Cerebrospinal Fluid Leaks and Pseudomeningocele after Posterior Fossa Surgery: Effect of an Autospray Dural Sealant

Lee, Young M.; Ordaz, Angel; Durcanova, Beata; Viner, Jennifer; Theodosopoulos, Philip V.; Aghi, Manish K.; McDermott, Michael W.

doi:10.7759/cureus.8379

Cited by 5 publications

(7 citation statements)

References 11 publications

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“…Lee et al reported a 27.0% combined incidence of CSF leak or PMC in their series of 122 patients undergoing posterior fossa surgery. 14 In a series of adult patients with CM-I undergoing PFD with duraplasty, Almotairi and Tisell reported an 11.5% incidence of any postoperative CSF disturbance and, although their incidence was lower than in the present study, a similar number of their included patients (4/51 [7.8%]) did require permanent CSF diversion. 1 Galan et al reported a 21.8% incidence of either PMC or CSF leak, with a readmission rate of 13%.…”

Section: Discussioncontrasting

confidence: 60%

“…This is similar to the systematic review by Kinaci et al and the more recent, single-institution experience of Lee et al, neither of whom found a significant association between use of a dural sealant and postoperative CSF-related complications. 14,15 In contrast, Galan et al found that fibrin glue dural sealants specifically reduced the risk of postoperative PMC, but they did not find the same association with PEG sealants. 9 Their study, with its larger sample size (n = 165) and greater incidence of postoperative CSF disturbances (41.8% risk of PMC or CSF leak), may have been better powered to detect a difference among dural sealants.…”

Section: Discussionmentioning

confidence: 94%

“…Our series identified 18 (30.5%) patients with postoperative PMC or CSF leak, corresponding to the wide range of reported postoperative CSF disturbances-from 8% to 36%-in the extant literature. 9,11,[13][14][15] In our population, 11 (18.6%) patients underwent some sort of operative intervention. The operative and nonoperative management of these patients is shown in Table 3.…”

Section: Discussionmentioning

confidence: 99%

“…[11][12][13] The incidence of PMC and CSF leak following PFD for adult patients with CM-I varies widely, with reports ranging from 8% to 36%. 9,11,[13][14][15] The management of these complications also differs across centers, with potential options ranging from conservative management, wound resuturing, wound aspiration, wound exploration, to temporary or permanent CSF diversion. 11,13 For the present study, we sought to investigate patient and perioperative features that may affect the incidence of postoperative CSF-related complications at our center.…”

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confidence: 99%

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Incidence and management of postoperative pseudomeningocele and cerebrospinal fluid leak after Chiari malformation type I decompression

Atchley

Alam

Gross

et al. 2023

Neurosurgical Focus

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OBJECTIVE The optimal surgical management of Chiari malformation type I (CM-I) remains controversial and heterogeneous. The authors sought to investigate patient-specific, technical, and perioperative features that may affect the incidence of CSF-related complications including pseudomeningocele and CSF leak at their institution. METHODS The authors performed a single-center, retrospective review of all adult patients with CM-I who underwent posterior fossa decompression. Patient demographics, operative details, and perioperative factors were collected via electronic medical record review. The authors performed Fisher’s exact test and independent Student t-tests for categorical and continuous variables, respectively. Univariate regression analysis was performed to determine odds ratios. A multivariable regression analysis was performed for those factors with p < 0.10 or large effect sizes (OR ≥ 2.0 or ≤ 0.50) by univariate analysis. The STROBE guidelines for observational studies were followed. RESULTS A total of 59 adult patients were included. Most patients were female (78.0%), and the mean body mass index was 32.2 (± 9.0). Almost one-third (30.5%) of patients had a syrinx on preoperative imaging. All patients underwent expansile duraplasty, of which 47 (79.7%) were from autologous pericranium. Arachnoid opening for fourth ventricular inspection was performed in 26 (44.1%) cases. CSF-related complications were identified in 18 (30.5%) of cases. Thirteen (22.0%) patients required readmission and 11 (18.6%) required intervention such as wound revision (n = 5), wound revision with CSF diversion (n = 4), CSF diversion alone (n = 1), or blood patch (n = 1). Three (5.1%) patients required permanent CSF diversion. Male sex (OR 3.495), diabetes mellitus (OR 0.249), tobacco use (OR 2.53), body mass index more than 30 (OR 2.45), preoperative syrinx (OR 1.733), autologous duraplasty (OR 0.331), and postoperative steroids (OR 2.825) were included in the multivariable analysis. No factors achieved significance by univariate or multivariable analysis (all p > 0.05). CONCLUSIONS The authors report a single-center, retrospective experience of posterior fossa decompression for 59 adults with CM-I. No perioperative or technical features were found to affect the CSF-related complication rate. More standardized practices within centers are necessary to better delineate the true risk factors and potential protective factors against CSF-related complications.

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Section: Discussioncontrasting

confidence: 60%

Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Incidence and management of postoperative pseudomeningocele and cerebrospinal fluid leak after Chiari malformation type I decompression

Atchley

Alam

Gross

et al. 2023

Neurosurgical Focus

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“…[ 2 ] Lumbar drains (LDs) are second-line therapy for iatrogenic CSF leaks. [ 5 , 7 , 10 ] Understandably, accessing the lumbar space comes with its own set of risks that should be weighed against the benefits of performing the procedure. One of the most common and major risks is CNS infection.…”

Section: Introductionmentioning

confidence: 99%

Navigated lumbar drain placement: A description of technique and case example

Montgomery¹,

Blue²,

Spadola³

et al. 2023

Surgical Neurology International

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Background: Lumbar drain (LD) placement can be a difficult procedure leading to postprocedure complications, particularly in patients with persistent cerebrospinal fluid leaks or a large body habitus. The objective of this technical case report is to describe the use of Medtronic’s SureTrak Navigation system for navigated LD placement. Case Description: The patient was an 18-year-old morbidly obese male who initially underwent a suboccipital craniectomy with duraplasty and a C1 laminectomy for Chiari Malformation. Postoperatively, he developed a pseudomeningocele and was taken to the operating room for wound revision, duraplasty repair, and LD placement. Medtronic’s SureTrak Navigation system was used for LD placement before wound revision. Successful LD placement was achieved in a single pass using the SureTrak Navigation. The patient did well postoperatively, and LD removal occurred on postoperative day 6. The patient was discharged in good condition without evidence of a cerebral spinal fluid leak. Conclusion: Navigation using the SureTrak system is a reasonable option to use in patients with a high body mass index and a persistent cerebrospinal fluid leak. When the patient is already undergoing an operative procedure, it can aid in an efficient low-risk intervention completed in a single prone positioning.

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Comparison of Pericranial Autograft and AlloDerm for Duraplasty in Patients With Type I Chiari Malformation: Retrospective Cohort Analysis

Hoffman¹,

Bunch²,

Paul³

et al. 2021

ONSURG

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BACKGROUND Pericranial autograft is a popular option for duraplasty during Chiari decompression with several theoretical advantages, but comparisons to other materials have yielded mixed results. OBJECTIVE To compare outcomes between pericranial autograft and AlloDerm (BioHorizons). METHODS Consecutive suboccipital craniectomies for patients with type I Chiari malformation (CM-I) over an 8-yr period at a single institution were identified. Exclusion criteria included revision surgeries and suboccipital decompressions without duraplasty. Outcomes included incisional cerebrospinal fluid (CSF) leakage, length of stay (LOS), wound complication, aseptic meningitis, syrinx improvement, and symptomatic improvement. RESULTS A total of 101 patients (70 females and 31 males) with a median (interquartile range) age of 17 yr (11-32) met the inclusion criteria. There were 51 (50%) patients who underwent duraplasty with pericranial autograft, and the remainder underwent duraplasty with AlloDerm. There were 9 (9%) patients who experienced a postoperative CSF leak. After adjusting for confounding factors, obesity (odds ratio [OR]: 4.69, 95% CI: 1.03-25.6) and use of AlloDerm (OR: 10.54, 95% CI: 1.7-206.12) were associated with CSF leak. Wound complication occurred in 8 (8%) patients but was not associated with graft type (P = .8). Graft type was not associated with LOS, syrinx improvement, or symptom improvement. Reoperations occurred in 10 patients with 4 in the autograft group and 6 in the AlloDerm group (P = .71). CONCLUSION In patients with CM-I, expansile duraplasty with AlloDerm was associated with greater odds of CSF leakage than pericranial autograft. Obesity was also associated with increased odds of CSF leakage.

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Cerebrospinal Fluid Leaks and Pseudomeningocele after Posterior Fossa Surgery: Effect of an Autospray Dural Sealant

Cited by 5 publications

References 11 publications

Incidence and management of postoperative pseudomeningocele and cerebrospinal fluid leak after Chiari malformation type I decompression

Incidence and management of postoperative pseudomeningocele and cerebrospinal fluid leak after Chiari malformation type I decompression

Navigated lumbar drain placement: A description of technique and case example

Comparison of Pericranial Autograft and AlloDerm for Duraplasty in Patients With Type I Chiari Malformation: Retrospective Cohort Analysis

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