Prolonged Jackson-Pratt drainage in the management of lumbar cerebrospinal fluid leaks

Hughes, Samuel A.; Ozgur, Burak M.; German, Michael; Taylor, William R.

doi:10.1016/j.surneu.2005.11.052

Cited by 68 publications

(50 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Other adjuncts in the management of durotomies include fibrin glue, muscle patch, dural patch, 8 subfascial drain, 12,15 subarachnoid drain, 29 CT-guided percutaneous fibrin glue patch, 21 and epidural blood patch. We routinely use an intraoperative Valsalva maneuver to check for watertight closure after primary dural repair.…”

Section: Discussionmentioning

confidence: 99%

Management of intended durotomy in minimally invasive intradural spine surgery

Tan¹,

Takagi²,

Straus³

et al. 2014

SPI

View full text Add to dashboard Cite

Object Minimally invasive surgery (MIS) has been increasingly used for the treatment of various intradural spinal pathologies in recent years. Although MIS techniques allow for successful treatment of intradural pathology, primary dural closure in MIS can be technically challenging due to a limited surgical corridor through the tubular retractor system. The authors describe their experience with 23 consecutive patients from a single institution who underwent MIS for intradural pathologies, along with a review of pertinent literature. Methods A retrospective review of a prospectively collected surgical database was performed to identify patients who underwent MIS for intradural spinal pathologies between November 2006 and July 2013. Patient demographics, preoperative records, operative notes, and postoperative records were reviewed. Primary outcomes include operative duration, estimated blood loss, length of bed rest, length of hospital stay, and postoperative complications, which were recorded prospectively. Results Twenty-three patients who had undergone MIS for intradural spinal pathologies during the study period were identified. Fifteen patients (65.2%) were female and 8 (34.8%) were male. The mean age at surgery was 54.4 years (range 30–74 years). Surgical pathologies included neoplastic (17 patients), congenital (3 patients), vascular (2 patients), and degenerative (1 patient). The most common spinal region treated was lumbar (11 patients), followed by thoracic (9 patients), cervical (2 patients), and sacral (1 patient). The mean operative time was 161.1 minutes, and the mean estimated blood loss was 107.2 ml. All patients were allowed full activity less than 24 hours after surgery. The median length of stay was 78.2 hours. Primary sutured dural closure was achieved using specialized MIS instruments with adjuvant fibrin sealant in all cases. The rate of postoperative headache, nausea, vomiting, and diplopia was 0%. No case of cutaneous CSF fistula or symptomatic pseudomeningocele was identified at follow-up, and no patient required revision surgery. Conclusions Primary dural closure with early mobilization is an effective strategy with excellent clinical outcomes in the use of MIS techniques for intradural spinal pathology. Prolonged bed rest after successful primary dural closure appears unnecessary, and the need for watertight dural closure should not prevent the use of MIS techniques in this specific patient population.

show abstract

Section: Discussionmentioning

confidence: 99%

Management of intended durotomy in minimally invasive intradural spine surgery

Tan¹,

Takagi²,

Straus³

et al. 2014

SPI

View full text Add to dashboard Cite

show abstract

“…A new treatment strategy has been proposed recently, which is to change the pressure difference to retard CSF leak. In this review, all treatment approaches were classified into two groups based on a fluid flow mechanics: 1) stopping CSF leak by direct suture or augmented closure with dural substitute material8, 9, 10, 11, 12, 13, 14, 15; 2) retarding CSF leak by reducing the subarachnoid fluid pressure and/or increasing the epidural space pressure 16, 17, 18, 19, 20, 21, 22, 23, 24…”

Section: Treatment Strategiesmentioning

confidence: 99%

“…The flow of CSF in the subarachnoid space is based on the difference in CSF pressures between 2 communicating points 16, 22, 23, 24. Therefore, CSF leak can be retarded by decreasing the difference between the two pressures, including reducing the subarachnoid fluid pressure and increasing the epidural space pressure.…”

Section: Treatment Strategiesmentioning

confidence: 99%

Treatment of cerebrospinal fluid leak after spine surgery

Zhao

Tian

Jia

et al. 2017

Chinese Journal of Traumatology

View full text Add to dashboard Cite

Owing to the complexity of spinal surgery, there is a great prevalence of dural tear causing cerebrospinal fluid (CSF) leakage. Many studies focused on suture repair for dural tear to stop CSF leak. Now some new treatment strategies have shown a promising effect that is listed as follows: 1) creating watertight dural closure to stop CSF leak with the help of dural substitute material; and 2) retarding CSF leak by changing pressure difference, including reducing the subarachnoid fluid pressure, increasing the epidural space pressure and both. In fact several methods mentioned above are usually combined to treat CSF leak. However, no update review summarized the relevant studies implemented in recent years. In this review, the authors would compare the effects of different dural closure techniques, and introduce the latest treatment methods and mechanisms.

show abstract

“…Rather, this approach is similar to methods proposed for the management of post-spinal surgery CSF leaks. 13 The link between CSF leakage and infection, however, is well-established. 14- 19 We would suggest that pro- Fig.…”

Section: Discussionmentioning

confidence: 99%