Postoperative Cervical Cord Compression Induced by Hydrogel Dural Sealant (DuraSeal®)
A 59-year-old man presented to the outpatient department with a 2-year history of progressive leg numbness. MRI (Magnetic resonance image) had shown intradural mass broad-based on the left side of the dura that compresses the cord severely, displacing it to the right posterior aspect at C7 level (). Opening the lamina and dura at C7 level, the mass removal was performed. The mass was totally removed and the histopathologic findings of frozen biopsy were consistent with those of a meningioma. When repairing dura, DuraSeal® was applied to dural surface that was incompletely approximated with sutures. Eight hours after surgery, the patient developed left-side weakness to motor grade I. A MRI scan was urgently performed, which demonstrated a large extradural mass which was causing severe cord compression at the level of tumor removal (). The patient underwent an emergency wound exploration. On reoperating wound, a thick layer of gelatinous material consistent with DuraSeal® was initially encountered. The layer of hydrogel compressed the dural sac severely. The hydrogel layer was excised. Also the minimal amount of surgicel was removed, which was separate and not interfering with the DuraSeal®. After surgery the patient is showing slightly improvement with his power increasing to motor grade II.