Use of an External Ventricular Drain for Treatment of a Thoracolumbar Cerebrospinal Fluid Leak: A Case Report and Review of Literature.

Abstract

Post-operative cerebrospinal fluid (CSF) leak is a known complication in spine surgery. This mostly iatrogenic issue is typically treated using a variety of modalities (i.e., bed rest, epidural patch), CSF diversion methods, or primary repair. The use of an external ventricular drain to treat this post-operative complication has been infrequently reported. We describe a case of a CSF leak after thoraco-lumbar surgery treated using an external ventricular drain and a review of the literature regarding this treatment modality. A 70-year-old man presented to our clinic with a recent diagnosis of multiple myeloma with progressive thoracic kyphosis and spinal stenosis. He developed progressive neurological deficits over the course of several weeks. Radiological studies showed significant thoracic kyphosis and severe cord compression in the thoraco-lumbar area. The patient underwent a T9-L4 posterior instrumentation and fusion with decompression surgery that developed post-operative wound infection and a CSF leak. An external ventricular drain (EVD) was used successfully as a CSF diversion method where direct thoracolumbar approaches were not feasible. Given the effectiveness of EVD placement in treating this post-operative complication, we concluded that the use of an EVD can be a potentially safe and effective way to treat thoracolumbar CSF leakage when lumbar or cervical drainage is not feasible.