyst (11.5%, n=3), hematoma (7.7%, n=2), arachnoid web (3.8%, n=1), and tethered cord (3.8%, n=1). None of the 26 patients who underwent dural repair with AnastoClips suffered postoperative CSF leak. 11.5% (n=3) had urinary retention postoperatively while 3.8% (n=1) had a hematoma.

Conclusion : The AnastoClips system is able to be easily used though a minimally invasive tube system and was found to possess a 0% CSF leak postoperatively when combined with minimally invasive spine techniques. Preventing CSF leak enhances patient outcomes by reducing hospital length of stay, decreasing morbidity, and decreasing associated complications.