Administration of iatrogenic spinal cerebrospinal fluid leaks: A cohort of 124 sufferers.
Clin Neurol Neurosurg. 2018 Apr 22;170:61-66
Authors: Woodroffe RW, Nourski KV, Helland LC, Walsh B, Noeller J, Kerezoudis P, Hitchon PW
OBJECTIVES: Cerebrospinal fluid leaks are a frequent complication of spinal surgical procedure, with reported charges between 2 and 20%. Administration is extremely variable and depending on comorbidities, complexity of the index process, and surgeons’ expertise. Therapy choices embrace major or delayed restore, with or with out spinal drainage. Utilizing a retrospective cohort, the authors purpose to determine the suitable administration of iatrogenic spinal cerebrospinal fluid (CSF) leaks.
PATIENTS AND METHODS: We queried our institutional database for postoperative spinal CSF leaks between 1/1/2007 and three/14/2017 utilizing Present Procedural Terminology (CPT) and Worldwide Classification of Illness (ICD) codes. Excluded have been sufferers who had primarily intradural procedures corresponding to tethered wire launch, tumor resection, and posterior fossa decompression. Info concerning affected person demographics, surgical traits, and postoperative course was gathered, together with whether or not major closure (with nonabsorbable suture) was achieved, lumbar drain placement at preliminary surgical procedure, use of fibrin sealant, variety of subsequent explorations, charge of an infection, size of keep, and variety of hospital admissions.
RESULTS: Our cohort consisted of 124 sufferers who suffered intraoperative iatrogenic CSF leak out of 3965 procedures, for a charge of three.1%. Major dural closure (±lumbar drain) was tried in 64 sufferers, with profitable restore in 47 (73.four%). Lumbar drain placement (±major closure) was carried out in 49, with success in 43 (87.eight%). Delayed exploration of the surgical wound was required in 34 sufferers. Sufferers in whom major closure couldn’t be achieved and didn’t have a lumbar drain positioned had a 39.5% reexploration charge. Sufferers who have been handled with delayed exploration had statistically vital improve in size of keep (19.6 vs. 7.eight days), hospital admissions (2.1 vs. 1.zero), and infections (15 vs. zero).
CONCLUSION: CSF leaks are fraught with problems requiring reexploration for restore in 27.four% of circumstances. Major restore of the leak and use of fibrin sealant upon discovery, with consideration of lumbar drain, must be carried out each time doable, as they’re related to shorter hospital stays, fewer hospital admissions, and decrease charges of reoperation and an infection.
PMID: 29730270 [PubMed – as supplied by publisher]