Cauda equina syndrome caused by the application of DuraSeal™ in a microlaminectomy surgery: A case report

BACKGROUND The management of dural tears is important. While a massive dura can be repaired with absorbable suture lines, cerebrospinal fluid leakage can be attenuated by dural sealant when an unintended tiny durotomy occurs intraoperatively. DuraSeal is often used because it can expand to seal tears. This case emphasizes the need for caution when DuraSeal is used as high expansion can cause complications following microlaminectomy. CASE SUMMARY A 77-year-old woman presented with L2/3 and L3/4 lateral recess stenosis. She underwent microlaminectomy, foraminal decompression, and disk height restoration using an IntraSPlNE (R) device. A tiny incident durotomy occurred intraoperatively and was sealed using DuraSeallm. However, decreased muscle power, urinary incontinence, and absence of anal reflexes were observed postoperatively. Emergent magnetic resonance imaging revealed fluid collection causing thecal sac indentation and central canal compression. Surgical exploration revealed that the gel-like DuraSeal had entrapped the hema toma and, consequently, compressed the thecal sac and nerve roots. While we removed all DuraSeatim and exposed the nerve root, the patient's neurological function did not recover postoperatively. CONCLUSION DuraSeal expansion must not be underestimated. Changes in neurological status require investigation for cauda equine syndrome due to expansion.