• World Neurosurg · Dec 2018

    Cerebrospinal Fluid Leak and Symptomatic Pseudomeningocele After Intradural Spine Surgery.

    • Jonathan N Sellin, KolcunJohn Paul GJPGDepartment of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA., and Allan D Levi.
    • Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.
    • World Neurosurg. 2018 Dec 1; 120: e497-e502.

    ObjectiveTo describe the incidence of and characterize risk factors for cerebrospinal fluid leak and symptomatic pseudomeningocele (CSFL/SP) after intradural spine surgery.MethodsA retrospective analysis of a prospectively collected and consecutive series of patients undergoing intradural spine surgery by the senior author (A.D.L.) was conducted over a period of 20 years.ResultsData on 460 surgeries performed on 430 consecutive patients were gathered. The incidence of CSFL/SP formation was 2.8% (n = 13). Of the 13 cases complicated by CSFL/SP, 4 were successfully managed nonoperatively (4/13, 31%); 9 postoperative CSFL/SP required surgical repair (9/13, 69%), making for an overall postoperative surgical repair rate of 1.9% (9/460). Factors significantly related to development of postoperative CSFL/SP on the Fisher exact test were surgery located at the craniocervical junction (risk ratio [RR] 2.7, P = 0.03) and use of any external cerebrospinal fluid drain (any drain: RR 2.5, P = 0.02; lumbar drain specifically: RR 2.6, P = 0.02), the latter finding most likely being attributable to selection bias. No significant difference was observed between primary dural closure and closure incorporating the use of one or more dural repair adjuncts. In addition, the total number of dural repair adjuncts used did not significantly influence the development of postoperative CSFL/SP.ConclusionsWe present the largest series of intradural spine surgeries focusing specifically on the risk factors for and management of CSFL/SP. Although craniocervical junction surgery and use of external cerebrospinal fluid drain were associated with CSFL/SP, type of closure and type/number of dural substitutes were not.Copyright © 2018 Elsevier Inc. All rights reserved.

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