Anterior cervical micro-dural repair of cerebrospinal fluid fistula after surgery for ossification of the posterior longitudinal ligament

Epstein, Nancy E.; Hollingsworth, Renee

doi:10.1016/s0090-3019(99)00135-4

Cited by 40 publications

(30 citation statements)

References 8 publications

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“…Moreover, the standard practice of keeping patients with lumbar drains on bed rest to prevent rapid CSF drainage due to positional change may increase the risk of postoperative morbidity due to the development of deep venous thrombosis and pulmonary embolism after prolonged immobilization. 59 The use of flow-regulated CSF draining systems using a volumetric pump set to withdraw CSF at a controlled rate, 22,30 a low-pressure control valve, 20 or a combined volume-and pressure-controlled system (LiquoGuard; Möller Medical) may overcome most of these potential problems associated with lumbar drains.…”

Section: Intraoperative Strategiesmentioning

confidence: 99%

“…More complex intraoperative CSF leaks may require the addition of closed-system WP or LP shunts. 20 Such complex dural tears include those that are not accessible without performing additional bone resection to gain access for a direct repair. Epstein 19 described performing a complex primary dural repair combined with placement of both WP and LP shunts in patients undergoing multilevel anterior cervical corpectomies and fusion to resect OPLL.…”

Section: Intraoperative Strategiesmentioning

confidence: 99%

“…Additionally, when choosing an anterior approach, the surgeon must be aware of intra-and postoperative management strategies to treat a CSF leak and minimize manipulation of the thecal sac to avoid any spinal cord damage. 20,36,52 In this article, we review the literature on intra-and postoperative management of cervical dural tears during surgery for OPLL and suggest a treatment algorithm. …”

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confidence: 99%

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Management of cerebrospinal fluid leaks after anterior decompression for ossification of the posterior longitudinal ligament: a review of the literature

Mazur¹,

Jost²,

Schmidt³

et al. 2011

FOC

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Object Anterior decompression is an effective way to treat cervical myelopathy associated with ossification of the posterior longitudinal ligament (OPLL); however, this approach is associated with an increased risk of a dural tear and resultant CSF leak because fusion of the dura with the ossified PLL is common in these cases. The authors review the literature and present an algorithm for treatment of CSF leaks in these patients. Methods A MEDLINE review was performed to identify papers related to CSF leak after anterior decompression for OPLL, and data were summarized to identify treatment options for various situations. A treatment algorithm was identified based on these findings and the experience of the authors. Results Eleven studies were identified that presented data on intra- and postoperative management of a CSF leak during ventral surgery for OPLL. The incidence of cervical dural tears and CSF leaks after anterior decompression procedures for OPLL ranged from 4.3% to 32%. Techniques including preventative measures, intraoperative dural repair with various materials, and postoperative drainage or shunt placement have all been used. Conclusions Although direct dural repair is the preferred treatment for CSF leak, this technique is not always technically possible. In these cases, intraoperative adjuncts in combination with postoperative measures can be used to decrease the pressure gradient across the dural tear.

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Section: Intraoperative Strategiesmentioning

confidence: 99%

Section: Intraoperative Strategiesmentioning

confidence: 99%

mentioning

confidence: 99%

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Management of cerebrospinal fluid leaks after anterior decompression for ossification of the posterior longitudinal ligament: a review of the literature

Mazur¹,

Jost²,

Schmidt³

et al. 2011

FOC

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“…However, if arachnoid membrane damage occurred, it was difficult to patch or sew up due to the narrow surgical field and the limited area of membrane defect. Furthermore, although a cerebrospinal fluid pseudocyst was possible, in our experience the dural tear healed, and the pseudocyst gradually disappeared after 2 months of repeated aspiration, and CSF leakage can be cured using just conservative treatment [20][21][22].…”

Section: Csfmentioning

confidence: 59%

Choice of surgical approach for ossification of the posterior longitudinal ligament in combination with cervical disc hernia

et al. 2009

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Ossification of the posterior longitudinal ligament (OPLL) is a common spinal disorder that presents with or without cervical myelopathy. Furthermore, there is evidence suggesting that OPLL often coexists with cervical disc hernia (CDH), and that the latter is the more important compression factor. To raise the awareness of CDH in OPLL for spinal surgeons, we performed a retrospective study on 142 patients with radiologically proven OPLL who had received surgery between January 2004 and January 2008 in our hospital. Plain radiograph, three-dimensional computed tomography construction (3D CT), and magnetic resonance imaging (MRI) of the cervical spine were all performed. Twenty-six patients with obvious CDH (15 of segmental-type, nine of mixed-type, two of continuoustype) were selected via clinical and radiographic features, and intraoperative findings. By MRI, the most commonly involved level was C5/6, followed by C3/4, C4/5, and C6/7. The areas of greatest spinal cord compression were at the disc levels because of herniated cervical discs. Eight patients were decompressed via anterior cervical discectomy and fusion (ACDF), 13 patients via anterior cervical corpectomy and fusion (ACCF), and five patients via ACDF combined with posterior laminectomy and fusion. The outcomes were all favorable. In conclusion, surgeons should consider the potential for CDH when performing spinal cord decompression and deciding the surgical approach in patients presenting with OPLL.

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“…21 Incidence of cerebrospinal leak following anterior cervical spine surgeries in a series of 1994 patients reported by Hannallah et al, was 0.1% and it was shown that leak is more common in primary corpectomy, revision corpectomy and in OPLL rather than anterior cervical discectomy and fusion. 22 Dural defects, irrespective of the means by which they occur after anterior discectomy or corpectomy which are not properly repaired, permit CSF egress to the surrounding tissues through a fistula 23 When the CSF pulse pressure exceeds the interstitial pressure of the surrounding tissue, a pseudomeningocele can develop in anterior compartment of the neck. Therefore, cervical pseudomeningocele can be classified into 2 types: acute and chronic ones with consideration of the time of clinical presentation.…”

Section: Discussionmentioning

confidence: 99%

Remote Cervical Pseudomeningocele Following Anterior Cervical Corpectomy and Fusion: Report of a Case and Review of the Literature

Rahimizadeh¹,

Soufiani²,

Rahimizadeh

2016

Int J Spine Surg

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Iatrogenic cervical pseudomeningocele is a rare event and majority are located posteriorly as a delayed complication of inadvertent dural tear after decompressive laminectomy. However, iatrogenic anterior cervical pseudomeningocele subsequent to discectomy or corpectomy is a rare pathology. The time necessary for formation of pseudomeningocele varies and depend on the width of the dural tear and the flow of cerebrospinal fluid leakage. Large tears with high CSF flow usually result in early collection of the cerebrospinal fluid in anterior compartment of the neck designated acute pseudomeningoceles. Micro-tears of dura mater, with low flow of cerebrospinal fluid may lead to late formation of a pseudomeningocele known as chronic ones.Herein a 49-year-old woman in whom cervical pseudomeningocele appeared clinically as a mass on the anterior aspect of the neck, six months after anterior cervical corpectomy for cervical spondylotic myelopathy is presented. Otherwise, she was neurologically stable. Cystoperitoneal shunt was proposed which she refused. Surprisingly, at 2-year follow-up, the cyst had remained of the same size. To the best of our knowledge, this is the first example of post-operative chronic cervical pseudomeningocele in the literature, the event that might propose the self-limited natural course of this rare pathology in chronic cases.keywords: anterior cervical discectomy fusion (acdf), anterior cervical corpectomy fusion (accf), cervical pseudomeningocele, complication, cystoperitoneal shunt volume 10 article 36

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Anterior cervical micro-dural repair of cerebrospinal fluid fistula after surgery for ossification of the posterior longitudinal ligament

Cited by 40 publications

References 8 publications

Management of cerebrospinal fluid leaks after anterior decompression for ossification of the posterior longitudinal ligament: a review of the literature

Management of cerebrospinal fluid leaks after anterior decompression for ossification of the posterior longitudinal ligament: a review of the literature

Choice of surgical approach for ossification of the posterior longitudinal ligament in combination with cervical disc hernia

Remote Cervical Pseudomeningocele Following Anterior Cervical Corpectomy and Fusion: Report of a Case and Review of the Literature

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