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Management of CSF leak following spinal surgery

Child's Nervous System volume 30, pages 1543–1547 (2014)Cite this article

Abstract

Purpose

Postoperative CSF leak is a known complication of spinal surgery especially after surgery for neural tube defects (NTD). The problem can metamorphose into a severe infection. This article hopes to shed some light on the management of these problems and suggests precautions so as to reduce their occurrence.

Materials and methods

A retrospective analysis of 102 children, between the ages of 1 day and 12 years, operated for various spinal pathologies, over the past 2.5 years by the same surgeon (CB) was done. The various methods of dural closure were noted. The methods of management of postoperative CSF leaks were analysed, and the patients were followed till discharge.

Results

The incidence of CSF leak was found to be 12.7 %. The methods of management included lumbar drain only (n = 7), lumbar drain with re-exploration (n = 3), lumbar drain followed by lumboperitoneal shunt (n = 2) and only lumboperitoneal shunt (n = 1). The use of fibrin glue did not seem to significantly prevent the incidence of CSF leak in cases.

Conclusions

Primary and meticulous dural closure is sine qua non in preventing postoperative CSF leak. A lumbar drain is a convenient and economical method of managing the problem initially failing which more invasive methods like re-exploration may be employed.

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Author information

Affiliations

  1. Kanchi Kamakoti CHILDS Trust Hospital (KKCTH), 12 A, Nageshwara Road, Nungambakkam, Chennai 34, India

    Chidambaram Balasubramaniam, Santosh Mohan Rao & K. Subramaniam

Authors
  1. Chidambaram Balasubramaniam
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  2. Santosh Mohan Rao
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  3. K. Subramaniam
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Corresponding author

Correspondence to Chidambaram Balasubramaniam.

Additional information

This article was presented in part at the annual meeting of the International Society for Pediatric Neurosurgery held at Sydney, Australia in 2012.

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Balasubramaniam, C., Rao, S.M. & Subramaniam, K. Management of CSF leak following spinal surgery. Childs Nerv Syst 30, 1543–1547 (2014). https://doi.org/10.1007/s00381-014-2496-2

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  • DOI: https://doi.org/10.1007/s00381-014-2496-2

Keywords

  • CSF leak
  • Primary dural closure
  • Dural graft
  • Lumbar drain