Treatment of cerebrospinal fluid leak after spine surgery

Zhao, Fang; Tian, Rong; Jia, Yang; Xu, Tao; Yang, Liu

doi:10.1016/j.cjtee.2016.12.002

Cited by 84 publications

(59 citation statements)

References 28 publications

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“…On reviewing the literature, we felt an epidural blood patch was preferable for our symptomatic patient, noting a case where this was used effectively to manage a persistent CSF leak following spinal catheter insertion during transphenoidal pituitary surgery . Neurosurgical review has also highlighted that epidural blood patch can be beneficial in managing CSF leak following spinal surgery, particularly when the location of the leak is unknown .…”

mentioning

confidence: 99%

Correspondence

McHugh

Davies

Dob

2019

Anaesthesia Reports

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CorrespondenceWe read with interest the report by Shields et al. on the management of cerebrospinal fluid (CSF) leak after accidental dural puncture, as we have recently managed a similar case [1]. An epidural was inserted at L3-4 for labour analgesia in a 32-year-old parturient, however, this was ineffective. A second epidural attempt at the same level 10 h later was complicated by accidental dural puncture. A catheter was threaded 4 cm intrathecally and used for labour analgesia for 6 h until delivery. Over the following 24 h, the patient developed a significant postural headache and leakage of CSF from the site of the epidural attempts.With consent, an epidural blood patch was performed under sterile aseptic conditions and 20 ml of autologous blood was injected into the epidural space at L3-4 with the patient in the left lateral position. The headache resolved within 4 h and no further fluid leakage occurred. The patient was discharged home with no ongoing symptoms.There is no consensus regarding the optimal management of such cases. On reviewing the literature, we felt an epidural blood patch was preferable for our symptomatic patient, noting a case where this was used effectively to manage a persistent CSF leak following spinal catheter insertion during transphenoidal pituitary surgery [2]. Neurosurgical review has also highlighted that epidural blood patch can be beneficial in managing CSF leak following spinal surgery, particularly when the location of the leak is unknown [3].This complication may be more common than previously thought. Such cases provoke thought regarding the use of intrathecal catheters in the management of accidental dural puncture as the development of a CSF leak may be more concerning than a post-dural puncture headache.

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mentioning

confidence: 99%

Correspondence

McHugh

Davies

Dob

2019

Anaesthesia Reports

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“…Management of CSF leakage entails two aspects based on CSF dynamics [17]: to prevent CSF leak with direct watertight closure of the dura mater and to retard CSF leak by reducing the subarachnoid CSF pressure and/or increasing the epidural space pressure. Prevention is of great importance in managing CSF leakage complication.…”

Section: Csf Leakagementioning

confidence: 99%

Surgical Treatment of Benign Spinal Cord Tumors

Qi¹,

Shan²,

Feng³

et al. 2019

Cancer Immunotherapy and Biological Cancer Treatments

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Benign spinal cord tumors (SCTs) are uncommon neoplasms that can arise within or adjacent to the spinal cord. Depending on their anatomical location, benign SCTs can be categorized as intramedullary, intradural-extramedullary, and extradural. The three most common benign SCTs are meningioma, nerve sheath tumors, and ependymoma. Both meningioma and nerve sheath tumors develop in the intradural-extramedullary compartment, while ependymoma occurs in the intramedullary space. Spinal meningiomas derive from arachnoidal cells and most commonly occur within the thoracic segment of the spine. Nerve sheath tumors, including schwannomas and neurofibromas, are closely associated with spinal nerves. Half of the spinal cord ependymomas arise in the lumbosacral segment or the filum terminale. Surgical treatment of large or symptomatic benign SCTs concentrates on total or subtotal resection of the tumors, which should be cautiously individualized based on the tumor location and histopathology. A curable complete resection should be achieved if possible while preserving the nervous function of the spinal cord and minimizing potential complications. Thoracic spinal roots may be sacrificed to acquire a total resection, yet cervical and lumbar nerve roots should be preserved prudently. Due to the vulnerable and complex anatomic nature of the spinal cord, maximal resection of the tumors can be achieved with the aid of appropriate intraoperative neural monitoring and meanwhile preserve nervous function.

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“…Obwohl häufig die direkte Naht von Duraverletzungen eingesetzt wird, hat diese dennoch eine Versagensrate von 5 -9 % [15].…”

Section: Direkte Naht Bei Akzidentiellen Durotomien Und Kleinen Duradunclassified

“…Fettlappenplastiken sind eine sinnvolle Alternative zur Muskellappenplastik. Sie können revaskularisieren, schützen vor Narbengewebe und bilden weniger Adhäsionen mit den neuralen Strukturen [15].…”

Section: Direkte Naht Bei Akzidentiellen Durotomien Und Kleinen Duradunclassified

Die iatrogene Duraverletzung/Liquorfistel

Rickert

Rauschmann

2019

Die Wirbelsäule

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ZusammenfassungDie Duraverletzung mit daraus resultierendem Verlust von Liquor cerebrospinalis ist eine der häufigsten Komplikationen bei Operationen an der Wirbelsäule bzw. am Spinalkanal. Manche Autoren sehen die Verletzung der Dura sogar als die häufigste Komplikation in der Wirbelsäulenchirurgie an. Zur Versorgung von Verletzungen der Rückenmarkshaut stehen zahlreiche erfolgversprechende Strategien und Therapieansätze zur Verfügung, dennoch gibt es bisher keine einheitlichen Richtlinien. Gute klinische Ergebnisse können mit der primären „wasserdichten“ Duranaht erzielt werden, weshalb diese auch angestrebt werden sollte. Ein der Defektgröße angepasstes intraoperatives Management zum Duraverschluss kann helfen einen persistierenden Liquorverlust und Revisionsoperationen zu vermeiden. Dennoch lässt der aktuelle Konsens in der Literatur Spielraum für individuelle Therapiemöglichkeiten und Behandlungskonzepte.

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Treatment of cerebrospinal fluid leak after spine surgery

Cited by 84 publications

References 28 publications

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Surgical Treatment of Benign Spinal Cord Tumors

Die iatrogene Duraverletzung/Liquorfistel

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