Abstract
Background:In spinal surgery, cerebrospinal fluid (CSF) fistulas attributed to deliberate dural opening (e.g., for tumors, shunts, marsupialization of cysts) or inadvertent/traumatic dural tears (DTs) need to be readily recognized, and appropriately treated.Methods:During spinal surgery, the dura may be deliberately opened to resect intradural lesions/tumors, to perform shunts, or to open/marsupialize cysts. DTs, however, may inadvertently occur during primary, but are seen more frequently during revision spinal surgery often attributed to epidural scarring. Other etiologies of CSF fistulas/DTs include; epidural steroid injections, and resection of ossification of the posterior longitudinal ligament (OPLL) or ossification of the yellow ligament (OYL). Whatever the etiology of CSF fistulas or DTs, they must be diagnosed utilizing radioisotope cisternography (RIC), magnetic resonance imaging (MRI), computed axial tomography (CT) studies, and expeditiously repaired.Results:DTs should be repaired utilizing interrupted 7-0 Gore-Tex (W.L. Gore and Associates Inc., Elkton, MD, USA) sutures, as the suture itself is larger than the needle; the larger suture occludes the dural puncture site. Closure may also include muscle patch grafts, dural patches/substitutes (bovine pericardium), microfibrillar collagen (Duragen: Integra Life Sciences Holdings Corporation, Plainsboro, NJ), and fibrin glues or dural sealants (Tisseel: Baxter Healthcare Corporation, Deerfield, IL, USA). Only rarely are lumbar drains and wound-peritoneal and/or lumboperitoneal shunts warranted.Conclusion:DTs or CSF fistulas attributed to primary/secondary spinal surgery, trauma, epidural injections, OPLL, OYL, and other factors, require timely diagnosis (MRI/CT/Cisternography), and appropriate reconstruction.
Highlights
Two major types of cerebrospinal fluid (CSF) fistulas/ dural tears (DTs) are encountered during spinal surgery [Table 1]
The first are deliberate dural incisions required to remove intradural pathology, including tumors or cysts, as well as those required for elective shunt placement
The frequency and type of anticipated vs. traumatic CSF fistulas/DTs encountered during spinal surgery are reviewed, along with other etiologies of dural breach The various operations/procedures that result in CSF leaks/DTs, the techniques utilized to diagnose fistulas, and their treatment with multiple adjunctive measures are assessed [Table 1]
Summary
Two major types of cerebrospinal fluid (CSF) fistulas/ dural tears (DTs) are encountered during spinal surgery [Table 1]. There are multiple other etiologies that may contribute to the deliberate or inadvertent dural opening; dural pathology extending to/through the dura (occasional discs, synovial cysts, hypertrophy/ossification of the yellow ligament [OYL] or ossification of the posterior longitudinal ligament [OPLL]), and other factors. The frequency and type of anticipated vs traumatic CSF fistulas/DTs encountered during spinal surgery are reviewed, along with other etiologies of dural breach (e.g., with epidural steroid injection, spontaneous DT, others) The various operations/procedures that result in CSF leaks/DTs, the techniques utilized to diagnose fistulas, and their treatment with multiple adjunctive measures are assessed [Table 1]. Cerebrospinal fluid (CSF) fistulas attributed to deliberate dural opening (e.g., for tumors, shunts, marsupialization of cysts) or inadvertent/traumatic dural tears (DTs) need to be readily recognized, and appropriately treated
Sign-in/Register to view highlights & summary 
Published Version
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call