Successful 10-year long-term follow-up after artificial dural patch suturing for iatrogenic dural defect created...

Spinal arachnoid cysts (SACs) are rare intraspinal lesions containing cerebrospinal fluid (CSF). Symptomatic SACs require surgical decompression, but excision can be complicated by iatrogenic dural tears (incidental durotomy), which occur in 1-17% of spinal surgeries. Effective, watertight closure is critical to prevent CSF leakage, infection, and recurrence. Long-term data exceeding 5 years on artificial dural patch repairs are scarce.

A 50-year-old female presented with severe low back pain and left-leg radiating pain. Magnetic resonance imaging (MRI) revealed a T2-hyperintense intradural cystic lesion at L2-3 compressing the cauda equina, consistent with an arachnoid cyst. She underwent L2-3 posterior decompression and posterolateral fusion with microscopic cyst excision. During adhesiolysis, a significant dural tear occurred. The defect was repaired using a suturable artificial dural patch to achieve watertight closure. Postoperative recovery was uneventful. At the 10-year follow-up, the patient remained asymptomatic, and MRI confirmed a stable repair without cyst recurrence or pseudomeningocele.

The imaging features supported a symptomatic intradural SAC. Literature mandates surgical intervention for symptomatic cases but emphasizes meticulous dural repair to minimize CSF leak risks. Our findings align with systematic reviews suggesting patch-reinforced closure yields lower leak rates (5.5%) compared to suture alone. The 10-year stability validates the biocompatibility and durability of the artificial patch.

Artificial dural patch suturing delivered excellent, durable outcomes over a decade after intradural cyst excision. This technique is recommended for managing complex dural defects to ensure long-term success.