Inlay-onlay dural repair technique [Neurosurgery Wiki]

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====== Inlay-onlay dural repair technique ======

Sitz et al. described the case of a recurrent [[cerebrospinal fluid fistula treatment]] successfully solved using an [[inlay-onlay]] dural repair technique
((Sitz M, Rot S, Gutowski P, Kreißl L, Lemcke J. Step Back in Order to Go Forward: Willful Enlargement and Sandwich Closure Technique for Spinal Dura Repair after Several Unsuccessful Closure Attempts. J Neurol Surg A Cent Eur Neurosurg. 2021 Feb 4. doi: 10.1055/s-0040-1721020. Epub ahead of print. PMID: 33540456.)).
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Richter et al. presented three lumbar-spine cases with dural opening, [[intended]] or [[unintended]], in the setting of thin native dura providing poor suture substrate. In each case, the inlay-onlay sandwich graft technique was used to achieve a successful lasting [[dural closure]]. Two of these cases initially involved the delayed failure of primary suture repair or standard basic [[dural graft]]. Re-exploration in these two cases revealed widened suture defects due to fragile native dura, resulting in delayed postoperative Cerebrospinal fluid fistula. They also reported a case of inlay-onlay sandwich [[patch]] [[graft]] for initial dural closure in adult tethered cord release in the setting of thin native dura, in which simple primary closure was not feasible. They illustrated this inlay-onlay graft operative technique, which can potentially be used for repairing dural openings involving thin native dura without intrinsic tissue strength to support primary suture repair. They envisioned that this technique can also be further extrapolated or adapted to other regions of dural repair as needed
((Richter B, Xu C, Jho DH (2016) Technical Note: Inlay-Onlay Sandwich Graft Technique for Repairing Durotomy in Spine Surgery for Fragile Dura. J Spine Neurosurg 5:3. doi: 10.4172/2325-9701.1000224)).