{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,31]],"date-time":"2026-10-31T23:00:28Z","timestamp":1793487628208,"version":"4.5.0"},"reference-count":68,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,4,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>CSF leaks are a significant source of patient morbidity following intradural spine surgeries. Watertight dural closure is crucial during these procedures to minimize the risk of a CSF leak. This study reports postoperative outcomes and changes in patient management after switching to penetrating titanium clips for dural closure in a large cohort of pediatric patients receiving a tethered cord release (TCR) or a selective dorsal rhizotomy (SDR).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>An IRB-approved retrospective review was conducted of the medical charts of all patients who underwent thoracolumbar dorsal midline dural closure with the AnastoClip GC Closure System during the 7 years between May 22, 2017, and May 21, 2024. Selected data such as evidence of a CSF leak and postoperative length of stay were collected.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>A total of 290 patients were treated with AnastoClips GC for dural closure. Of these patients, 232 (80.0%) underwent a TCR only, 52 (17.9%) received an SDR, and 6 (2.1%) underwent a complex TCR. The mean duration between surgery and last follow-up was 7.96 months (range 0.27\u201354.57 months). One patient, who received a simple TCR, experienced a transient pseudomeningocele without headache, emesis, or visible leak that resolved without surgical intervention within 8 weeks. Three (1%) patients had positional headaches without other evidence of a CSF leak, all limited to the initial 2 weeks of postoperative care. Six (2%) patients had delayed wound healing, 2 of whom underwent operative wound revisions. As of January 1, 2021, patients no longer had to lie flat postoperatively. While 60.6% of TCR patients were discharged from the hospital on POD 1 (none on POD 0) prior to this date, 87.5% of patients were discharged from the hospital on either POD 0 (3.1%) or POD 1 (84.4%) afterward. Similarly, 50% of SDR patients were discharged on POD 2 or 3 after the need for lying flat postoperatively was removed versus 21% before the protocol change.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>AnastoClip GC Closure System titanium clips are safe and effective for dural closure in both TCR and SDR, with rare complications. Their efficacy has prompted us to remove flat bed rest requirements for postoperative patients, significantly reducing the length of stay, and has opened the door to making simple TCRs a same-day surgery.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2024.10.peds24425","type":"journal-article","created":{"date-parts":[[2025,1,24]],"date-time":"2025-01-24T21:21:53Z","timestamp":1737753713000},"page":"391-399","source":"Crossref","is-referenced-by-count":6,"title":["Titanium clips and ligamentum flavum\u2013epidural fat patch graft for midline lumbar durotomy closure in pediatric neurosurgery"],"prefix":"10.3171","volume":"35","author":[{"given":"Lisa B. E.","family":"Shields","sequence":"first","affiliation":[{"name":"Norton Neuroscience Institute, Norton Healthcare, Louisville;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ian S.","family":"Mutchnick","sequence":"additional","affiliation":[{"name":"Norton Children\u2019s Hospital and Norton Children\u2019s Neuroscience Institute, Norton Healthcare, Louisville; and"},{"name":"Department of Neurological Surgery, University of Louisville, Kentucky"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1","series-title":"World Neurosurg","first-page":"e1049","article-title":"Tailored strategies to manage cerebrospinal fluid leaks or pseudomeningocele after surgery for tethered cord syndrome","volume":"114","author":"Udayakumaran S","year":"2018","unstructured":"Udayakumaran S, Rathod CT. Tailored strategies to manage cerebrospinal fluid leaks or pseudomeningocele after surgery for tethered cord syndrome. World Neurosurg. 2018;114:e1049\u2013e1056."},{"issue":"13","key":"b2","series-title":"World J Clin Cases","first-page":"2903","article-title":"Clinical management of dural defects: a review","volume":"11","author":"Dong RP","year":"2023","unstructured":"Dong RP, Zhang Q, Yang LL, Cheng XL, Zhao JW. Clinical management of dural defects: a review. World J Clin Cases. 2023;11(13):2903\u20132915."},{"issue":"2","key":"b3","series-title":"Chin J Traumatol","first-page":"81","article-title":"Treatment of cerebrospinal fluid leak after spine surgery","volume":"20","author":"Fang Z","year":"2017","unstructured":"Fang Z, Tian R, Jia YT, Xu TT, Liu Y. Treatment of cerebrospinal fluid leak after spine surgery. Chin J Traumatol. 2017;20(2):81\u201383."},{"key":"b4","series-title":"World Neurosurg X","first-page":"100348","article-title":"Application of nonpenetrating titanium clips for primary spinal dural closure following intradural tethered cord release in pediatric tethered cord syndrome: Profile of safety, efficacy, efficiency, and complications","volume":"22","author":"O\u2019Neill BE","year":"2024","unstructured":"O\u2019Neill BE, Godil JA, Brown NJ, Loya J, Silva A, Winer J. Application of nonpenetrating titanium clips for primary spinal dural closure following intradural tethered cord release in pediatric tethered cord syndrome: Profile of safety, efficacy, efficiency, and complications. World Neurosurg X. 2024;22:100348."},{"key":"b5","series-title":"Clin Neurol Neurosurg","first-page":"107422","article-title":"Novel use of nonpenetrating titanium clips for pediatric primary spinal dural closure: A technical note","volume":"222","author":"Shahrestani S","year":"2022","unstructured":"Shahrestani S, Brown NJ, Loya J,  Novel use of nonpenetrating titanium clips for pediatric primary spinal dural closure: A technical note. Clin Neurol Neurosurg. 2022;222: 107422."},{"issue":"1","key":"b6","series-title":"J Neurosurg Pediatr","first-page":"35","article-title":"Preventing cerebrospinal fluid leak following transection of a tight filum terminale","volume":"8","author":"Chern JJ","year":"2011","unstructured":"Chern JJ, Tubbs RS, Patel AJ,  Preventing cerebrospinal fluid leak following transection of a tight filum terminale. J Neurosurg Pediatr. 2011;8(1):35\u201338."},{"issue":"2","key":"b7","series-title":"Childs Nerv Syst","first-page":"299","article-title":"CSF complications following intradural spinal surgeries in children","volume":"30","author":"Liu V","year":"2014","unstructured":"Liu V, Gillis C, Cochrane D, Singhal A, Steinbok P. CSF complications following intradural spinal surgeries in children. Childs Nerv Syst. 2014;30(2):299\u2013305."},{"issue":"4","key":"b8","series-title":"Childs Nerv Syst","first-page":"1013","article-title":"Cerebrospinal fluid leakage after intradural spinal surgery in children","volume":"39","author":"Slot EMH","year":"2023","unstructured":"Slot EMH, van Doormaal TPC, van Baarsen KM,  Cerebrospinal fluid leakage after intradural spinal surgery in children. Childs Nerv Syst. 2023;39(4):1013\u20131019."},{"issue":"6","key":"b9","series-title":"J Neurosurg Spine","first-page":"812","article-title":"Utility of nonpenetrating titanium clips for dural closure during spinal surgery to prevent postoperative cerebrospinal fluid leakage","volume":"23","author":"Ito K","year":"2015","unstructured":"Ito K, Aoyama T, Horiuchi T, Hongo K. Utility of nonpenetrating titanium clips for dural closure during spinal surgery to prevent postoperative cerebrospinal fluid leakage. J Neurosurg Spine. 2015;23(6):812\u2013819."},{"key":"b10","series-title":"Spine Summit 2024","article-title":"AnastoClip dural closure in minimally invasive, intradural spine surgery","author":"Bandlamuri S","year":"2024","unstructured":"Bandlamuri S, Entezami P, German J, Paul A, Spurgas M. AnastoClip dural closure in minimally invasive, intradural spine surgery. Poster presented at: Spine Summit 2024; February 21, 2024; Las Vegas, NV. 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Tech Neurosurg Neurol. 2018:1(3):1-4."},{"key":"b13","series-title":"J Spine Res Surg","first-page":"67","article-title":"Study on the role of nonpenetrating titanium clips in dural repair","volume":"2","author":"Naveenkumar K","year":"2020","unstructured":"Naveenkumar K, Krishnakumer R. Study on the role of nonpenetrating titanium clips in dural repair. J Spine Res Surg. 2020;2:67\u201376."},{"issue":"10","key":"b14","series-title":"Neurol Med Chir (Tokyo)","first-page":"514","article-title":"Skull base dural closure using a modified nonpenetrating clip device via an endoscopic endonasal approach: technical note","volume":"60","author":"Teramoto S","year":"2020","unstructured":"Teramoto S, Tahara S, Hattori Y, Morita A. Skull base dural closure using a modified nonpenetrating clip device via an endoscopic endonasal approach: technical note. 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Clinical and radiological results of lumbar microdiskectomy technique with preserving of ligamentum flavum comparing to the standard microdiskectomy technique. Surg Neurol. 2002;57(1):5\u201314."},{"issue":"3","key":"b24","series-title":"J Spinal Disord","first-page":"240","article-title":"Compressive epidural autologous free fat graft in a patient with failed back syndrome: case report","volume":"8","author":"Israel Z","year":"1995","unstructured":"Israel Z, Constantini S. Compressive epidural autologous free fat graft in a patient with failed back syndrome: case report. J Spinal Disord. 1995;8(3):240\u2013242."},{"issue":"3","key":"b25","series-title":"Asian Spine J","first-page":"370","article-title":"Epidural fibrosis after lumbar disc surgery: prevention and outcome evaluation","volume":"9","author":"Mohi Eldin MM","year":"2015","unstructured":"Mohi Eldin MM, Abdel Razek NM. Epidural fibrosis after lumbar disc surgery: prevention and outcome evaluation. 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World Neurosurg X. 2024;22:100348."},{"key":"b5","series-title":"Clin Neurol Neurosurg","first-page":"107422","article-title":"Novel use of nonpenetrating titanium clips for pediatric primary spinal dural closure: A technical note","volume":"222","author":"Shahrestani S","year":"2022","unstructured":"Shahrestani S, Brown NJ, Loya J,  Novel use of nonpenetrating titanium clips for pediatric primary spinal dural closure: A technical note. Clin Neurol Neurosurg. 2022;222: 107422."},{"issue":"1","key":"b6","series-title":"J Neurosurg Pediatr","first-page":"35","article-title":"Preventing cerebrospinal fluid leak following transection of a tight filum terminale","volume":"8","author":"Chern JJ","year":"2011","unstructured":"Chern JJ, Tubbs RS, Patel AJ,  Preventing cerebrospinal fluid leak following transection of a tight filum terminale. 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Neurol Med Chir (Tokyo). 2020;60(10):514\u2013519."},{"key":"b15","series-title":"Surg Technol Int","first-page":"85","article-title":"Expanding use of nonpenetrating clips in various surgical specialities","volume":"14","author":"Zeebregts CJ","year":"2005","unstructured":"Zeebregts CJ, Kirsch WM, Reijnen MM, Zhu YH, van den Dungen JJ. Expanding use of nonpenetrating clips in various surgical specialities. Surg Technol Int. 2005;14:85\u201395."},{"issue":"6","key":"b16","series-title":"Technical note. J Neurosurg","first-page":"947","article-title":"Titanium dural clip testing","volume":"81","author":"Levy DI","year":"1994","unstructured":"Levy DI, Sonntag VK. Titanium dural clip testing. Technical note. J Neurosurg. 1994;81(6):947\u2013949."},{"key":"b17","article-title":"AnastoClip GC Closure System. LeMaitre","unstructured":"AnastoClip GC Closure System. LeMaitre. 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