Predictive factors for dural tear and cerebrospinal fluid leakage in patients undergoing lumbar surgery

2006 ◽  
Vol 5 (3) ◽  
pp. 224-227 ◽  
Author(s):  
Anthony H. Sin ◽  
Gloria Caldito ◽  
Donald Smith ◽  
Mahmoud Rashidi ◽  
Brian Willis ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Fat Graft ◽  
Csf Leak ◽  
Dural Tear ◽  
Lumbar Surgery ◽  
History Of Surgery ◽  
Csf Leakage ◽  
History Of ◽  
Group A ◽  
Group B

Object A dural tear resulting in a cerebrospinal fluid (CSF) leak is a well-known risk of lumbar spinal procedures. The authors hypothesized that the incidence of CSF leakage is higher in cases involving repeated operations and those in which the surgeon performing the surgery is less experienced; however, they postulated that the overall outcome of the patient would not be adversely affected by a dural tear. Methods An institutional review board–approved protocol at Louisiana State University Health Sciences Center, Shreveport, was initiated in August 2003 to allow prospective comparison of data obtained in patients in whom a CSF leak occurred (Group A) and those in whom no CSF leak occurred (Group B) during lumbar surgery. Basic demographic information, descriptive findings regarding the tear, history of other surgeries, hospital length of stay (LOS), and immediate disposition at the time of discharge were compared between the two groups. Seventy-seven patients were eligible for this study. One patient refused to participate. In 12 (15.8%) of 76 patients CSF leakage developed. In three patients the presence of a tear was questioned, and the patients were clinically treated as if a tear were present. The patients in Group A were older than those in Group B (59.8 ± 16.9 and 49.4 ± 13.6 years of age, respectively; p = 0.02, Fisher exact test). In terms of those with a history of surgery, there was no significant difference between patients with and patients without a CSF leak (three [25%] of 12 patients [Group A] compared with 28 [43.8%] of 64 patients [Group B]; p = 0.34, two-sample t-test). In the 12 patients with dural tears, nine (75%) were caused by a resident-in-training, and the Kerrison punch was the instrument most often being used at the time (55%). This is significantly greater than 50% at the 5% level (p = 0.044, binomial test). The authors were able to repair the tear primarily with suture in all but one patient, whose tear was along the nerve root sleeve. In all cases fibrin glue and a muscle/fat graft were used to cover the tear, and all patients were assigned to bed rest from 24 to 48 hours after the operation. In Group A one patient required rehabilitation at discharge. The LOS in Group A was greater than that in Group B (median 5 days compared with 3 days), but no additional complication was noted. Conclusions The incidence of CSF leakage was 16% in 76 patients, and there were no other complications. Older patient age and higher level of the surgeon’s training were factors contributing to the incidence, but the history of surgery was not.

Collagen Matrix With Mucoperiosteum Graft as an Effective Fatless Flapless Reconstruction After Endoscopic Pituitary Adenoma Resection

2020 ◽  
Author(s):  
Mostafa Shahein ◽  
Alaa S Montaser ◽  
Juan M Revuelta Barbero ◽  
Guillermo Maza ◽  
Alexandre B Todeschini ◽  
...  
Keyword(s):  
Pituitary Adenoma ◽  
Skull Base ◽  
Collagen Matrix ◽  
Leak Rate ◽  
Fat Graft ◽  
Csf Leak ◽  
Endoscopic Endonasal ◽  
Skull Base Reconstruction ◽  
Group A ◽  
Group B

Abstract BACKGROUND Proper skull base reconstruction after endoscopic endonasal pituitary surgery is of great importance to decrease the rate of complications. OBJECTIVE To assess the safety and efficacy of reconstruction with materials other than fat graft and naso-septal flaps (NSF) to avoid their associated morbidities. METHODS The authors’ institutional database for patients who underwent endoscopic endonasal approach for pituitary adenoma was reviewed. Exclusion criteria included recurrence, postradiation therapy, and reconstruction by fat graft or NSF. They were divided into group A, where collagen matrix (CM) (DuraGen® Plus Matrix, Integra LifeSciences Corporation, Plainsboro, New Jersey) alone was used; group B, where CM and simple mucoperiosteum graft were used and group C, which included cases without CM utilization. RESULTS The study included 252 patients. No age, gender, or body mass index statistically significant difference between groups. Group B included the largest tumor size (23.0 mm) in comparison to groups A (18.0 mm) and C (13.0 mm). Suprasellar extension was more frequently present (49.4%) in comparison to groups A (29.8%, P = .001) and C (21.2%, P < .001). Postoperative cerebrospinal fluid (CSF) leak rate was 0%, 2.9%, and 6% in groups A, B, and C, respectively. In group B, the CSF leak rate decreased from 45.9% intraoperatively to 2.9% postoperatively (P < .001). In group A, the CSF leak reduction rate was almost statistically significant (P = .06). CONCLUSION Utilization of CM and simple mucosperiosteal graft in skull base reconstruction following pituitary adenoma surgery is an effective method to avoid the morbidities associated with NSF or fat graft.

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.

scholarly journals CSF Otorrhea Complicating Temporal Bone Osteoradionecrosis in a Patient with Nasopharyngeal Carcinoma

2005 ◽  
Vol 84 (1) ◽  
pp. 39-40 ◽  
Author(s):  
Bernard Y.K. Lim ◽  
Kenny Peter Pang ◽  
Wong Kein Low ◽  
How Ming Tan
Keyword(s):  
Cerebrospinal Fluid ◽  
Nasopharyngeal Carcinoma ◽  
Temporal Bone ◽  
Middle Ear ◽  
Csf Leak ◽  
Old Chinese ◽  
Csf Leakage ◽  
History Of

A 44-year-old Chinese man with a history of nasopharyngeal carcinoma that was treated with radiotherapy presented with fluid in the middle ear. We performed a myringotomy and subsequently made a diagnosis of cerebrospinal fluid (CSF) leakage secondary to osteoradionecrosis of the temporal bone. To the best of our knowledge, this is only the second reported case of an otogenic CSF leak resulting from osteoradionecrosis of the temporal bone. This case highlights the controversial role of myringotomy in the management of CSF otorrhea.

Prevention of intraoperative cerebrospinal fluid leaks by lumbar cerebrospinal fluid drainage during surgery for pituitary macroadenomas

2012 ◽  
Vol 116 (6) ◽  
pp. 1299-1303 ◽  
Author(s):  
Gautam U. Mehta ◽  
Edward H. Oldfield
Keyword(s):  
Cerebrospinal Fluid ◽  
Transsphenoidal Surgery ◽  
Surgical Repair ◽  
Fat Graft ◽  
Csf Leak ◽  
Cerebrospinal Fluid Leakage ◽  
Cerebrospinal Fluid Drainage ◽  
Csf Drainage ◽  
Csf Leakage ◽  
Csf Leaks

Object Cerebrospinal fluid leakage is a major complication of transsphenoidal surgery. An intraoperative CSF leak, which occurs in up to 50% of pituitary tumor cases, is the only modifiable risk factor for postoperative leaks. Although several techniques have been described for surgical repair when an intraoperative leak is noted, none has been proposed to prevent an intraoperative CSF leak. The authors postulated that intraoperative CSF drainage would diminish tension on the arachnoid, decrease the rate of intraoperative CSF leakage during surgery for larger tumors, and reduce the need for surgical repair of CSF leaks. Methods The results of 114 transsphenoidal operations for pituitary macroadenoma performed without intraoperative CSF drainage were compared with the findings from 44 cases in which a lumbar subarachnoid catheter was placed before surgery to drain CSF at the time of dural exposure and tumor removal. Results Cerebrospinal fluid drainage reduced the rate of intraoperative CSF leakage from 41% to 5% (p < 0.001). This reduction occurred in macroadenomas with (from 57% to 5%, p < 0.001) and those without suprasellar extension (from 29% to 0%, p = 0.31). The rate of postoperative CSF leakage was similar (5% vs 5%), despite the fact that intraoperative CSF drainage reduced the need for operative repair (from 32% to 5%, p < 0.001). There were no significant catheter-related complications. Conclusions Cerebrospinal fluid drainage during transsphenoidal surgery for macroadenomas reduces the rate of intraoperative CSF leaks. This preventative measure obviated the need for surgical repair of intraoperative CSF leaks using autologous fat graft placement, other operative techniques, postoperative lumbar drainage, and/or reoperation in most patients and is associated with minimal risks.

scholarly journals Comparison of Outcome of Decompressive Craniectomy with Wide Dural Flap Duraplasty Versus Dural Slits in the Management of Post Traumatic Acute Subdural Hematoma in Terms of Postoperative CSF Leak

2019 ◽  
Vol 23 (3) ◽  
pp. 163-169
Author(s):  
GHAYUR ABBAS ◽  
RIFFAT ULLAH KHAN ◽  
USAMA BIN ZUBAIR ◽  
SAJID NAZEER BHATTI
Keyword(s):  
Decompressive Craniectomy ◽  
Acute Subdural Hematoma ◽  
Csf Leak ◽  
P Value ◽  
Chi Square ◽  
Csf Leakage ◽  
Group A ◽  
Post Traumatic ◽  
The Difference ◽  
Group B

Objective: To compare the frequency of postoperative cerebrospinal fluid (CSF) leak after decompressive craniectomy with wide dural flap duraplasty versus dural slits in patients with post traumatic acute subdural hematoma.Material and Methods: The study was conducted from August 2017 to February 2018 in the Department of Neurosurgery, PIMS, Islamabad. A total of ninety-two (n = 92) adult patients of either gender between age 15-55 years presented with isolated, unilateral traumatic acute sub dural hematoma (ASDH) with midline shift of 5mm were categorized into 2 groups; Group A (DC with open dural flap) and Group B (DC with dural slits). Patients were observed for CSF leakage for four weeks.Results: Results showed that the overall frequency of CSF leak was not significantly different in both groups and revealed that the CSF leak was observed in 10.9% (n = 5/46) in group A (DC plus open dural flap) and in 21.7% (n = 10/46) in group B (DC plus dural slits) (P = 0.158). The difference was not significant in terms of frequency of CSF leak in both groups when results were stratified with respect to gender, age, duration of trauma and baseline GCS. P value (chi-square) was found to be > 0.05 in all cases.Conclusions: The postoperative CSF leak was observed in higher percentages in patients who underwent DC with dural slits as compared to the patients who underwent DC with open dural flaps for surgical management of ASDH. The difference, however, was not statistically significant.

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

2000 ◽  
Vol 9 (1) ◽  
pp. 1-4 ◽  
Author(s):  
Perry Black
Keyword(s):  
Cerebrospinal Fluid ◽  
Posterior Fossa ◽  
Effective Means ◽  
Fat Graft ◽  
Posterior Fossa Surgery ◽  
Dural Tear ◽  
Fat Grafts ◽  
Csf Leakage ◽  
Dural Tears ◽  
Csf Leaks

Cerebrospinal fluid (CSF) leaks are relatively common following spinal or posterior fossa surgery. A midline dural tear in the spine is readily repaired by direct application of a suture. 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 ventra1 dural leak. Leaks in the posterior fossa are managed similarly to those in the spine. Dural suture lines, following suboccipital or 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 150 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 posterior fossa and spinal surgery.

scholarly journals Autologous bone reconstruction as sandwich technique in pediatric posterior fossa surgery: finding a noble eightfold path for developing countries

2019 ◽  
Vol 6 (9) ◽  
pp. 3251
Author(s):  
Suyash Singh ◽  
Kamlesh Singh Bhaisora ◽  
Arun Kumar Srivastava ◽  
Sanjay Behari
Keyword(s):  
Posterior Fossa ◽  
Pediatric Population ◽  
Csf Leak ◽  
Posterior Fossa Surgery ◽  
Surgical Closure ◽  
Csf Leakage ◽  
Group A ◽  
Autologous Bone ◽  
The Aesthetic ◽  
Group B

Background: Sub-occipital craniotomy in pediatric population is difficult owing to uneven surface of growing calvaria and thin dura. Our novel technique using autologous bone chips and gelfoam bridges the two standard techniques. In this study, we intend to compare the surgical outcome in pediatric posterior fossa tumours.Methods: We included patients, operated via midline sub-occipital approach, from January 2013 to October 2018 and grouped them, on basis of whether or not sandwich reconstruction was done. We compared pseudomeningocele, post-operative headache, CSF leakage and postoperative hydrocephalus requiring CSF diversion. The aesthetic outcome was assessed using Stony Brook scar evaluation scale (SBSES).Results: 124 patients, divided into group A (n=53), group B (n=58) and group C (n=13) based on technique of surgical closure. The sandwich closure is significantly better in terms of both aesthesis and post-operative pain (p<0.05). There was a trend showing that sandwich closure decreases risk for pseudomeningocoele, wound infection, CSF leak and post-operative hydrocephalus. Median SBSES Score in group B was 4 compared to 2 in group A and patients were significantly more satisfied.Conclusions: The uniform bone coverage with sandwich closure provides nearly similar reconstruction to craniotomy. All risks of using drill over pediatric calvaria are eliminated and advantages are carried. The bony barrier prevents adhesion and decreases both immediate and delayed headache. The technique is not only technically easier and aesthetically better, but also has better long term satisfactory results with possibility of neo-bone formation. 

Appreciation of the importance of pregravid preparation and reproductive attitudes of women of childbearing age in the city of Omsk

GYNECOLOGY ◽  
2018 ◽  
Vol 20 (6) ◽  
pp. 48-52
Author(s):  
E N Kravchenko ◽  
R A Morgunov
Keyword(s):  
Women Of Childbearing Age ◽  
Childbearing Age ◽  
Pregnancy And Childbirth ◽  
Perinatal Center ◽  
History Of ◽  
Group A ◽  
Group B ◽  
Complicated Pregnancy ◽  
The Relationship ◽  
The City

The aim of the study. Assess the importance of pregravid preparation and outcomes of pregnancy and childbirth, depending on the reproductive attitudes of women in the city of Omsk. Materials and methods. The study included 92 women who were divided into groups: group A (n=43) - women whose pregnancy was planned; group B (n=49) - women whose pregnancy occurred accidentally. Each group was divided into subgroups depending on age: from 18 to 30 and from 31 to 49 years. For each patient included in the study, a specially designed map was filled out. These patients were interviewed at the City Clinical Perinatal Center. Results. Comparative analysis revealed the relationship between the reproductive settings of women of childbearing age and the peculiarity of the course of pregnancy and childbirth in these patients. Summary. The majority of women of fertile age are married: in subgroup AA - 25 (96.2%), AB - 13 (76.5%), BA - 25 (92.6%), BB - 20 (91.0%). The predominant number of women of fertile age have one or more abortions: in subgroup AA - 12 (46.2%), AB - 6 (35.3%), in subgroups of comparison BA - 8 (29.6%), BB - 6 (27.3%). More than half of the women of fertile age surveyed have a history of untreated cervical pathology (from 40.8% to 64.7%). The course of pregnancy in women planning pregnancy in most cases proceeded without complications: in subgroup AA - 13 (50.0%), AB - 11 (64.7%). The most common cause of complicated pregnancy in women whose pregnancy occurred accidentally is the threat of spontaneous miscarriage: in subgroup BA - 15 (55.6%), BB - 16 (72.7%). The uncomplicated course of labor more often [subgroup AA - 19 (73.0%), AB - 12 (70.6%)] was observed in women whose pregnancy was planned and they were motivated to give birth to a healthy child.

The Use of Methylene Blue Staining Test in Determining the CSF Leaks Location of the Anterior Skull Base

2018 ◽  
Vol 69 (6) ◽  
pp. 1376-1377
Author(s):  
Razvan Hainarosie ◽  
Teodora Ghindea ◽  
Irina Gabriela Ionita ◽  
Mura Hainarosie ◽  
Cristian Dragos Stefanescu ◽  
...  
Keyword(s):  
Methylene Blue ◽  
Cerebrospinal Fluid ◽  
Intrathecal Injection ◽  
Diagnostic Procedures ◽  
Blue Staining ◽  
Csf Leak ◽  
Glucose Content ◽  
Csf Rhinorrhea ◽  
Cerebrospinal Fluid Rhinorrhea ◽  
Csf Leakage

Cerebrospinal fluid rhinorrhea represents drainage of cerebrospinal fluid into the nasal cavity. The first steps in diagnosing CSF rhinorrhea are a thorough history and physical examination of the patient. Other diagnostic procedures are the double ring sign, glucose content of the nasal fluid, Beta-trace protein test or beta 2-transferrin. To establish the exact location of the defect imagistic examinations are necessary. However, the gold standard CSF leakage diagnostic method is an intrathecal injection of fluorescein with the endoscopic identification of the defect. In this paper we analyze a staining test, using Methylene Blue solution, to identify the CSF leak�s location.

scholarly journals Cerebrospinal fluid leakage after cranial surgery in the pediatric population—a systematic review and meta-analysis

2021 ◽  
Author(s):  
Emma M. H. Slot ◽  
Kirsten M. van Baarsen ◽  
Eelco W. Hoving ◽  
Nicolaas P. A. Zuithoff ◽  
Tristan P. C van Doormaal
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Cerebrospinal Fluid ◽  
Pediatric Population ◽  
Meta Analysis ◽  
Leakage Rate ◽  
Csf Leak ◽  
Cerebrospinal Fluid Leakage ◽  
Cranial Surgery ◽  
Csf Leakage

Abstract Background Cerebrospinal fluid (CSF) leakage is a common complication after neurosurgical intervention. It is associated with substantial morbidity and increased healthcare costs. The current systematic review and meta-analysis aim to quantify the incidence of cerebrospinal fluid leakage in the pediatric population and identify its risk factors. Methods The authors followed the PRISMA guidelines. The Embase, PubMed, and Cochrane database were searched for studies reporting CSF leakage after intradural cranial surgery in patients up to 18 years old. Meta-analysis of incidences was performed using a generalized linear mixed model. Results Twenty-six articles were included in this systematic review. Data were retrieved of 2929 patients who underwent a total of 3034 intradural cranial surgeries. Surprisingly, only four of the included articles reported their definition of CSF leakage. The overall CSF leakage rate was 4.4% (95% CI 2.6 to 7.3%). The odds of CSF leakage were significantly greater for craniectomy as opposed to craniotomy (OR 4.7, 95% CI 1.7 to 13.4) and infratentorial as opposed to supratentorial surgery (OR 5.9, 95% CI 1.7 to 20.6). The odds of CSF leakage were significantly lower for duraplasty use versus no duraplasty (OR 0.41 95% CI 0.2 to 0.9). Conclusion The overall CSF leakage rate after intradural cranial surgery in the pediatric population is 4.4%. Risk factors are craniectomy and infratentorial surgery. Duraplasty use is negatively associated with CSF leak. We suggest defining a CSF leak as “leakage of CSF through the skin,” as an unambiguous definition is fundamental for future research.

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