A Caltech Library Service

Novel use of nonpenetrating titanium clips for pediatric primary spinal dural closure: A technical note

Shahrestani, Shane and Brown, Nolan J. and Loya, Joshua and Patel, Neal A. and Gendreau, Julian L. and Himstead, Alexander S. and Pierzchajlo, Noah and Singh, Rohin and Sahyouni, Ronald and Diaz-Aguilar, Luis Daniel and Rennert, Robert C. and Levy, Michael L. (2022) Novel use of nonpenetrating titanium clips for pediatric primary spinal dural closure: A technical note. Clinical Neurology and Neurosurgery, 222 . Art. No. 107422. ISSN 0303-8467. doi:10.1016/j.clineuro.2022.107422.

Full text is not posted in this repository. Consult Related URLs below.

Use this Persistent URL to link to this item:


Background: Dural closure is an important part of any pediatric spinal procedure with intradural pathology to prevent post-operative cerebrospinal fluid (CSF) egress and associated complications. Utilization of nonpenetrating titanium clips is one closure option that may have technical advantages such as ease of use and amenability to a narrow surgical corridor. No data exist on the efficacy of these clips for pediatric spinal dural closure. Methods: A single surgeon case series of 152 pediatric patients underwent procedures involving lumbar durotomy with subsequent dural closure using the AnastoClip® nonpenetrating titanium clip closure system. Rates of infection and cerebrospinal fluid leak were measured during the follow-up period. Results: A total of 152 pediatric patients (mean age: 6.25 ± 5.85 years, 50.7 % female) underwent intradural surgery with clip closure. The mean follow-up time was 57.0 ± 28.5 months. All patients were initially indicated for procedures involving spinal durotomy, with a majority being isolated tethered cord release (84.2 %). Others required tethered cord release and excision of a lipomyelomeningocele, spinal meningioma or arachnoid cyst (15.8 %). Post operative CSF leak occurred in two (1.32 %) patients at 11 and 18 days. Only one (0.66 %) patient was diagnosed with an infection, which was in a separate patient from those that had CSF leaks. Conclusion: The remarkably low incidence of post-operative CSF leak and infection with nonpenetrating titanium clips suggests a strong safety and efficacy profile for this form of dural closure in a pediatric cohort. Further research evaluating this technique is required to fully demonstrate its acceptability as a cost-effective alternative to traditional suture-based closure.

Item Type:Article
Related URLs:
URLURL TypeDescription
Shahrestani, Shane0000-0001-7561-4590
Brown, Nolan J.0000-0002-6025-346X
Loya, Joshua0000-0002-0852-0014
Patel, Neal A.0000-0003-4992-1356
Gendreau, Julian L.0000-0001-8412-0437
Himstead, Alexander S.0000-0001-9244-700X
Singh, Rohin0000-0001-5258-507X
Sahyouni, Ronald0000-0002-2124-0535
Rennert, Robert C.0000-0001-6779-3592
Levy, Michael L.0000-0001-7545-8620
Additional Information:There are no conflicts of interest in this study. There are also no disclosures of funding for this study. Institutional Review Board (IRB) approval was obtained prior to analysis.
Record Number:CaltechAUTHORS:20221107-999291600.36
Persistent URL:
Usage Policy:No commercial reproduction, distribution, display or performance rights in this work are provided.
ID Code:117760
Deposited By: Research Services Depository
Deposited On:18 Nov 2022 19:19
Last Modified:18 Nov 2022 23:26

Repository Staff Only: item control page