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

Abstract

BACKGROUND: Postoperative cerebrospinal fluid leakage (CSFL) is a feared complication after surgery on intradural pathologies and may cause postoperative complications and subsequently higher treatment costs. OBJECTIVE: To assess whether prolonged bed rest may lower the risk of CSFL. METHODS: We performed a retrospective cohort study including patients with intradural pathologies who underwent surgery at our department between 2013 and 2021. Cohorts included patients who completed 3 days of postoperative bed rest and patients who were mobilized earlier. The primary end point was the occurrence of clinically proven CSFL. RESULTS: Four hundred and thirty-three patients were included (female [51.7%], male [48.3%]) with a mean age of 48 years (SD ±20). Bed rest was ordered in 315 cases (72.7%). In 7 cases (N = 7/433, 1.6%), we identified a postoperative CSFL. Four of them (N = 4/118) did not preserve bed rest, showing no significant difference to the bed rest cohort (N = 3/315; P = .091). In univariate analysis, laminectomy (N = 4/61; odds ratio [OR] 8.632, 95% CI 1.883-39.573), expansion duraplasty (N = 6/70; OR 33.938, 95% CI 4.019-286.615), and recurrent surgery (N = 5/66; OR 14.959, 95% CI 2.838-78.838) were significant risk factors for developing CSFL. In multivariate analysis, expansion duraplasty was confirmed as independent risk factor (OR 33.937, 95% CI 4.018-286.615, P = .001). In addition, patients with CSFL had significant higher risk for meningitis (N = 3/7; 42.8%, P = .001). CONCLUSION: Prolonged bed rest did not protect patients from developing CSFL after surgery on intradural pathologies. Avoiding laminectomy, large voids, and minimal invasive approaches may play a role in preventing CSFL. Furthermore, special caution is indicated if expansion duraplasty was done.

Resection of Intramedullary Hemangioblastoma: Timing of Surgery and Its Impact on Neurological Outcome and Quality of Life

“…In other cases, laminoplasty was performed, and the laminae were fixed after tumor resection. Furthermore, both hemilaminectomy and laminoplasty reduce the risk of CSF leak [ 32 ]. Indeed, the only patient in this series with a CSFL had a laminectomy at the level of C1.…”

Timing of Resection of Spinal Meningiomas and Its Influence on Quality of Life and Treatment

“…More invasive surgical approaches do not seem to be required in most cases, even in ventral located and calcified meningiomas [11,27,39,40], and other intradural tumors [41]. Furthermore, minimal invasive unilateral approaches seem to play a role in preventing CSF leakage, one of the more frequent possible complications of after surgery on intra-dural pathologies [20,22,42,43]. In this study we noticed one case of postoperative CSF leakage (1.54%).…”

A Retrospective Cohort Study Evaluating the Comparative Effectiveness of Unilateral Hemilaminectomy and Bilateral Laminectomy in the Resection of Spinal Meningiomas

“…This suggests that resection of the dura, which is associated with higher rate of complications related to duraplasty, is not required. 2,14,35,36 In contrary, STR is the main predictor of tumor recurrence, which again highlights the importance of achieving GTR. 25,26,37 One more important fact is that resection in case of a recurrent tumor is one of the main factors for poor outcome after such surgery, 9,31 indicating the importance of avoiding it by achieving the goal of GTR in first surgery.…”

“…Although not statistically significant in this study, previous studies have suggested that laminectomy may be a risk factor for developing cerebrospinal fluid leakage after durotomy. 36,41,47…”