A synthetic dural sealant polymer named "DuraSeal" is used in our institution followingdural breach at spinal surgery.
It has a high water content,
therefore follows CSF signal on all sequences.
It can easily be mistaken for CSF pseudomeningocele on postoperative MRI.
The learning objectives are therefore:
To raise awareness of potential diagnostic confusion with this product;
To aid patient safety by sharing our experience in our institution with this product.
In our institution,
spinal surgery is performed by both neurosurgeons and orthopaedic surgeons. Spinal MRI is reported by MSK radiologists,
and the general radiology workforce.
many disparate groups contribute to the patient imaging pathway,
and they do not all come into contact with each other at learning events,
formalised discrepancy meetings or informally in conversation.
This means that information which is common to one group may not be easily disseminated to the other groups.
Imaging findings OR Procedure Details
The use of dural sealants to obtain watertight closure after intradural procedures has been standard practice for many years. In addition to primary closure (which is the gold standard,
although not 100% successful) the use of an adjunct to aid the seal and reduce the incidence of post operative CSF leak is increasingly seen as good practice (Haque,
With autografts (pericranium or small bowel submucosa) the increased morbidity of these superadded operative procedures makes the use of a synthetic substance attractive (Rosen,...
The potential for misinterpretation of this postoperative imaging phenomena is high. This may lead to unnecessary repeat surgery or at the very least,
misplaced concern regarding procedure success.
Particularly in institutions where MRI spines are reported by MSK and neuroradiologists,
and operations are performed by both orthopaedic and neurosurgeons,
the potential for miscommunication is clear.
All surgeons who use the product should be aware of the potential for postoperative imaging confusion.
They should clearly document when the product has been used both in the patient’s...
Primary dural repair in minimally invasive spine surgery.
Case reports in Medicine [Online] 2013:6.
Available at: http://www.hindawi.com/journals/crim/2013/876351/abs/ [Accessed: 21 April 2016].
Polyethylene glycol hydrogel spinal sealant (DuraSeal Spinal Sealant) as an adjunct to sutured dural repair in the spine: results of a prospective,
randomized controlled study.
Spine [Online] 36:1906–12.
Available at: http://www.ncbi.nlm.nih.gov/pubmed/22008746 [Accessed: 22 March 2016].