• Ken Matsushima, Ryo Hashimoto, Masahide Gondo, Hirokazu Fukuhara, Michihiro Kohno, and Hiroyuki Jimbo.
• Department of Neurosurgery, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan; Department of Neurosurgery, Tokyo Medical University, Tokyo, Japan.
• World Neurosurg. 2016 Nov 1; 95: 619.e5-619.e10.

BackgroundIncidental durotomy is a relatively common complication in spinal surgeries, and treatment of persistent cerebrospinal fluid (CSF) leakage is still challenging, especially in cases for which "watertight" suturing is inapplicable. The usefulness of a nonvascularized perifascial areolar tissue (PAT) graft recently was emphasized for plastic and skull base surgeries. Its hypervascularity allows for early engraftment and long-term survival, and its flexibility is advantageous in fixing defects of complex shapes in limited surgical spaces.Case DescriptionThe authors report a case of persistent CSF leakage after cervical spine surgery in which a PAT graft was used successfully for direct closure of the dural defect. The noninvasive, spin-labeled magnetic resonance imaging technique was used for postoperative assessment of CSF dynamics, not for CSF accumulation but for CSF leakage itself. In addition, some potential causes for the rare development of communicating hydrocephalus after cervical laminoplasty, as seen in this case, are discussed.ConclusionsPAT was used successfully as an alternative free graft material for direct spinal dural closure, and its hypervascularity seemed to assist with rapid resolution of CSF leakage in our case. Spin-labeled magnetic resonance imaging may enable assessment of spinal CSF dynamics without invasion.Copyright © 2016 Elsevier Inc. All rights reserved.

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