Cerebrospinal Fluid Leak after Repair of Congenital Spinal Pathologies, Incidence and Management

Khan, Bilal; Haqqani, Usman; Khattak, Rizwan Ullah; Hussain, Shafaat

doi:10.36552/pjns.v24i3.469

Cited by 4 publications

(3 citation statements)

References 6 publications

(6 reference statements)

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“…They employed VP shunts and simple suturing to control CSF leaks similar to ours but they also employed a tincture of benzoyl which was not used in our study. 17 Another study by Baldia et al, in which he noted CSF leaks in 16/305 patients operated for the tethered cord (4.5%). In our study, the incidence of CSF leak in tethered cord patients was 2/9 (2.5%).…”

Section: Discussionmentioning

confidence: 95%

Incidence of Post-Operative Cerebrospinal Fluid Leak in Patients Operated for Spinal Dysraphism

Raheel Gohar,

Lal Rehman,

Iram Bokhari

et al. 2023

Pak J Neurol Surg

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for spinal dysraphism. Materials and Methods: 80 patients who underwent surgery for spinal dysraphism were enrolled in this study. This study was conducted at Neurosurgery Unit, JPMC, Karachi. Patients from 1 month to 3 years of age were included in the study. Patients were followed for 2 months post-surgery. The incidence of cerebrospinal fluid leak among patients operated for spina bifida was determined. Results: Mean age was 1.5 years ± 5 months. There were 68.7% males and 31.3% females. 47.5% of patients had myelomeningocele, 41.3% of patients had meningocele, and 11.25% of patients had Tethered cords. Among 80 patients, 16.3% developed CSF leaks. 6.3% of patients were those who developed postoperative hydrocephalus and their CSF leak resolved after the VP shunt. In 8.8% of patients, CSF leaks resolved after suturing the leak area. 1.3% of patients with CSF leak developed meningitis; he was kept on antibiotics and was discharged on the 10th day of readmission. 5% of patients developed wound infections, they were kept on antibiotics, and daily dressings and were discharged within a week. Conclusion: Most common location for myelomeningocele and meningocele is the lumbosacral area followed by the thoracic and cervical regions. Overall, 28.6% developed complications. 16.3% of patients developed CSF leaks.CSF leak was seen more in myelomeningocele repair patients as compared to meningocele and tethered cord. Most of the leaks can be managed with simple suturing and VP shunts in patients complicated by postoperative hydrocephalus. Keywords: Myelomeningocele (MMC), Meningocele, Cerebrospinal fluid leak (CSF), VP Shunt.

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Section: Discussionmentioning

confidence: 95%

Incidence of Post-Operative Cerebrospinal Fluid Leak in Patients Operated for Spinal Dysraphism

Raheel Gohar,

Lal Rehman,

Iram Bokhari

et al. 2023

Pak J Neurol Surg

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“…These findings were comparable to the studies conducted in past. [18,19] CSF leaks are common after spinal dysraphy surgery, with an incidence ranging from 8% to 30%. [20,21] The incidence of post-op CSF leakage in our research was 32.7 percent; many of these patients reacted to simple sutures of skin strengthening and tincture application of post-op benzoyl, and a study by Marino R also supported and approved the use of CSF leak tincture benzoyl.…”

Section: Discussionmentioning

confidence: 99%

The Incidence and Treatment of Cerebrospinal Fluid Leakage Following Repair of Congenital Spinal Pathologies

Ahmed¹,

Khalil²,

Khan³

et al. 2022

PJMHS

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Objective: The study's goal is to find out how often individuals with myelomeningocele and TCS repair have leakage of cerebrospinal fluid. Study Design: Cross-sectional Place and Duration: Women medical college Abbottabad and Children hospital and the institute of child health, Multan, during from the period July, 2021 to Dec, 2021. Methods: There were 55 participants of both sexes in this research. Those being treated ranged in age from 5 to 20 years old. After obtaining written permission, we collected demographic data on each patient, including their age, gender, and BMI measurements. There were patients who had TCS repair as well as those who had undergone myelomeningocele repair procedures. It was determined how often cerebrospinal fluid leaks occurred in patients. SPSS 22.0 was used to analyze all of the data. Results: Among 55 cases, majority were males 32 (58.2%) and 23 (41.8%) were females. Included patients had mean age 9.5±6.14 years. Frequency of CSF leak was found among 18 (32.7%) patients. The mean duration of CSF leaks was 13.11±10.34 days. In 18 patients of CSF leaks, Frequency of MMC repair was 11, TCS release was found in 3 patients and meningocele repair in 4 patients. With the use of tincture benzoyl-enhanced primary wound healing in three patients with CSF leaks during surgery, the HCP postoperative signs were resolved. HCP was found in two further patients after their sutures mended with benzoyl tinctures, and they were placed in the shunt. Conclusion: In this research, we found that CSF leaks are more common in patients having myelomeningocele and TCS repair. Skin-healing tincture benzoyl will help these people. Keywords: Cerebrospinal fluid leak (CSF), Tether cord syndrome (TCS), Myelomeningocele (MMC)

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“…The treatment of choice for TCS is neurosurgical transection of the spinal cord end thread. Unfortunately, the healing process is hindered due to the release of cerebrospinal fluid (CSF) through the surgical wound [16][17][18][19]. The key factors in the wound healing process are transforming growth factor β (TGF-β) superfamily [20,21], four isoforms (A-D) of vascular endothelial growth factor (VEGF) [22], tumor necrosis factor α (TNF-α) [23], extracellular matrix metalloproteinases (MMPs) [24,25], fibroblast growth factors (FGF) or interleukins (ILs), and genes encoding collagen (COL) proteins [26].…”

Section: Introductionmentioning

confidence: 99%

Clinical analysis of tethered cord syndrome and gene expression profiling of wound healing surgery

Staszkiewicz¹,

Gładysz²,

Golec³

et al. 2023

pdia

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Introduction:The method to prevent progression of symptoms in tethered cord syndrome (TCS) is neurosurgery. However, postoperative wound healing is a lengthy process and is hindered by the release of cerebrospinal fluid (CSF) through the wound. To the best of the authors' knowledge, there is no study evaluating the changes in the expression of factors involved in the wound healing process after neurosurgery for TCS. Aim: To clinically analyse two cases of TCS and evaluate the change in expression of selected genes during the postoperative wound healing process. Material and methods: Determination of TCS in two adult patients (woman, aged 26 years; man, aged 53 years) was based on magnetic resonance imaging (MRI). After confirming the initial diagnosis, a neurosurgical procedure was performed to remove the intrathecal spreading adipoma and transect the medullary terminal thread in patients. In the postoperative period, impaired wound healing was noted as a result of CSF secretion through the surgical wound. Results: Molecularly, there was an increase in expression of all genes assessed in skin biopsy specimens compared to skin samples. Impaired postoperative wound healing after neurosurgery for TCS is expected due to CSF leakage through the surgical wound. The greatest changes were noted for metalloproteinases (MMPs) and four isoforms (A-D) of vascular endothelial growth factor A-D (VEGF-A-D; p < 0.05). Conclusions: Changes in the expression of our selected genes can be used to monitor and predict the process of wound healing and scar formation, which occurred in our cases at 19 and 20 days after surgery.

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Cerebrospinal Fluid Leak after Repair of Congenital Spinal Pathologies, Incidence and Management

Cited by 4 publications

References 6 publications

Incidence of Post-Operative Cerebrospinal Fluid Leak in Patients Operated for Spinal Dysraphism

Incidence of Post-Operative Cerebrospinal Fluid Leak in Patients Operated for Spinal Dysraphism

The Incidence and Treatment of Cerebrospinal Fluid Leakage Following Repair of Congenital Spinal Pathologies

Clinical analysis of tethered cord syndrome and gene expression profiling of wound healing surgery

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