Cerebrospinal Fluid Drainage in the Management of CSF Leak Following Acoustic Neuroma Surgery

Fishman, Andrew J.; Hoffman, Ronald A.; Roland, J. Thomas; Lebowitz, Richard A.; Cohen, Noel L.

doi:10.1097/00005537-199608000-00017

Cited by 79 publications

(51 citation statements)

References 9 publications

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“…Minovi et al [18] also reported on one case (1.1%) of lethal PE after DVT in a series of 89 AN patients operated on via MFA. There is a comparable rate of PE in further series with mixed approaches of 0.2%-1.1% [14,[19][20][21][25][26][27] .…”

Section: Deep Venous Thrombosismentioning

confidence: 73%

See 1 more Smart Citation

Complications of the Middle Cranial Fossa Approach for Acoustic Neuroma Removal

Scheich

Ginzkey²,

Müller³

et al. 2017

Int Adv Otol

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Section: Deep Venous Thrombosismentioning

confidence: 73%

“…We found three cases of DVT (1.5%) and one consecutive case of (lethal) PE (0.5%). Most AN surgery series via MFA have particular cases of DVT, leading to a DVT rate of 1%-2% [3,11,13,15,25] . Minovi et al [18] also reported on one case (1.1%) of lethal PE after DVT in a series of 89 AN patients operated on via MFA.…”

Section: Deep Venous Thrombosismentioning

confidence: 99%

Complications of the Middle Cranial Fossa Approach for Acoustic Neuroma Removal

Scheich

Ginzkey²,

Müller³

et al. 2017

Int Adv Otol

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“…For all patients combined, there was no association between presence of comorbidities and wound complications (p ¼ 0.43). There was no apparent association between the presence of comorbidities and wound complications when analyzed separately 9 as well as Ruiz-Fornells and colleagues, 10 reported 17% and 15% CSF leakage, respectively. At the opposite end of the spectrum, Falcioni and coworkers 11 reported a series of 200 translabyrinthine approaches and several CPA tumor removals with a zero incidence of CSF leaks.…”

Section: Datamentioning

confidence: 74%

Utilization of Preoperative Cerebrospinal Fluid Drain in Skull Base Surgery

Bien¹,

Bowdino²,

Moore

et al. 2007

Skull Base

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Objective: Retrospectively assess the efficacy of lumbar cerebrospinal fluid (CSF) drainage placed preoperatively in skull base operations in decreasing the incidence of postoperative CSF fistula. Methods: A retrospective review of 150 patients undergoing a posterior fossa craniotomy from 1989 to 2000 was conducted. Patients were divided into those receiving preoperative lumbar drains and those that did not. The rates of postoperative CSF leakage were compared between the two groups. Patient data were analyzed to determine if there were other comorbidities affecting the postoperative incidence of CSF leakage such as smoking, diabetes, or hypertension. Results: Between 1989 and 1994, 25/72 (35%) patients with no preoperative lumbar drain had a postoperative CSF leak. From 1995 to 2000, 9/78 (12%) patients with a preoperative lumbar drain had a CSF leak. This was a 23% decreased incidence of postoperative CSF leakage and a significant decrease in the probability (p < 0.001) of CSF leakage in patients treated with a preoperative lumbar drain. The comorbidities of diabetes, smoking, or hypertension did not increase the probability of a CSF leak (p ¼ 0.43). Conclusions: A preoperatively placed lumbar drain can significantly lower the rate of postoperative CSF leakage after skull base surgery. The drain is a welltolerated adjunct to dural closure and helps increase surgical exposure of the posterior fossa. The comorbidities of diabetes, smoking, or hypertension do not contribute to an increased rate of CSF leakage.

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“…These findings are consistent with a large body of experience describing CSF leak rates following infratentorial procedures of 8%-17%. 5,9,10,16 Infratentorial surgery predisposes a patient to CSF leak because the hydrostatic pressure of the fluid column places additional stress upon the suture line. The association between prolonged postoperative steroid duration and CSF leak likely comes from the immunosuppressive properties of corticosteroids that can interfere with normal wound healing.…”

Section: Discussionmentioning

confidence: 99%

The incidence of complications in elective cranial neurosurgery associated with dural closure material

Walcott

Neal

Sheth

et al. 2014

JNS

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Object. Dural closure with synthetic grafts has been suggested to contribute to the incidence of infection and CSF leak. The objective of this study was to assess the contribution of choice of dural closure material, as well as other factors, to the incidence of infection and CSF leak.Methods. A retrospective, consecutive cohort study of adult patients undergoing elective craniotomy was established between April 2010 and March 2011 at a single center. Exclusion criteria consisted of trauma, bur hole placement alone, and temporary CSF fluid diversion.Results. Three hundred ninety-nine patients were included (mean follow-up 396.6 days). Nonautologous (synthetic) dural substitute was more likely to be used (n = 106) in cases of reoperation (p = 0.001). Seventeen patients developed a surgical site infection and 12 patients developed a CSF leak. Multivariate logistic regression modeling identified estimated blood loss (OR 1.002, 95% CI 1.001-1.003; p < 0.001) and cigarette smoking (OR 2.198, 95% CI 1.109-4.238; p = 0.019) as significant predictors of infection. Synthetic dural graft was not a predictor of infection in multivariate analysis. Infratentorial surgery (OR 4.348, 95% CI 1.234-16.722; p = 0.024) and more than 8 days of postoperative corticosteroid treatment (OR 3.886, 95% CI 1.052-16.607; p = 0.048) were significant predictors for the development of CSF leak. Synthetic dural graft was associated with a lower likelihood of CSF leak (OR 0.072, 95% CI 0.003-0.552; p = 0.036).Conclusions. The use of synthetic dural closure material is not associated with surgical site infection and is associated with a reduced incidence of CSF leak. Modifiable risk factors exist for craniotomy complications that warrant vigilance and further study. (http://thejns.org/doi/abs/10.3171/2013.8.JNS13703) Key WorDS • dura • pericranium • infection • complication • cerebrospinal fluid • craniotomy • surgical techniqueAbbreviations used in this paper: ASA = American Society of Anesthesiologists; BMI = body mass index; EBL = estimated blood loss; ECoG = electrocorticography; ICU = intensive care unit.

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Cerebrospinal Fluid Drainage in the Management of CSF Leak Following Acoustic Neuroma Surgery

Cited by 79 publications

References 9 publications

Complications of the Middle Cranial Fossa Approach for Acoustic Neuroma Removal

Complications of the Middle Cranial Fossa Approach for Acoustic Neuroma Removal

Utilization of Preoperative Cerebrospinal Fluid Drain in Skull Base Surgery

The incidence of complications in elective cranial neurosurgery associated with dural closure material

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