Cerebrospinal fluid leaks following intradural spinal surgery—Risk factors and clinical management

Abstract

BackgroundCerebrospinal fluid leakage (CSFL) following spinal durotomy can lead to severe sequelae. However, while several studies have investigated accidental spinal durotomies, the risk factors and influence of clinical management in planned durotomies remain unclear.MethodsWe performed a retrospective analysis of all patients who underwent planned intradural spinal surgery at our institution between 2010 and 2020. Depending on the occurrence of a CSFL, patients were dichotomized and compared with respect to patient and case-related variables as well as dural closure technique, epidural drainage placement, and timing of mobilization.ResultsA total of 351 patients were included. CSFL occurred in 4.8% of all cases. Surgical indication, tumor histology, location within the spine, previous intradural surgery, and medical comorbidities were not associated with an increased risk of CSFL development (all p > 0.1). Age [odds ratio (OR), 0.335; 95% confidence interval (CI), 0.105–1.066] and gender (OR, 0.350; 95% CI, 0.110–1.115) were not independently associated with CSFL development. There was no significant association between CSFL development and the dural closure technique (p = 0.251), timing of mobilization (p = 0.332), or placement of an epidural drainage (p = 0.321).ConclusionCSFL following planned durotomy pose a relevant and quantifiable complication risk of surgery that should be factored in during preoperative patient counseling. Our data could not demonstrate superiority of any particular dural closure technique but support the safety of both early mobilization within 24 h postoperatively and epidural drainage with reduced or no force of suction.

The Role of Prolonged Bed Rest in Postoperative Cerebrospinal Fluid Leakage After Surgery of Intradural Pathology—A Retrospective Cohort Study

“…However, several studies could not verify this. 2,4,11,34,39 In comparison with other studies, we could not find any association between the development of CSFL and underlying pathology-tumor vs nontumor-and localization level of the durotomy in the spine. 4,6,39 Furthermore, Jesse et al reported a higher incidence of CSFL when the approach was in the cervicothoracic junction, explained by the higher movements in that area 6 ; however, none of the patients in this study operated for pathology in this region developed a CSFL.…”

“…These findings support previous results that bed rest does not play a significant role in preventing CSFL. 5,6,9,11,12 Beyond that, our data did not show an association between early mobilization and the occurrence of other postoperative adverse events.…”

“…[4][5][6][7][8][9] Thus, the role of bed rest is still unclear. [9][10][11][12] In general, studies showed that early mobilization and discharge of patients after surgery had very positive effects on the patients' outcome. Same effects might apply to patients operated for intradural lesions.…”

Subfascial drains are safe and effective in preventing postoperative cerebrospinal fluid leaks after intradural spine tumor surgery

“…This brief period of drainage allowed for early mobilization and a shorter hospital stay; our average hospital length of stay was five days. [ 2 ] Despite the use of SD, we found no postoperative infections, and just one patient reported a nonpositional headache immediately postoperatively and was later found to have COVID pneumonia. Notably, no patients developed postoperative CSF leaks, and no revision procedures were warranted within the 30–90 postoperative window.…”

Review of Cervical Schwannomas: Presentation, Pathogenesis, Management, Complications and Future Directions

“…Another possible complication of spinal surgery is CSF leak. CSF leak following spinal durotomy appears to occur in about 5% of cases and appears to be associated with prior surgery at the index level and cervical vs thoracic location, but does not appear to depend on dural closure technique or other covariates [24,34,48,49,50]. CSF leak is associated with serious infections including meningitis and healing disorders with subsequent repeat surgery [50].…”