Management of Cerebrospinal Fluid Leak following Posterior Cranial Fossa Surgery.

Imran Altaf Hussain,Shahzad Shams,Anjum Habib Vohra

doi:10.12669/pjms.326.9956

Imran Altaf Hussain, Shahzad Shams + Show 1 more

Open Access

https://doi.org/10.12669/pjms.326.9956

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Abstract

Objective:Cerebrospinal fluid leakage remains a significant cause of morbidity following posterior fossa surgery, and its treatment remains a difficult problem. The aim of the study was to propose a treatment algorithm for its management.Methods:A retrospective, single-center study was conducted on 147 patients who underwent elective posterior fossa surgery for a variety of diseases. Patients with post operative CSF leakage had either been treated initially with conservative measures including re-suturing of the wound, with CSF lumbar drainage to be employed in case the CSF leakage didn’t stop, or the initial intervention was the institution of CSF lumbar drainage simultaneously with conservative measures. VP (ventriculo-peritoneal) shunt was done in patients with gross hydrocephalus on postoperative CT brain.Results:There were 25 (17%) cases of CSF leakage, including 24 incisional CSF leaks and one case of CSF otorrhea. In eight patients with incisional CSF leakage treated initially with conservative measures including re-suturing of the wound, CSF leakage stopped in only two cases. CSF lumbar drainage instituted later on in six cases with persistent leakage stopped the CSF leakage. In fourteen patients managed initially with re-suturing of the wound and concomitant CSF lumbar drainage, CSF leakage settled in all the cases. Two patients with gross hydrocephalus on post operative CT were managed successfully with VP shunt. Re-suturing of the wound with concomitant CSF lumbar drainage was found to be significantly associated (p=0.003) with the stoppage of CSF leakage, and the settlement of meningitis (p= 0.014).Conclusion:Incisional CSF leaks after posterior fossa surgery should be managed with re-suturing of the wound and concomitant CSF lumbar drainage, instead of an initial trial of conservative therapy alone.

Highlights

Cerebrospinal fluid (CSF) leak remains a significant source of morbidity in neurosurgery, after posterior fossa surgery.[1]
Treatment options include either to start with conservative measures including re-suturing of the wound and to opt for CSF lumbar drainage in case the CSF leakage doesn’t stop,[6,7] or to institute CSF lumbar drainage simultaneously with the conservative measures as the initial intervention.[8]
There were no cases of CSF leakage after microvascular decompression (MVD) for trigeminal neuralgia in 20 cases

Summary

Introduction

Cerebrospinal fluid (CSF) leak remains a significant source of morbidity in neurosurgery, after posterior fossa surgery.[1]. CSF leakage poses a risk of significant morbidity and remains potentially life-threatening due to the risk of meningitis.[1,3,4] the costs related to treating patients affected by this complication have been estimated to be 141% greater than that of patients without a CSF leak.[1]. Treatment of postoperative CSF leak following posterior fossa surgery remains a difficult and perplexing problem.[5] Treatment options include either to start with conservative measures including re-suturing of the wound and to opt for CSF lumbar drainage in case the CSF leakage doesn’t stop,[6,7] or to institute CSF lumbar drainage simultaneously with the conservative measures as the initial intervention.[8] Surgical repair is done in case these measures fail.[9] Studies conducted on the topic have shown conflicting results and there is no consensus on the optimal method of treatment. The purpose of our study was to retrospectively assess the efficacy of both these treatment regimens, and to propose a treatment algorithm for the management of cerebrospinal fluid leakage following posterior cranial fossa surgery

Methods

Results

Conclusion