CSF complications following intradural spinal surgeries in children
- 426 Downloads
Cerebrospinal fluid (CSF) leakage is a complication of intradural spinal surgery and is associated with poor wound healing and infection. The incidence of CSF leak is reported at ∼16 % in adults, but little information is available in children.
The aim of this study is to determine the CSF leak rate and predisposing factors after intradural pediatric spinal surgeries.
This study was a retrospective chart review of 638 intradural spinal operations at BC Children’s Hospital. CSF leak was defined as pseudomeningocele or CSF leak through incision. Primary operations to untether lipomyelomeningoceles, myelomeningocele/meningocele closure, and Chiari decompressions were excluded.
CSF leaks occurred in 7.1 %, with 3 % having overt CSF leaks through skin (OCSF leak). CSF leaks, specifically OCSF leaks, were associated with postoperative wound infection (P = 0.0016). Sixteen of 45 cases of CSF leak required reoperation. The type of dural suture used, site of operation, or use of fibrin glue did not affect CSF leak rates. Previous spinal surgery (P < 0.0001), use of dural graft (P = 0.0043), method of dural suturing (P = 0.0023), and procedure performed (P < 0.001) were associated with postoperative CSF leakage. Patients with CSF leak were older than those without leak (98 vs. 72 months, P = 0.002).
Our results provide evidence on intraoperative factors that may predispose to CSF leaks after spinal intradural surgery and may help guide surgical practice. This study confirms that the pediatric population shares many of the same risk factors for CSF leak as in adult populations. Further research is needed to explain how specific factors are associated with CSF leaks.
KeywordsPseudomeningocele CSF leak Spinal surgery Children Technique Outcome Complication
The authors have no personal financial or institutional interest in any of the drugs, materials, or devices described in this article. Victor Liu was supported by a summer studentship from Child and Family Research Institute.
Ethics for this study was approved by BC Children’s Hospital.
- 1.Black P (2000) Cerebrospinal fluid leaks following spinal or posterior fossa surgery: use of fat grafts for prevention and repair. Neurosurgical focus 9(1): e4Google Scholar
- 2.Boogaarts JD, Grotenhuis JA, Bartels RH, Beems T (2005) Use of a novel absorbable hydrogel for augmentation of dural repair: results of a preliminary clinical study. Neurosurgery 57(1 Suppl):146–151, discussion 146–151Google Scholar
- 3.Borgesen SE, Vang PS (1973) Extradural pseudocysts: a cause of pain after lumbar-disc operation. Acta Orthop Scand 44(1):12–20Google Scholar
- 4.Bosacco SJ, Gardner MJ, Guille JT (2001) Evaluation and treatment of dural tears in lumbar spine surgery: a review. Clin Orthop Relat Res (389):238–247Google Scholar
- 5.Cappabianca P, Esposito F, Magro F, Cavallo LM, Solari D, Stella L, de Divitiis O (2010) Natura abhorret a vacuo–use of fibrin glue as a filler and sealant in neurosurgical “dead spaces”. Technical Note. Acta Neurochir (Wien) 152(5):897–904Google Scholar
- 6.Chern JJ, Tubbs RS, Patel AJ, Gordon AS, Bandt SK, Smyth MD, Jea A, Oakes WJ (2011) Preventing cerebrospinal fluid leak following transection of a tight filum terminale. J Neurosurg Pediatr 8(1):35–38Google Scholar
- 7.Drake JM, Riva-Cambrin J, Jea A, Auguste K, Tamber M, Lamberti-Pasculli M (2010) Prospective surveillance of complications in a pediatric neurosurgery unit. J Neurosurg Pediatr 5(6):544–548Google Scholar
- 8.Jankowitz BT, Atteberry DS, Gerszten PC, Karausky P, Cheng BC, Faught R, Welch WC (2009) Effect of fibrin glue on the prevention of persistent cerebral spinal fluid leakage after incidental durotomy during lumbar spinal surgery. Eur Spine J 18(8):1169–1174Google Scholar
- 9.Koo J, Adamson R, Wagner FC Jr, Hrdy DB (1989) A new cause of chronic meningitis: infected lumbar pseudomeningocele. Am J Med 86(1):103–104Google Scholar
- 10.Luce EA, Walsh J (1985) Wound closure of the myelomeningocele defect. Plast Reconstr Surg 75(3):389–393Google Scholar
- 11.Maher CO, Goumnerova L, Madsen JR, Proctor M, Scott RM (2007) Outcome following multiple repeated spinal cord untethering operations. J Neurosurg 106(6 Suppl):434–438Google Scholar
- 12.Megyesi JF, Ranger A, MacDonald W, Del Maestro RF (2004) Suturing technique and the integrity of dural closures: an in vitro study. Neurosurgery 55(4):950–954, discussion 954–955Google Scholar
- 13.Nakamura H, Matsuyama Y, Yoshihara H, Sakai Y, Katayama Y, Nakashima S, Takamatsu J, Ishiguro N (2005) The effect of autologous fibrin tissue adhesive on postoperative cerebrospinal fluid leak in spinal cord surgery: a randomized controlled trial. Spine (Phila Pa 1976) 30(13):E347–E351Google Scholar
- 14.Narotam PK, Jose S, Nathoo N, Taylon C, Vora Y (2004) Collagen matrix (DuraGen) in dural repair: analysis of a new modified technique. Spine (Phila Pa 1976) 29(24):2861–2867, discussion 2868–2869Google Scholar
- 15.Robertson JT, Soble-Smith J, Powers N, Nelson PA (2003) Prevention of cerebrospinal fistulae and reduction of epidural scar with new surgical hemostat device in a porcine laminectomy model. Spine (Phila Pa 1976) 28(19):2298–2303Google Scholar
- 16.Sin AH, Caldito G, Smith D, Rashidi M, Willis B, Nanda A (2006) Predictive factors for dural tear and cerebrospinal fluid leakage in patients undergoing lumbar surgery. J Neurosurg Spine 5(3):224–227Google Scholar
- 17.Sugawara T, Itoh Y, Hirano Y, Higashiyama N, Shimada Y, Kinouchi H, Mizoi K (2005) Novel dural closure technique using polyglactin acid sheet prevents cerebrospinal fluid leakage after spinal surgery. Neurosurgery 57(4 Suppl):290–294, discussion 290–294Google Scholar
- 18.Verner EF, Musher DM (1985) Spinal epidural abscess. Med Clin North Am 69(2):375–384Google Scholar
- 19.Zide BM (1992) How to reduce the morbidity of wound closure following extensive and complicated laminectomy and tethered cord surgery. Pediatr Neurosurg 18(3):157–166Google Scholar