Closed subarachnoid drainage for management of cerebrospinal fluid leakage after an operation on the spine.

Kitchel, Scott H.; Eismont, Frank J.; Green, B A

doi:10.2106/00004623-198971070-00004

Cited by 206 publications

(101 citation statements)

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“…The success rate of this protocol was 11.8 % in our study. This rate was much lower than other studies reported elsewhere, ranging from 84 to 94 % [32][33][34]. Our findings had close similarity to Bell's et al [18] study, who reported the successful treatment of 2 of 5 patients undergoing lumbar drainage.…”

Section: Discussionsupporting

confidence: 87%

A 7-Year Study of 1,278 Patients with Maxillofacial Trauma and Cerebrospinal Fluid Leak

Hasheminia

Motamedi

Hashemzehi

et al. 2014

J. Maxillofac. Oral Surg.

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Background A number of patients with facial fractures have cerebrospinal fluid (CSF) leak that may result in meningitis and other central nervous system complications. Commonly, CSF leak occurs following trauma, but the etiology and pattern of this disorder are different from region to region. This study aims to evaluate the distribution of CSF leak in patients with maxillofacial fractures in Isfahan province, Iran. Patients and Methods In this retrospective cross-sectional study, 1,287 medical files of patients admitted to a medical center with head and face injuries were evaluated during a 7-year period (2004)(2005)(2006)(2007)(2008)(2009)(2010). Data was obtained using descriptive analysis. Results Of the 1,278 patients with head and maxillofacial fractures, 16 (1.25 %) males and one (0.07 %) female had CSF leak; all these cases had skull base fracture. Of these, 52.9 % had maxillary fracture, 23.5 % nasal fracture, 41.1 % orbital fracture, 11.7 % mandibular fracture, 23.5 % frontal fracture, and 41.1 % had more than one site of fracture. 58.8 % had rhinorrhea and 41.2 % otorrhea. Of all these patients with CSF leak, 8 (47 %), 2 (11.8 %), and 7 (41.2 %) cases were treated spontaneously, using lumbar drain placement, and by surgical intervention, respectively. Conclusions Cerebrospinal fluid leak was observed most frequently in patients with fracture in the zygomatic and maxillary bone, and mostly exhibited itself as rhinorrhea and/or otorrhea. All cases with CSF leak had skull base fracture as well. However, post-traumatic CSF leaks are uncommon and are generally treated without surgical intervention (59 %). Distribution of CSF leak varies from one region to another and knowing this fact helps to manage the injury and prevent the complications.

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Section: Discussionsupporting

confidence: 87%

A 7-Year Study of 1,278 Patients with Maxillofacial Trauma and Cerebrospinal Fluid Leak

Hasheminia

Motamedi

Hashemzehi

et al. 2014

J. Maxillofac. Oral Surg.

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“…A minor dural lesion noted during surgery, adequately sutured and treated with a day of bed rest postoperatively is no major issue but in the other end of the spectrum complication problems such as dural fistulas and cysts, meningitis, arachoiditis and epidural abscesses can occur. In addition to direct closure by sutures, also fascial, muscular and artificial grafts exist, further fibrin glue, and, another possibility, sub arachnoid drainage also may be utilized [10]. Some conflict regarding the long-term outcome after dural lesion exists [11,12].…”

Section: Discussionmentioning

confidence: 99%

Dural lesions in decompression for lumbar spinal stenosis: incidence, risk factors and effect on outcome

2011

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Introduction Decompression for lumbar spinal stenosis is one of the most frequent operations on the spine today. The most common complication seems to be a peroperative dural lesion. There are few prospective studies on this complication regarding incidence and effect on long-term outcome; this is the background for the current study. Materials and methods Swespine, the Swedish Spine Register documents the majority ([80%) of lumbar spine operations in Sweden today. Within the framework of this register, totally 3,699 operations for spinal stenosis during a 5-year period were studied regarding complications and 1-year postoperative outcome. Mean patient age was 66 (37-92) years and 44% were males. Fourteen percent were smokers and 19% had undergone previous lumbar spine surgery. Results The overall incidence of a peroperative dural lesion was 7.4%, 8.5% of patients undergoing decompressive surgery only and 5.5% of patients undergoing decompressive surgery ? fusion (p \ 0.001). A logistic regression analysis demonstrated that (high) age (p \ 0.0004), previous surgery (p \ 0.036) and smoking (p \ 0.049) were significantly predictive factors for dural lesions. An odds ratio estimate demonstrated an age-related risk increase with 2.7% per year. The risk for dural lesions also increased with number of levels decompressed. The 1-year outcome was identical in the two groups with and without a dural lesion.Conclusion A dural lesion was seen in 7.4% of decompressive operations for spinal stenosis. High age, previous surgery and smoking were risk factors for sustaining a lesion, which, however, did not affect the 1-year outcome negatively.

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“…The small but serious risk for the latter complications calls for immediate attention when dural lesion is noted during surgery. A number of treatment modalities have been presented ranging from direct closure by sutures to facial, muscular, or artificial grafts, fibrin glue and closed subarachnoid drainage [7].…”

Section: Discussionmentioning

confidence: 99%

Dural lesions in lumbar disc herniation surgery: incidence, risk factors, and outcome

2009

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In lumbar disc herniation surgery, dural lesions seem to be the most common complication today. Studies on incidence of and outcome after a dural lesion are mainly based on retrospective studies. In a prospective study within the framework of the Swedish Spine Register, 4,173 patients operated on for lumbar disc herniation were evaluated using pre-and 1-year postoperative protocols and complication registration. Mean patient age was 41 (18-81) years and 53% of the patients were male. 93% of the operations were performed on the two lowermost lumbar levels. The incidence of dural lesions in the material was 2.7%. In patients with previous disc surgery, the incidence was doubled, 5%, a significant increase (P = 0.02). Patients with dural lesions preoperatively had more back pain and inferior scores in general health and role emotional domains of the SF-36. These factors, however, were because they had been operated on previously, not related to the dural lesion as such. The relative improvement after surgery was similar whether a dural lesion had occurred or not. It is concluded that a dural lesion is a technical complication which must be solved at the time of surgery but which does not bear any negative implications on the long-term outcome for the patient.

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Closed subarachnoid drainage for management of cerebrospinal fluid leakage after an operation on the spine.

Cited by 206 publications

References 0 publications

A 7-Year Study of 1,278 Patients with Maxillofacial Trauma and Cerebrospinal Fluid Leak

A 7-Year Study of 1,278 Patients with Maxillofacial Trauma and Cerebrospinal Fluid Leak

Dural lesions in decompression for lumbar spinal stenosis: incidence, risk factors and effect on outcome

Dural lesions in lumbar disc herniation surgery: incidence, risk factors, and outcome

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