Management of CSF leak following spinal surgery

Balasubramaniam, Chidambaram; Rao, Santosh Mohan; Subramaniam, Kathirvel

doi:10.1007/s00381-014-2496-2

Cited by 8 publications

(10 citation statements)

References 12 publications

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“…The use of a PEG-hydrogel was evaluated in another study, which reported a 5.4% CSF leak risk in procedures in which this type of sealant was used [7]. Two studies investigating the association between the use of fibrin glue and CSF leakage did not find a statistically significant effect [5,9]. Currently, we believe that there is insufficient evidence to recommend the use of additional methods to augment dural closure.…”

Section: Discussionmentioning

confidence: 99%

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Cerebrospinal fluid leakage after intradural spinal surgery in children

et al. 2023

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Purpose This study aimed to establish the incidence of CSF leakage in children and associated complications after intradural spinal surgery in three tertiary neurosurgical referral centers and to describe the treatment strategies applied. Methods Patients of 18 years or younger who underwent intradural spinal surgery between 2015 and 2021 in three tertiary neurosurgical referral centers were included. Patients who died or were lost to follow-up within six weeks after surgery were excluded. The primary outcome measure was CSF leakage within six weeks after surgery, defined as leakage of CSF through the skin. Secondary outcome measures included the presence of pseudomeningocele (PMC), meningitis, and surgical site infection (SSI). Results We included a total of 75 procedures, representing 66 individual patients. The median age in this cohort was 5 (IQR = 0-13 years. CSF leakage occurred in 2.7% (2/75) of procedures. It occurred on days 3 and 21 after the index procedure, respectively. One patient was treated with a pressure bandage and an external lumbar drain on day 4 after diagnosis of the leak, and the other was treated with wound revision surgery on day 1 after the leak occurred. In total, 1 patient developed a PMC without a CSF leak which was treated with wound revision surgery. SSI occurred in 10.7%, which included both cases of CSF leak. Conclusions CSF leakage after intradural spinal surgery in the pediatric population is relatively rare (2.7%). Nevertheless, the clinical consequences with respect to secondary complications such as infection and the necessity for invasive treatment are serious.

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Section: Discussionmentioning

confidence: 99%

“…Therefore, in the current study, we will define CSF leakage as incisional CSF leakage and consider PMC separately. Furthermore, reports on CSF leakage after intradural spinal surgery based on recent data are limited and mostly include a specific indication only [5][6][7][8][9][10][11].…”

Section: Introductionmentioning

confidence: 99%

Cerebrospinal fluid leakage after intradural spinal surgery in children

et al. 2023

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“…The common postoperative complications of untethering include cerebrospinal fluid (CSF) leakage, wound infection, meningitis, bladder dysfunction, and neurological deterioration [314]. We encountered complications in seven patients, in which CSF leakage occurred in four patients, two patients had worsened urinary control, and postoperative infection.…”

Section: Discussionmentioning

confidence: 99%

Variation in Outcome in Tethered Cord Syndrome

2016

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Study DesignFifty patients surgically treated for tethered cord syndrome (TCS) were retrospectively studied at Liaquat National Hospital, Karachi from 2010 until 2014.PurposeTo assess the common presentations of TCS in our part of the world and the surgical outcome of the different presentations.Overview of LiteratureTCS is a stretch-induced functional disorder of the spinal cord with its caudal part anchored by an inelastic structure, which results in characteristic symptoms and signs. Due to the variety of lesions and clinical presentations and the absence of high-quality clinical outcome data, the decision regarding treatment is difficult.MethodsFifty consecutive patients with TCS were reviewed retrospectively with a follow-up period of 12–48 months. The majority of the patients were 0-15 years of age with the mean age of 4 years. The presenting complaints and the associated pathologies were documented, and the patients were assessed using the new Karachi TCS severity scale for clinical assessment.ResultsEighty five percent of the patients with thickened filum terminale improved. Sixty six percent of the patients with diastematomyelia, 60% with lipoma and only 46% with myelomeningocele showed clinical improvement postoperatively. Sixty two percent of the patients who presented with paraperesis improved following surgery while 37% remained stable and only one patient deteriorated. Back and leg pain improved in 93% of patients and 50% of patients with urinary impairment improved.ConclusionsOutcome of patients with TCS varies according to pathology and severity of symptoms. Diastematomyelia and thickened filum had the best outcome. The Karachi TCS severity scale is a valid tool for future studies.

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“…In this sense, postoperative CSF leakage is a known complication of spinal surgery. The ideal material to be used in the dural closure is still a matter of debate [43]. Prompt surgery is recommended to prevent the complications such as meningitis, CSF fistulas, and pseudocyst formation with potential nerve compression [44].…”

Section: Spinal Cordmentioning

confidence: 99%

“…Thus, in a retrospective analysis done by Balasubramaniam et al [43], evaluating children submitted to surgery for various spinal pathologies, FS had no effect, though the numbers were statistically too small. Jankowitz et al [55] reached a similar conclusion that the use of FS did not significantly decrease the incidence of subsequent CSF leakage while studying the potential efficacy of FS TISSEEL® (Baxter) for enhancing dural repair after lumbar spine surgery.…”

Section: Spinal Cordmentioning

confidence: 99%

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

Biscola

Cartarozzi

Ulian-Benitez

et al. 2017

J Venom Anim Toxins Incl Trop Dis

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Lesions to the nervous system often produce hemorrhage and tissue loss that are difficult, if not impossible, to repair. Therefore, scar formation, inflammation and cavitation take place, expanding the lesion epicenter. This significantly worsens the patient conditions and impairment, increasing neuronal loss and glial reaction, which in turn further decreases the chances of a positive outcome. The possibility of using hemostatic substances that also function as a scaffold, such as the fibrin sealant, reduces surgical time and improve postoperative recovery. To date, several studies have demonstrated that human blood derived fibrin sealant produces positive effects in different interventions, becoming an efficient alternative to suturing. To provide an alternative to homologous fibrin sealants, the Center for the Study of Venoms and Venomous Animals (CEVAP, Brazil) has proposed a new bioproduct composed of certified animal components, including a thrombin-like enzyme obtained from snake venom and bubaline fibrinogen. Thus, the present review brings up to date literature assessment on the use of fibrin sealant for nervous system repair and positions the new heterologous bioproduct from CEVAP as an alternative to the commercial counterparts. In this way, clinical and pre-clinical data are discussed in different topics, ranging from central nervous system to peripheral nervous system applications, specifying positive results as well as future enhancements that are necessary for improving the use of fibrin sealant therapy.Electronic supplementary materialThe online version of this article (doi:10.1186/s40409-017-0103-1) contains supplementary material, which is available to authorized users.

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Management of CSF leak following spinal surgery

Abstract: 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.

Cited by 8 publications

References 12 publications

Cerebrospinal fluid leakage after intradural spinal surgery in children

Cerebrospinal fluid leakage after intradural spinal surgery in children

Variation in Outcome in Tethered Cord Syndrome

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

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