Penetrating trauma causing cerebrospinal fluid leak without nerve root damage

Carpenter, Holly; Hurndall, Katherine-Helen; Asokan, Ajay; Fernandes, Roland

doi:10.1136/bcr-2017-221461

Cited by 2 publications

(7 citation statements)

References 2 publications

(1 reference statement)

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“…[ 9 ] Therefore, most penetrating spinal injuries are treated surgically utilizing laminectomy, resection of retained foreign bodies, including knife blades, removal/decompression of hematomas, and exploration/ watertight closure involving direct/indirect dural repairs. [ 2 , 3 , 6 , 8 ]…”

Section: Discussionmentioning

confidence: 99%

“…Lack of success with spinal drain placement for these DT/CSF fistulas has included overdrainage, pneumocephalus, intracranial hemorrhages, and meningitis (i.e., 3–8%). [ 2 , 7 ] Rather, pedicle multifidus muscle flaps are effective alternatives for managing such penetrating spinal dural lacerations [ Figures 5 and 6 ]. [ 10 , 11 ]…”

Section: Discussionmentioning

confidence: 99%

“…Penetrating spinal injuries may result in dural tears (DT)/cerebrospinal fluid (CSF) leaks that can result in wound infections, meningitis, and abscesses. [2,3,6,8] Although direct dural suturing is the gold standard for repairing DT, [5] non-suturable lacerations may require indirect dural repair utilizing grafts and/or pedicle multifidus muscle flaps. [1,4,10] Here, we reviewed two cases [Table 1] and the literature defining the safety, efficacy, pros and cons of utilizing grafts and/or pedicle multifidus muscle flaps to repair spine-trauma-related DT/CSF fistulas.…”

Section: Introductionmentioning

confidence: 99%

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Pedicled multifidus muscle flaps to treat dural tears due to penetrating spinal stab wounds: Two case reports and a literature review

Policicchio,

Boccaletti,

Casu

et al. 2024

Surgical Neurology International

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Background: Penetrating spinal injuries occasionally lead to dural tears (DT) and cerebrospinal fluid (CSF) leaks that risk both infectious and neurological complications. Here, we reviewed two cases and the literature regarding the safety/efficacy and limitations of repairing traumatic DT utilizing pedicled multifidus muscle flaps. Case Description: Two males, ages 73 and 50, presented with Brown-Sequard syndromes and DT/CSF fistulas attributed to knife-induced spinal injuries at the D3–D4 and D11–D12 levels. Intraoperatively, DT was repaired utilizing pedicle multifidus muscle flaps. Postoperatively, both patients demonstrated partial recovery of neurological function along with no residual symptoms/signs of DT/CSF fistulas. Conclusion: Penetrating traumatic spinal injuries may result in DT/CSF fistulas that can be adequately repaired utilizing pedicle multifidus muscle flaps.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Pedicled multifidus muscle flaps to treat dural tears due to penetrating spinal stab wounds: Two case reports and a literature review

Policicchio,

Boccaletti,

Casu

et al. 2024

Surgical Neurology International

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“…[11] At present, there are only three case reports of spinal stab injury in the absence of neurologic deficit. [1,3,11] Here, we describe an unusual case of lumbar spine stab injury in a young adult with consequent penetrating fracture of the lamina and secondary CSFL with no neurological deficit that required multimodal intervention, including nonsurgical and surgical treatment.…”

Section: Introductionmentioning

confidence: 98%

“…[ 11 ] At present, there are only three case reports of spinal stab injury in the absence of neurologic deficit. [ 1 , 3 , 11 ]…”

Section: Introductionunclassified

Cerebrospinal fluid leak following penetrating trauma to the spine without neurological deficit: A case report

Ramírez-Ferrer¹,

Abaunza-Camacho²,

Pineda-Martinez³

et al. 2022

Surgical Neurology International

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Background: Posttraumatic spinal cerebrospinal fluid leak (CSFL) without neurological deficit is a rare entity. Historically, the first-line treatment is a nonsurgical approach, which includes Trendelenburg positioning, carbonic anhydrase inhibitor (acetazolamide), and subarachnoid catheter, with a high successful rate of leak correction. However, in some cases, this first-line treatment could fail, being necessary the surgical approach. Case Description: A 23-year-old male with a recent stab wound to his lumbar region, complained of positional headache and fluid outflow through his wound. On physical examination, an active CSFL was detected without evidence of neurologic deficit. Imaging studies showed a CSF collection extending from the right L4 lamina to the subcutaneous tissue. CSF studies revealed bacterial meningitis. The treatment with carbonic anhydrase inhibitors, Trendelenburg position, lumbar subarachnoid catheter, and antibiotics was initiated. Failure of conservative measures prompted a surgical treatment to resolve the CSFL. Intraoperatively, a dura mater defect was identified, and an autologous paravertebral muscle flap was used for water-tight closure of the defect. The patient recovered without further complications and with CSFL resolution. Conclusion: Even though the nonsurgical approach is the first-line of treatment of traumatic CSFL cases, failures can occur. The evidence of a CSF trajectory in imaging studies could be a predictor of treatment failure of the nonsurgical treatment. The surgical treatment as second-line treatment has outstanding results regarding CSFL correction and should be considered when the prediction rate to nonsurgical approach failure is high.

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Penetrating trauma causing cerebrospinal fluid leak without nerve root damage

Cited by 2 publications

References 2 publications

Pedicled multifidus muscle flaps to treat dural tears due to penetrating spinal stab wounds: Two case reports and a literature review

Pedicled multifidus muscle flaps to treat dural tears due to penetrating spinal stab wounds: Two case reports and a literature review

Cerebrospinal fluid leak following penetrating trauma to the spine without neurological deficit: A case report

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