{"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":1793487628211,"version":"4.5.0"},"reference-count":23,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2024,12,3]],"date-time":"2024-12-03T00:00:00Z","timestamp":1733184000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Brain Sciences"],"abstract":"<jats:p>Background\/Objectives: Postoperative cerebrospinal fluid (CSF) fistulas remain a significant concern in spinal neurosurgery, particularly following dural closure. The incidence of dural tears during spinal surgery is estimated between 1.6% and 10%. While direct suturing remains the gold standard, it has a failure rate of 5\u201310%. Various materials and techniques have been used to enhance dural closure. This study aims to assess the effectiveness of non-penetrating titanium clips (AnastoClip\u00ae) for dural closure in intradural spinal lesion surgeries. Methods: A prospective analysis was conducted on 272 patients who were operated on for intradural spinal lesions from August 2017 to December 2023. Dural closure was performed using non-penetrating titanium clips with sealant, and, in select cases, autologous grafts. Postoperative care included early mobilization and routine MRI to assess outcomes. A comparative analysis was performed with a cohort of 81 patients treated with traditional sutures. Results: Among the 272 patients, postoperative CSF leaks occurred in 32 cases (11.76%), requiring various management approaches. Thirteen cases required surgical revision, while others resolved with external lumbar drainage or fluid aspiration. Compared to the suture group, which had a fistula rate of 23.46%, the titanium clip group had a significantly lower fistula rate. Logistic regression analysis did not find statistically significant associations between fistula risk and clinical factors. Conclusions: Non-penetrating titanium clips provide an effective alternative to sutures for dural closure, reducing CSF leak rates. They preserve dural integrity, reduce operative time, and avoid imaging artifacts, making them a viable advancement in spinal surgery with outcomes comparable to, or better than, traditional techniques.<\/jats:p>","DOI":"10.3390\/brainsci14121223","type":"journal-article","created":{"date-parts":[[2024,12,3]],"date-time":"2024-12-03T04:01:29Z","timestamp":1733198489000},"page":"1223","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Cerebrospinal Fluid Leak Prevention in Intradural Spine Surgery: A Long Series Analysis of Closure with Non-Penetrating Titanium Clips"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-5968-1986","authenticated-orcid":false,"given":"Leonardo","family":"Anselmi","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Italy"},{"name":"Department of Biomedical Sciences, Humanitas University, Via R.L Montalcini 2, 20072 Pieve Emanuele, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5893-2201","authenticated-orcid":false,"given":"Carla Daniela","family":"Anania","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Cleofe","family":"Ubezio","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences, Humanitas University, Via R.L Montalcini 2, 20072 Pieve Emanuele, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Generoso","family":"Farinaro","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Italy"},{"name":"Department of Biomedical Sciences, Humanitas University, Via R.L Montalcini 2, 20072 Pieve Emanuele, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donato","family":"Creatura","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Italy"},{"name":"Department of Biomedical Sciences, Humanitas University, Via R.L Montalcini 2, 20072 Pieve Emanuele, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"Ortolina","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7377-3683","authenticated-orcid":false,"given":"Massimo","family":"Tomei","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6081-5963","authenticated-orcid":false,"given":"Ali","family":"Baram","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maurizio","family":"Fornari","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,12,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e497","DOI":"10.1016\/j.wneu.2018.08.112","article-title":"Cerebrospinal Fluid Leak and Symptomatic Pseudomeningocele After Intradural Spine Surgery","volume":"120","author":"Sellin","year":"2018","journal-title":"World Neurosurg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1016\/j.wneu.2021.02.079","article-title":"Effectiveness of Repair Techniques for Spinal Dural Tears: A Systematic Review","volume":"149","author":"Choi","year":"2021","journal-title":"World Neurosurg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"59","DOI":"10.3340\/jkns.2013.53.1.59","article-title":"Burr Hole Drainage: Could Be Another Treatment Option for Cerebrospinal Fluid Leakage after Unidentified Dural Tear during Spinal Surgery?","volume":"53","author":"Huh","year":"2013","journal-title":"J. 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