Subarachnoid–Pleural Fistulae—Management With a Transdiaphragmatic Pedicled Greater Omental Flap: Report of Two Cases

Study Design. This report describes the treatment of chronic subarachnoid–pleural fistulae using a pedicled greater omentum transfer flap. Objective. To describe a new technique for the management of chronic subarachnoid–pleural fistulae resulting from thoracic dural tears. Summary of Background Data. Thoracic dural tears with leakage of cerebral spinal fluid into the pleural space can occur after thoracic spine surgery. The treatment of chronic subarachnoid–pleural fistulae using an omental flap, however, has not been reported. Methods. The clinical, radiographic, and surgical details of two cases are described. Results. Pedicled greater omentum transferred to the thoracic spine was an effective method in the treatment of intractable thoracic dural tears for two patients. Conclusion. These cases demonstrate that pedicled greater omentum transferred to the thoracic spine can be a safe and effective technique for the management of intractable thoracic dural tears and their complications.

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