Sitz et al. described the case of a recurrent cerebrospinal fluid fistula treatment successfully solved using an inlay-onlay dural repair technique 1).
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 2).