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Prevention and treatment of CSF leaks in congenital complex spinal lipomas

  • How I Do it - Neurosurgical technique evaluation
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Abstract

Background

Congenital complex spinal lipomas (CSL) are challenging lesions to treat. Cerebrospinal fluid (CSF) leaks are feared complications due to the risk of infection, and subsequent scarring that may promote retethering. Much has been written in the literature on the surgical technique of CSL resection with less emphasis placed on the prevention and management of CSF leak.

Method

The authors describe the nuances in the prevention and management of CSF leaks in the context of CSL, including the operative approach, resection, closure and recommended postoperative care.

Conclusion

CSF leaks are complications that can be minimized with deliberate steps and meticulous surgical technique.

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Author information

Authors and Affiliations

  1. Neurosurgical Service, KK Women’s and Children’s Hospital, Singapore, Singapore

    Jia Xu Lim, Sharon YY Low, Lee Ping Ng & Wan Tew Seow

  2. Department of Neurosurgery, National Neuroscience Institute, Singapore, Singapore

    Sharon YY Low & Wan Tew Seow

  3. SingHealth Duke-NUS Neuroscience Academic Clinical Program, Singapore, Singapore

    Sharon YY Low & Wan Tew Seow

Authors
  1. Jia Xu Lim
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  2. Sharon YY Low
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  3. Lee Ping Ng
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  4. Wan Tew Seow
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Corresponding author

Correspondence to Sharon YY Low.

Additional information

Key points

1. CSF leaks in the treatment of complex spinal lipomas are potentially devastating.

2. Preoperative magnetic resonance imaging of the spine should be studied in detail to understand the anatomy of lipoma prior to surgery.

3. Each lipomas subtype has it challenges of resection and in its dural reconstruction.

4. Large subcutaneous lipomas are recommended to be left in situ during the resection to not introduce unnecessary postoperative dead space.

5. Dural preservation during the approach and dissection of lipoma is key to simplifying the steps of dural closure or duraplasty.

6. Residual fat adhered to the external dural surface can be incorporated into the dural closure especially when the dura is thinned from chronic compression.

7. Surgeons can consider primary dural closure after lipoma resection if the cord-sac ratio is deemed acceptable.

8. Running stitches using non-absorbable suture material should be used to perform watertight dural closure or duraplasty.

9. There is a role to consider the usage of dural sealants, especially in redo cases.

10. Postoperative measures to reduce intraspinal pressure via adequate pain control, prevention of constipation and urinary retention and appropriate positioning of the patient should be undertaken.

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Supplementary Information

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Supplementary Material 1: Short video describing techniques of CSF prevention in congenital complex spinal lipomas (MP4 221856 KB)

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Lim, J.X., Low, S.Y., Ng, L.P. et al. Prevention and treatment of CSF leaks in congenital complex spinal lipomas. Acta Neurochir 164, 1157–1160 (2022). https://doi.org/10.1007/s00701-021-05095-5

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  • DOI: https://doi.org/10.1007/s00701-021-05095-5

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