scholarly journals A Modified Footplate for the Kerrison Rongeur

2010 ◽  
Vol 4 (1) ◽  
Author(s):  
Alim P. Mitha ◽  
Mohamed S. Ahmad ◽  
Sarah J. Cohen ◽  
Janet S. Lieberman ◽  
Martin R. Udengaard ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Soft Tissue ◽  
Spinal Surgery ◽  
Significant Issue ◽  
Bone Removal ◽  
Cutting Surface ◽  
Cerebrospinal Fluid Leaks ◽  
Dural Tears ◽  
Csf Leaks ◽  
Tissue Compression

Use of the Kerrison rongeur for bone removal in spinal surgery is associated with dural tears and cerebrospinal fluid (CSF) leaks. We report a modification of the Kerrison rongeur footplate designed to reduce the risk of dural tears. A novel footplate was designed by incorporating the following parameters: (1) tapering the footplate to deflect soft tissue downward during positioning of the rongeur underneath the bone, and (2) making the footplate longer and wider than the cutting element to prevent soft tissue from entering into the cutting surface. Stereolithography models of the modified footplate were made and tested in a cadaver. A stainless steel modified footplate was then incorporated into an existing Kerrison rongeur as a working prototype, and tested in 20 laminectomy cases to clinically validate its design. The modified footplate prevented soft tissue from entering the cutting surface of the Kerrison rongeur in the manner intended by its design. No dural tears or CSF leaks were encountered in any instance. Potential soft tissue compression caused by an increase in footplate dimensions was not a significant issue in the rongeur size tested. This modification, however, might not be practical in rongeurs larger than 3 mm. The risk of dural tears and cerebrospinal fluid leaks in spinal surgery may be reduced by this footplate modification of the Kerrison rongeur. Soft tissue compression may limit the incorporation of this modification to rongeurs of 3 mm or smaller. The promising results warrant further tests with a wider range of sizes.

Cerebrospinal fluid leaks following spinal surgery: use of fat grafts for prevention and repair

2002 ◽  
Vol 96 (2) ◽  
pp. 250-252 ◽  
Author(s):  
Perry Black
Keyword(s):  
Cerebrospinal Fluid ◽  
Spinal Surgery ◽  
Effective Means ◽  
Fat Graft ◽  
Dural Tear ◽  
Disc Space ◽  
Fat Grafts ◽  
Csf Leakage ◽  
Dural Tears ◽  
Csf Leaks

✓ Cerebrospinal fluid (CSF) leaks are relatively common following spinal surgery. A midline dural tear in the spine is readily repaired by direct application of sutures; however, far-lateral or ventral dural tears are problematic. Fat is an ideal sealant because it is impermeable to water. In this paper the author reports his experience with using fat grafts for the prevention or repair of CSF leaks and proposes a technique in which a large sheet of fat, harvested from the patient's subcutaneous layer, is used to cover not only the dural tear(s) but all of the exposed dura and is tucked into the lateral recess. This procedure prevents CSF from seeping around the fat, which may be tacked to the dura with a few sutures. Fibrin glue is spread on the surface of the fat and is further covered with Surgicel or Gelfoam. For ventral dural tears (associated with procedures in which disc material is excised), fat is packed into the disc space to seal off the ventral dural leak. Dural suture lines following spinal intradural exploration are prophylatically protected from CSF leakage in the same manner. With one exception, 27 dural tears noted during 1650 spinal procedures were successfully repaired using this technique. There was one case of postoperative CSF leakage in 140 cases in which intradural exploration for tumor or other lesions was undertaken. Both postoperative CSF leaks were controlled by applying additional skin sutures. The use of a fat graft is recommended as a rapid, effective means of prevention and repair of CSF leaks following spinal surgery.

Significance of Empty Sella in Cerebrospinal Fluid Leaks

2003 ◽  
Vol 128 (1) ◽  
pp. 32-38 ◽  
Author(s):  
Rodney J. Schlosser ◽  
William E. Bolger
Keyword(s):  
Cerebrospinal Fluid ◽  
Intracranial Hypertension ◽  
Sella Turcica ◽  
Radiographic Finding ◽  
Empty Sella ◽  
Senior Author ◽  
Csf Leak ◽  
Benign Intracranial Hypertension ◽  
Cerebrospinal Fluid Leaks ◽  
Csf Leaks

OBJECTIVE: The role of elevated cerebrospinal fluid (CSF) pressures in the pathophysiology of various CSF leaks is not clear. Empty sella syndrome (ESS) is a radiographic finding that can be associated with elevated CSF pressures and may represent a radiographic indicator of intracranial hypertension. We present our experience with CSF leaks of various causes, the prevalence of ESS in the spontaneous and nonspontaneous categories, and the potential pathophysiology and unique management issues of the spontaneous CSF leak group. METHODS: We conducted a retrospective review of medical records, imaging studies, and surgical treatment of CSF leaks in patients treated by the senior author. RESULTS: Sixteen patients with spontaneous CSF leaks and 12 patients with nonspontaneous CSF leaks were surgically treated from 1996 through 2002. In the spontaneous group, 15 patients had complete imaging of the sella turcica. Ten had completely empty sellae and 5 had partially empty sellae, for a total of 100% (15 of 15). In the nonspontaneous group, 9 patients had complete imaging of the sella. Only 11% (1 of 9) had a partially empty sella and that was a congenital leak. Comparison of proportions between these 2 groups was significant ( P = 0.01). The spontaneous group consisted primarily of obese, middle-aged females (13 of 16 patients). CONCLUSION: Empty sella probably represents a sign of elevated intracranial pressure that leads to idiopathic, spontaneous CSF leaks. Spontaneous CSF leaks are strongly associated with the radiographic finding of an empty sella and are more common in obese females, similar to benign intracranial hypertension. This unique population may require more aggressive surgical and medical treatment to prevent recurrent or multiple leaks.

A physiological sealant for cerebrospinal fluid leaks

1977 ◽  
Vol 46 (2) ◽  
pp. 215-219 ◽  
Author(s):  
Gerald D. Silverberg ◽  
Christina B. Harbury ◽  
Edward Rubenstein
Keyword(s):  
Cerebrospinal Fluid ◽  
Histological Examination ◽  
Content Type ◽  
Cerebrospinal Fluid Leaks ◽  
The Brain ◽  
Fine Print ◽  
Csf Leaks

✓ A combination of concentrated platelets, thrombin, and fibrinogen was used to adhere a pericranial graft to surgically produced cerebrospinal fluid (CSF) fistulas in dogs. This sealant successfully stopped leakage of CSF in all fistulas produced in both acute and chronic preparations. All control animals leaked CSF acutely. In chronic control animals the CSF leaks sealed spontaneously but the grafts were not well incorporated. Histological examination of the grafts and underlying brain showed no injury to the brain or meningeal vessel from exposure to the platelet glue. Good fibrous union of the grafts to the dura was confirmed.

Computed tomography–guided epidural patching of postoperative cerebrospinal fluid leaks

2014 ◽  
Vol 21 (5) ◽  
pp. 805-810 ◽  
Author(s):  
Frank Mihlon ◽  
Peter G. Kranz ◽  
Andreia Roxana Gafton ◽  
Linda Gray
Keyword(s):  
Cerebrospinal Fluid ◽  
Spinal Surgery ◽  
Case Series ◽  
Clinical History ◽  
Percutaneous Intervention ◽  
Dural Defect ◽  
Retrospective Case ◽  
Ct Guided ◽  
Cerebrospinal Fluid Leaks ◽  
Dural Defects

Object Cerebrospinal fluid leaks due to unrecognized durotomy during spinal surgery are often managed with a second surgery for dural closure. CT-guided percutaneous patching targeted to the dural defect offers an alternative to surgery since it can be performed in a minimally invasive fashion without the need for general anesthesia. This case series describes the authors' experience using targeted CT-guided percutaneous patching to repair incidental durotomies incurred during spinal surgery. Methods This investigation is a retrospective case series involving patients who underwent CT-guided percutaneous patching of surgical incidental durotomies and were referred between January 2007 and June 2013. Their presenting clinical history, myelographic findings, and clinical outcomes, including the need for eventual surgical duraplasty, were reviewed. Results Nine cases were identified, including 7 durotomies incurred during lumbar discectomy, one due to a medial transpedicular screw breach, and one incurred during vertebrectomy for spinal osteosarcoma. All patients who had favorable outcomes with percutaneous intervention alone had 2 common features: dural defect of 4 mm or smaller and absence of a pseudomeningocele. Patients with CSF leaks complicated by pseudomeningocele and those with a dural defect of 6 mm or more all required eventual surgical management. Conclusions The authors' results suggest that findings on CT myelography may help predict which patients with postsurgical durotomy can be treated with percutaneous intervention. In particular, CT-guided patching may be more likely to be successful in those patients with dural defects of less than 5 mm and without pseudomeningocele. In patients with larger dural defects or pseudomeningoceles, percutaneous blood patching alone is unlikely to be successful.

scholarly journals Accidental Dural Tears in Minimally Invasive Spinal Surgery for Degenerative Lumbar Spine Disease

2021 ◽  
Vol 8 ◽  
Author(s):  
Stefan Aspalter ◽  
Wolfgang Senker ◽  
Christian Radl ◽  
Martin Aichholzer ◽  
Kathrin Aufschnaiter-Hießböck ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Minimally Invasive ◽  
Dead Space ◽  
Spinal Surgery ◽  
Surgical Techniques ◽  
Csf Leak ◽  
Previous Surgery ◽  
Minimally Invasive Spinal Surgery ◽  
Csf Leakage ◽  
Dural Tears

Background: One of the most frequent complications of spinal surgery is accidental dural tears (ADTs). Minimal access surgical techniques (MAST) have been described as a promising approach to minimizing such complications. ADTs have been studied extensively in connection with open spinal surgery, but there is less literature on minimally invasive spinal surgery (MISS).Materials and Methods: We reviewed 187 patients who had undergone degenerative lumbar spinal surgery using minimally invasive spinal fusions techniques. We analyzed the influence of age, Body Mass Index (BMI), smoking, diabetes, and previous surgery on the rate of ADTs in MISS.Results: Twenty-two patients (11.764%) suffered from an ADT. We recommended bed rest for two and a half to 5 days, depending on the type of repair required and the amount of cerebrospinal fluid (CSF) leakage. We could not find any statistically significant correlation between ADTs and age (p = 0.34,), BMI (p = 0.92), smoking (p = 0.46), and diabetes (p = 0.71). ADTs were significantly more frequent in cases of previous surgery (p < 0.001). None of the patients developed a transcutaneous CSF leak or post-operative infection.Conclusions: The frequency of ADTs in MISS appears comparable to that encountered when using open surgical techniques. Additionally, MAST produces less dead space along the corridor to the spine. Such reduced dead space may not be enough for pseudomeningocele to occur, cerebrospinal fluid to accumulate, and fistula to form. MAST, therefore, provides a certain amount of protection.

scholarly journals Case Report: An Intracranial Complication of COVID-19 Nasopharyngeal Swab

2021 ◽  
Vol 5 (3) ◽  
pp. 341-344
Author(s):  
Alexandria Holmes ◽  
Bryant Allen
Keyword(s):  
Cerebrospinal Fluid ◽  
Case Report ◽  
Acute Onset ◽  
Csf Leak ◽  
Nasopharyngeal Swab ◽  
Unique Case ◽  
Cerebrospinal Fluid Leaks ◽  
Streptococcal Meningitis ◽  
Persistent Headache ◽  
Csf Leaks

Introduction: Cerebrospinal fluid (CSF) leaks are often the result of trauma or recent surgical procedures; however, a subset can develop from non-traumatic etiologies. Cerebrospinal fluid leaks from congenital and spontaneous encephaloceles can be clinically occult and have devastating consequences if undetected for prolonged periods of time. This report highlights a unique case of meningitis after CSF leak caused by ruptured congenital meningocele during a routine nasopharyngeal swab.  Case Report: A 54-year-old female with diagnosed CSF leak presented to the emergency department (ED) with acute onset of severe headache, and neck and back pain. Prior to this presentation, the patient had experienced two months of persistent headache and rhinorrhea since her coronavirus disease 2019 (COVID-19) nasopharyngeal swab. As part of her outpatient workup, an otolaryngology consultation with subsequent beta-2 transferrin testing and magnetic resonance imaging was performed and she was diagnosed with a CSF leak from ruptured congenital meningocele. On ED presentation, she was afebrile, but with mild tachycardia, leukocytosis, and meningismus. Lumbar puncture revealed acute streptococcal meningitis. This patient’s meningitis developed due to prolonged occult CSF leak after her COVID-19 nasopharyngeal swab ruptured a pre-existing congenital meningocele.  Conclusion: Nasopharyngeal swabs are being performed much more frequently due to the COVID-19 pandemic. All front-line providers should be aware of the potential presence and rupture of congenital meningoceles in patients who have undergone recent nasopharyngeal swab when risk-stratifying for potential CSF leak and meningitis.

scholarly journals Current insights in CSF leaks: a literature review of mechanisms, pathophysiology and treatment options

2017 ◽  
Vol 7 (27) ◽  
pp. 143-151
Author(s):  
Elena Patrascu ◽  
Claudiu Manea ◽  
Codrut Sarafoleanu
Keyword(s):  
Cerebrospinal Fluid ◽  
Treatment Options ◽  
Bed Rest ◽  
Future Trend ◽  
Csf Leak ◽  
High Resolution Computed Tomography ◽  
Intracranial Complications ◽  
Cerebrospinal Fluid Leaks ◽  
Dural Lesion ◽  
Csf Leaks

Abstract A cerebrospinal fluid (CSF) leak occurs when there appears a fistula between the dura and the skull base and it is usually characterized by discharge of cerebrospinal fluid from the nose. Cerebrospinal fluid leaks may have many etiologies, the most common being trauma. The most common site of dural lesion is the cribriform plate of the ethmoid. Diagnosis can be achieved by a multitude of techniques, high-resolution computed tomography being the modality of choice and it may be completed with magnetic resonance imaging or cisternography. Treatment may be either conservative, either surgical, related to the cause, the site and the duration of CSF leak. Conservative treatment usually includes strict bed rest, elevated bed head and no straining, nose blowing or stretching, with resolution of the majority of traumatic CSF leaks in seven days. Surgical treatment consists of a variety of approaches (intracranial/extracranial, open/endoscopic). The future trend is represented by minimally invasive endoscopic approaches, with a success rate of almost 90%; however, open transcranial or extracranial interventions still have indications in the surgical management. CSF leaks must be correctly diagnosed and treated, because the risk of intracranial complications increases 10-fold when the leakage persists.

Treatment of Cerebrospinal Fluid Leaks and Gram-negative Bacillary Meningitis with Large Doses of Intrathecal Amikacin and Systemic Antibiotics

Neurosurgery ◽  
1986 ◽  
Vol 18 (4) ◽  
pp. 402-406 ◽  
Author(s):  
Verne E. Gilbert ◽  
Joe D. Beals ◽  
Stephen E. Natelson ◽  
William A. Tyler
Keyword(s):  
Cerebrospinal Fluid ◽  
Back Pain ◽  
Side Effects ◽  
Bactericidal Activity ◽  
Low Dose ◽  
Intrathecal Injection ◽  
Gram Negative ◽  
Cerebrospinal Fluid Leaks ◽  
Systemic Antibiotics ◽  
Csf Leaks

Abstract Six patients with cerebrospinal fluid (CSF) leaks and gram-negative bacillary meningitis (GNBM) were treated with large does of intrathecal amikacin (20 to 40 mg daily) and systemic antibiotics, Bactericidal activity was measured in the CSF of each patient, and the dose of intrathecal amikacin was increased if bactericidal activity was absent. Five of six patients had no bactericidal activity with systemic antibiotics alone and/or low dose intrathecal amikacin. All six patients were cured, and three of four patients with vertebral lesions had cessation of CSF leaks within 72 hours of the start of intrathecal amikacin. Intrathecal treatment for 7 to 10 days was adequate for five patients; the CSF of all patients was sterile within 72 hours, and all had a 90% reduction of pleocytosis in the CSF within 96 hours. One patient had radicular back pain after each intrathecal injection, but other side effects were not observed. These findings indicate that CSF leaks associated with GNBM can be effectively treated with large doses of intrathecal amikacin plus systemic antibiotics.

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