Risk Factors and Management Strategies of Cerebrospinal Fluid Leakage Following Lumbar Posterior Surgery

Abstract Objective: To analyze the risk factors of cerebrospinal fluid leakage(CSFL) following lumbar posterior surgery and summarize the related management strategies. Methods: A retrospective analysis was performed on 3179 patients with CSFL strategies lumbar posterior surgery in our hospital from January 2019 to December 2020. There were 807 cases of lumbar disc hemiation(LDH), 1143 cases of lumbar spinal stenosi (LSS), 1122 cases of lumbar spondylolisthesis(LS), 93 cases of lumbar degenerative scoliosis(LDS),14 cases of lumbar spinal benign tumor(LST). Data of gender, age, body mass index(BMI), duration of disease, diabete,smoking history, preoperative epidural hormone injection, number of surgical levels, surgical methods (total laminar decompression, fenestration decompression), revision surgery, extubation time, suture removal time, and complications were recorded.Results: The incidence of 115 cases with cerebrospinal fluid leakage,was 3.62% (115/3179).One-way ANOVA showed that gender, body mass index(BMI), smoking history, combined with type 2 diabetes and surgical method had no significant effect on CSFL(P >0.05). Age, type of disease, duration of disease, preoperative epidural hormone injection, number of surgical levels and revision surgery had effects on CSFL(P<0.05). Multivariate Logistic regression analysis showed that type of disease, preoperative epidural hormone injection, number of surgical levels and revision surgery were significantly affected CSFL(P<0.05), and duration of disease and age of the patients were not significantly affected CSFL (P >0.05).The extubation time of CSFL patients ranged from 7 to 11 days, with an average of 7.11±0.48 days, the extubation time of patients without CSFL was 1-3 days, with an average of 2.02±0.13 days, and there was a statistical difference between the two groups(P < 0.05).The removal time of CSFL patients was 12-14 days, with an average of 13.11±2.67 days, and the removal time of patients without CSFL was 10-14 days, with an average of 12.87±2.19 days, there was no statistically significant difference between the two groups (P>0.05). Conclusion: Type of disease, preoperative epidural hormone injection, number of surgical levels and revision surgery were the risk factors for CSFL. Effective prevention were the key to CSFL in lumbar surgery.Once appear, CSFL can also be effectively dealt with without obvious adverse reactions after intraoperative effectively repair dural, head down, adequate drainage after operation, the high position, rehydration treatment, and other treatments.

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Incidence and risk factors of subdural hematoma after intraoperative cerebrospinal fluid leakage during the transsphenoidal approach

Pituitary ◽

10.1007/s11102-016-0746-x ◽

2016 ◽

Vol 19 (6) ◽

pp. 565-572 ◽

Cited By ~ 2

Author(s):

Kazuhito Takeuchi ◽

Tadashi Watanabe ◽

Tetsuya Nagatani ◽

Yuichi Nagata ◽

Jonsu Chu ◽

...

Keyword(s):

Risk Factors ◽

Cerebrospinal Fluid ◽

Subdural Hematoma ◽

Transsphenoidal Approach ◽

Cerebrospinal Fluid Leakage ◽

Fluid Leakage

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Risk factors and management of incisional cerebrospinal fluid leakage after craniotomy: preliminary results of a retrospective international multicenter study

Brain and Spine ◽

10.1016/j.bas.2021.100813 ◽

2021 ◽

Vol 1 ◽

pp. 100813

Author(s):

A. Kinaci ◽

E.M. Slot ◽

M.H. Kollen ◽

M.R. Germans ◽

S. Amin-Hanjani ◽

...

Keyword(s):

Risk Factors ◽

Cerebrospinal Fluid ◽

Multicenter Study ◽

Cerebrospinal Fluid Leakage ◽

Preliminary Results ◽

Fluid Leakage ◽

International Multicenter Study ◽

International Multicenter

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Risk Factors for Cerebrospinal Fluid Leakage after Craniotomy and the Efficacy of Dural Sealants Application versus Dural Suturing Alone

The Nerve ◽

10.21129/nerve.2016.2.2.22 ◽

2016 ◽

Vol 2 (2) ◽

pp. 22-25 ◽

Cited By ~ 2

Author(s):

Byeong-Jin Ha ◽

Jin Hwan Cheong ◽

Hyeong-Joong Yi

Keyword(s):

Risk Factors ◽

Cerebrospinal Fluid ◽

Cerebrospinal Fluid Leakage ◽

Fluid Leakage ◽

Dural Suturing

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Traumatic cerebrospinal fluid leakage: risk factors and the use of prophylactic antibiotics

British Journal of Neurosurgery ◽

10.1080/02688699646880 ◽

1996 ◽

Vol 10 (6) ◽

pp. 571-576 ◽

Cited By ~ 62

Author(s):

D. Choi ◽

R. Spann

Keyword(s):

Risk Factors ◽

Cerebrospinal Fluid ◽

Prophylactic Antibiotics ◽

Cerebrospinal Fluid Leakage ◽

Fluid Leakage

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Identification of risk factors for postoperative cerebrospinal fluid leakage and comparison of two alternative dural augmentation techniques in posterior fossa and spinal surgeries

Turkish Neurosurgery ◽

10.5137/1019-5149.jtn.24432-18.0 ◽

2018 ◽

Author(s):

Muhammed Taha Eser ◽

Sahin Hanalioglu ◽

Mehmet Ziya Cetiner ◽

Samet Dinc ◽

Halil Olgun Peker ◽

...

Keyword(s):

Risk Factors ◽

Cerebrospinal Fluid ◽

Posterior Fossa ◽

Cerebrospinal Fluid Leakage ◽

Fluid Leakage ◽

Augmentation Techniques

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Risk factors for postoperative CSF leakage after elective craniotomy and the efficacy of fleece-bound tissue sealing against dural suturing alone: a randomized controlled trial

Journal of Neurosurgery ◽

10.3171/2014.6.jns131917 ◽

2014 ◽

Vol 121 (3) ◽

pp. 735-744 ◽

Cited By ~ 27

Author(s):

Gregor Hutter ◽

Stefanie von Felten ◽

Martin H. Sailer ◽

Marianne Schulz ◽

Luigi Mariani

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Cerebrospinal Fluid ◽

Controlled Trial ◽

Cerebrospinal Fluid Leakage ◽

Control Group ◽

Fluid Leakage ◽

Dural Closure ◽

Csf Leakage ◽

Dural Patch

Object Cerebrospinal fluid leakage is an immanent risk of cranial surgery with dural opening. Recognizing the risk factors for this complication and improving the technique of dural closure may reduce the associated morbidity and its surgical burden. The aim of this paper was to investigate whether the addition of TachoSil on top of the dural suture reduces postoperative CSF leakage compared with dural suturing alone and to assess the frequency and risk factors for dural leakage and potentially related complications after elective craniotomy. Methods The authors conducted a prospective, randomized, double-blinded single-center trial in patients undergoing elective craniotomy with dural opening. They compared their standard dural closure by running suture alone (with the use of a dural patch if needed) to the same closure with the addition of TachoSil on top of the suture. The primary end point was the incidence of CSF leakage, defined as CSF collection or any open CSF fistula within 30 days. Secondary end points were the incidence of infection, surgical revision, and length of stay in the intensive care unit (ICU) or intermediate care (IMC) unit. The site of craniotomy, a history of diabetes mellitus, a diagnosis of meningioma, the intraoperative need of a suturable dural substitute, and blood parameters were assessed as potential risk factors for CSF leakage. Results The authors enrolled 241 patients, of whom 229 were included in the analysis. Cerebrospinal fluid leakage, mostly self-limiting subgaleal collections, occurred in 13.5% of patients. Invasive treatment was performed in 8 patients (3.5%) (subgaleal puncture in 6, lumbar drainage in 1, and surgical revision in 1 patient). Diabetes mellitus, a higher preoperative level of C-reactive protein (CRP), and the intraoperative need for a dural patch were positively associated with the occurrence of the primary end point (p = 0.014, 0.01, and 0.049, respectively). Cerebrospinal fluid leakage (9.7% vs 17.2%, OR 0.53 [95% CI 0.23–1.15], p = 0.108) and infection (OR 0.18 [95% CI 0.01–1.18], p = 0.077) occurred less frequently in the study group than in the control group. TachoSil significantly reduced the probability of staying in the IMC unit for 1 day or longer (OR 0.53 [95% CI 0.27–0.99], p = 0.048). Postoperative epidural hematoma and empyema occurred in the control group but not in the study group. Conclusions Dural leakage after elective craniotomy/durotomy occurs more frequently in association with diabetes mellitus, elevated preoperative CRP levels, and the intraoperative need of a dural patch. This randomized controlled trial showed no statistically significant reduction of postoperative CSF leakage and surgical site infections upon addition of TachoSil on the dural suture, but there was a significant reduction in the length of stay in the IMC unit. Dural augmentation with TachoSil was safe and not related to adverse events. Clinical trial registration no. NCT00999999 (http://www.ClinicalTrials.gov).

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