Cerebrospinal fluid leakage after intradural spinal surgery in children

Abstract

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.

Risk factors for surgical site infection after percutaneous endoscopic lumbar discectomy

“…In our study, it was an independent risk factor for SSI, which is consistent with other study 35 . Apparently, cerebrospinal fluid leakage is a relative headache for clinicians, mainly because of its secondary complication such as infection 36 . This may be related to the persistent wound exudation after cerebrospinal fluid occurrence, which in turn leads to secondary infection.…”

“… 35 Apparently, cerebrospinal fluid leakage is a relative headache for clinicians, mainly because of its secondary complication such as infection. 36 This may be related to the persistent wound exudation after cerebrospinal fluid occurrence, which in turn leads to secondary infection. Therefore, spinal surgeons ensure delicate intraoperative manoeuvres to avoid damage to the dura mater.…”