Post-operative cerebrospinal fluid leak: single-continuous versus double-breasted dural repair of myelomeningocele

Abstract

BackgroundMyelomeningocele is the most common neural tube defect in our environment. Initial surgical management involves untethering and water-tight dural closure. Single-continuous dural repair is more straightforward and faster than the double-breasted repair, even though the latter offers more strength to the reconstructed dura as the repair is in two layers. Preference was given to single-continuous repair even though the two techniques were not compared in terms of post-operative cerebrospinal fluid leak. The aim of this study was to compare the frequency of cerebrospinal fluid (CSF) leak following single-continuous versus double-breasted dural repair of myelomeningocele.Patients and methodsThis was a randomized prospective study that reviewed all patients that presented to Usmanu Danfodiyo University Teaching Hospital (UDUTH) Sokoto, Nigeria, with myelomeningocele who met the inclusion criteria. Fifty-four patients were enrolled into the study randomized into two groups of 27 patients each. Group 1 had single-continuous repair, while group 2 had double-breasted technique. Post-operatively, patients were assessed for post-operative cerebrospinal fluid leak and pseudomeningocele. Data collected were analysed using the statistical package for social sciences version 22.0. The value for significance was set at 0.05.ResultsThe median age at presentation for both groups was 5 months. Both groups showed female preponderance with a female-to-male ratio of 1.3:1 and 1.7:1. Post-operative CSF leak occurred in 2(7.4%) patients in the single-continuous group compared to 3(11.1%) patients in the double-breasted group. Only 1(3.7%) patient in the single-continuous group developed pseudomeningocele and none in the double-breasted.ConclusionDural repair technique of myelomeningocele does not influence the occurrence of post-operative cerebrospinal fluid leak.