Management of CSF Leak Following Spinal Surgery

Overview

Journal Childs Nerv Syst

Specialty Pediatrics

Date 2014 Jul 21

PMID 25038841

Citations 5

Authors

Chidambaram Balasubramaniam

Santosh Mohan Rao

K Subramaniam

Affiliations

Soon will be listed here.

Abstract

Purpose: Postoperative CSF leak is a known complication of spinal surgery especially after surgery for neural tube defects (NTD). The problem can metamorphose into a severe infection. This article hopes to shed some light on the management of these problems and suggests precautions so as to reduce their occurrence.

Materials And Methods: A retrospective analysis of 102 children, between the ages of 1 day and 12 years, operated for various spinal pathologies, over the past 2.5 years by the same surgeon (CB) was done. The various methods of dural closure were noted. The methods of management of postoperative CSF leaks were analysed, and the patients were followed till discharge.

Results: The incidence of CSF leak was found to be 12.7%. The methods of management included lumbar drain only (n = 7), lumbar drain with re-exploration (n = 3), lumbar drain followed by lumboperitoneal shunt (n = 2) and only lumboperitoneal shunt (n = 1). The use of fibrin glue did not seem to significantly prevent the incidence of CSF leak in cases.

Conclusions: Primary and meticulous dural closure is sine qua non in preventing postoperative CSF leak. A lumbar drain is a convenient and economical method of managing the problem initially failing which more invasive methods like re-exploration may be employed.

Citing Articles

Neural Tube Defect in a Resource Limited Setting: Clinical Profile and Short Term Outcome.

Mengiste F, Shibeshi M, Gechera D Pediatric Health Med Ther. 2023; 14:289-299.

PMID: 37746523 PMC: 10517686. DOI: 10.2147/PHMT.S421868.

Cerebrospinal fluid leakage after intradural spinal surgery in children.

Slot E, van Doormaal T, van Baarsen K, Krayenbuhl N, Regli L, Germans M Childs Nerv Syst. 2023; 39(4):1013-1019.

PMID: 36790491 PMC: 10160141. DOI: 10.1007/s00381-022-05797-w.

Multiple uses of fibrin sealant for nervous system treatment following injury and disease.

Biscola N, Cartarozzi L, Ulian-Benitez S, Barbizan R, Castro M, Barroso Spejo A J Venom Anim Toxins Incl Trop Dis. 2017; 23:13.

PMID: 28293254 PMC: 5348778. DOI: 10.1186/s40409-017-0103-1.

The current state of the evidence for the use of drains in spinal surgery: systematic review.

Patel S, Griffiths-Jones W, Jones C, Samartzis D, Clarke A, Khan S Eur Spine J. 2017; 26(11):2729-2738.

PMID: 28190206 DOI: 10.1007/s00586-017-4983-0.

Variation in Outcome in Tethered Cord Syndrome.

Iqbal N, Qadeer M, Sharif S Asian Spine J. 2016; 10(4):711-8.

PMID: 27559452 PMC: 4995255. DOI: 10.4184/asj.2016.10.4.711.

References

Della Puppa A, Rossetto M, Scienza R . Use of a new absorbable sealing film for preventing postoperative cerebrospinal fluid leaks: remarks on a new approach. Br J Neurosurg. 2010; 24(5):609-11. DOI: 10.3109/02688697.2010.500413. View

Goel A . A shunting procedure employing cannulation of the lumbar theca through the meningocele sac. Br J Neurosurg. 1998; 11(5):429-30. DOI: 10.1080/02688699745934. View

Chern J, Tubbs R, Patel A, Gordon A, Bandt S, Smyth M . Preventing cerebrospinal fluid leak following transection of a tight filum terminale. J Neurosurg Pediatr. 2011; 8(1):35-8. DOI: 10.3171/2011.4.PEDS10502. View

Vallfors B, Hansson H, Svensson J . Absorbable or nonabsorbable suture materials for closure of the dura mater?. Neurosurgery. 1981; 9(4):407-13. DOI: 10.1227/00006123-198110000-00011. View

Liu V, Gillis C, Cochrane D, Singhal A, Steinbok P . CSF complications following intradural spinal surgeries in children. Childs Nerv Syst. 2013; 30(2):299-305. DOI: 10.1007/s00381-013-2276-4. View

Kaufman B, Matthews A, Zwienenberg-Lee M, Lew S . Spinal dural closure with nonpenetrating titanium clips in pediatric neurosurgery. J Neurosurg Pediatr. 2010; 6(4):359-63. DOI: 10.3171/2010.7.PEDS09545. View

Ogiwara H, Morota N, Joko M . Duration of horizontal decubitus after section of a tight filum terminale as a means to prevent cerebrospinal fluid leakage. Surg Neurol Int. 2012; 3:113. PMC: 3475885. DOI: 10.4103/2152-7806.101802. View

Parizek J, Nemeckova J, Mericka P, Elias P, Sercl M, LICHY J . [External lumbar cerebrospinal fluid drainage with controlled flow-- its use in pediatric neurosurgery]. Cas Lek Cesk. 1990; 129(36):1138-40. View

Verheggen R, Hahm G, LANG J, Freudenthaler S, Schaake T, Markakis E . A new technique of dural closure--experience with a vicryl mesh. Acta Neurochir (Wien). 1997; 139(11):1074-9. DOI: 10.1007/BF01411563. View

10.

Beier A, Barrett R, Soo T . Aneurysm clips for durotomy repair: technical note. Oper Neurosurg (Hagerstown). 2010; 66(suppl_1):ons-E124-ons-E125. DOI: 10.1227/01.NEU.0000365423.19998.3D. View

11.

Boop F, CHADDUCK W . Silastic duraplasty in pediatric patients. Neurosurgery. 1991; 29(5):785-7; discussion 788. DOI: 10.1097/00006123-199111000-00026. View

12.

Nakamura H, Matsuyama Y, Yoshihara H, Sakai Y, Katayama Y, Nakashima S . The effect of autologous fibrin tissue adhesive on postoperative cerebrospinal fluid leak in spinal cord surgery: a randomized controlled trial. Spine (Phila Pa 1976). 2005; 30(13):E347-51. DOI: 10.1097/01.brs.0000167820.54413.8e. View

13.

Levi B, Sugg K, Lien S, Kasten S, Muraszko K, Maher C . Outcomes of tethered cord repair with a layered soft tissue closure. Ann Plast Surg. 2011; 70(1):74-8. DOI: 10.1097/SAP.0b013e31822f9ada. View

14.

Ostling L, Bierbrauer K, Kuntz 4th C . Outcome, reoperation, and complications in 99 consecutive children operated for tight or fatty filum. World Neurosurg. 2011; 77(1):187-91. DOI: 10.1016/j.wneu.2011.05.017. View

15.

Wang B, Hong Y, Yi B, Yu X, Wang C . [Operative complications in tethered cord syndrome and their management]. Zhonghua Wai Ke Za Zhi. 2002; 40(4):284-6. View

16.

Rotenberg B, Marchie A, Cusimano M . Skin sealants: an effective option for closing cerebrospinal fluid leakage. Can J Surg. 2005; 47(6):466-8. PMC: 3211598. View

17.

Ito K, Yanagawa T, Horiuchi T, Sakai K, Hongo K . [Application of a polyethylene glycol hydrogel sealant system to prevent CSF leakage for lumbar intradural surgery: technical case report]. No Shinkei Geka. 2010; 38(12):1127-31. View

18.

Osbun J, Ellenbogen R, Chesnut R, Chin L, Connolly P, Cosgrove G . A multicenter, single-blind, prospective randomized trial to evaluate the safety of a polyethylene glycol hydrogel (Duraseal Dural Sealant System) as a dural sealant in cranial surgery. World Neurosurg. 2012; 78(5):498-504. DOI: 10.1016/j.wneu.2011.12.011. View