Oper Neurosurg. 2026 Jun 3. doi: 10.1227/ons.0000000000002083. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVES: Circumferential defects of the dural sleeve of exiting lumbar nerve roots may occur after incidental durotomy, trauma, or deliberate opening of the root cuff during resection of nerve sheath tumors. Standard onlay duraplasty can control cerebrospinal fluid (CSF) leakage but does not restore the tubular dural-epineural conduit. We describe a collagen-matrix cuff technique for root sleeve reconstruction and report our initial institutional experience.

METHODS: This single-center, retrospective case series includes 9 consecutive reconstructions performed between January 2022 and October 2025 for intraoperatively recognized circumferential defects of exiting lumbar nerve root sleeves not amenable to safe primary suturing. The cohort comprised 6 iatrogenic root sleeve defects occurring during elective lumbar procedures (including instrumented and noninstrumented decompressive and/or stabilizing surgeries), 2 post-traumatic cases, and 1 elective tumor case presented as the illustrative case (L3 nerve root ganglioneuroma resection). Clinical records, intraoperative notes, and imaging were reviewed retrospectively. Minimum clinical and MRI follow-up was 6 months for all patients. Adjunctive lumbar drainage was used in one iatrogenic case.

RESULTS: In all cases, a bovine pericardium-derived collagen matrix was prehydrated, tailored, positioned under the root, sutured proximally to the dural margin at the root axilla, and wrapped to form a tubular cuff bridging the dural sac to the epineural segment, with distal reinforcement using fat and fibrin sealant. No patient required reoperation for CSF leak or pseudomeningocele. There were no cases of symptomatic nerve root herniation or new permanent neurological deficit. Radicular symptoms were stable or improved at the last follow-up.

CONCLUSION: Collagen-matrix cuff reconstruction is a simple, anatomically oriented option for circumferential lumbar root sleeve defects when primary closure is not feasible. In this initial single-center experience, the technique provided stable reconstruction without CSF-related complications and may represent a useful adjunct in selected complex root sleeve injuries.

PMID:42233683 | DOI:10.1227/ons.0000000000002083