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The role of ICP monitoring in patients with persistent cerebrospinal fluid leak following spinal surgery: a case series

  • Clinical Article - Spine
  • Published:
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Abstract

Background

Cerebrospinal fluid (CSF) leak following spinal surgery is a relatively common surgical complication. A disturbance in the underlying CSF dynamics could be the causative factor in a small group of patients with refractory CSF leaks that require multiple surgical repairs and prolonged hospital admission.

Methods

A retrospective case series of patients with persistent post spinal surgery CSF leak referred to the hydrocephalus service for continuous intracranial pressure (ICP) monitoring. Patients’ notes were reviewed for medical history, ICP data, radiological data, and subsequent management and outcome.

Results

Five patients (two males/three females, mean age, 35.4 years) were referred for ICP monitoring over a 12-month period. These patients had prolonged CSF leak despite multiple repair attempts 252 ± 454 days (mean ± SD). On ICP monitoring, all five patients had abnormal results, with the mean ICP 8.95 ± 4.41 mmHg. Four had abnormal pulse amplitudes, mean 6.15 mmHg ± 1.22 mmHg. All five patients underwent an intervention. Three patients underwent insertion of ventriculoperitoneal (VP) shunts. One patient had venous sinus stent insertion and one patient underwent medical management with acetazolamide. All five of the patients’ CSF leak resolved post intervention. The mean time to resolution of CSF leak post intervention was 10.8  ± 12.9 days.

Conclusions

Abnormal cerebrospinal fluid dynamics could be the underlying factor in patients with a persistent and treatment-refractory CSF leak post spinal surgery. Treatments aimed at lowering ICP may be beneficial in this group of patients. Whether abnormal pressure and dynamics represent a pre-existing abnormality or is induced by spinal surgery should be a subject of further study.

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Authors and Affiliations

  1. Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, UK

    Claudia Craven, Ahmed K. Toma, Akbar A. Khan & Laurence D. Watkins

Authors
  1. Claudia Craven
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  2. Ahmed K. Toma
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  3. Akbar A. Khan
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  4. Laurence D. Watkins
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Correspondence to Claudia Craven.

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All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Craven, C., Toma, A.K., Khan, A.A. et al. The role of ICP monitoring in patients with persistent cerebrospinal fluid leak following spinal surgery: a case series. Acta Neurochir 158, 1813–1819 (2016). https://doi.org/10.1007/s00701-016-2882-5

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  • DOI: https://doi.org/10.1007/s00701-016-2882-5

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