Postoperative Cerebrospinal Fluid Fistula Research Articles

Treatment of postoperative subgaleal cerebrospinal fluid fistulas by using fibrin sealant. Technical note.

The authors describe a simple technique by which a postoperative subgaleal cerebrospinal fluid fistula is treated by local tapping and injection of fibrin sealant through the same needle.

Use of bone wax in the prevention of cerebrospinal fluid fistula in acoustic neuroma surgery.

Use of bone wax in the prevention of cerebrospinal fluid fistula in acoustic neuroma surgery.

A shunting procedure employing cannulation of the lumbar theca through the meningocele sac

An alternative thecoperitoneal shunting procedure is described to counter the problem of cerebrospinal fluid (CSF) fistula following surgery for meningocele and related conditions. The lumbar end of the shunt traverses the meningocele sac. The procedure was effectively employed to deal with postoperative CSF fistula in two cases operated on earlier for lipomeningomyelocele.

Bone window computed tomography for detection of dural defect associated with cervical ossified posterior longitudinal ligament.

Anterior decompression of a cervical ossified posterior longitudinal ligament (OPLL) which involves the dura mater occasionally results in a postoperative cerebrospinal fluid fistula. Bone window computed tomography (CT) was carried out to detect dural defects in 21 patients with cervical OPLL. Twelve of 21 patients had double-layer OPLL, and nine had single-layer OPLL. Dural defects were present in 10 of the 12 patients with double-layer OPLL compared with only one of the nine patients with single-layer OPLL. In addition, greater stenosis of the spinal canal by the OPLL was also associated with dural defect. Preoperative bone window CT can indicate likely locations of dural defect in patients with OPLL.

Craniofacial osteotomies to facilitate resection of large tumours of the anterior skull base

Large tumours of the anterior cranial fossa can be a major challenge to the neurosurgeon or the maxillofacial surgeon. However, skull base approaches facilitate their resection. We describe our experience with the extended subfrontal approach in treating tumours of the anterior cranial base. This approach was performed on 29 patients with large tumours of the anterior skull base. The final outcome in all 29 patients was favourable in terms of total resection of the tumour with minimal subsequent neurological deficit. Two patients developed transient oedema of the frontal lobes without persistent neurological sequelae. Another patient developed a postoperative cerebrospinal fluid fistula that was successfully repaired. The patients were followed for a period ranging from 6 to 28 months. There was no recurrence. The operative technique is described. En bloc removal of the roofs of the orbits and part of the anterior cranial fossa permits wide exposure of the lesion with minimal brain retraction. Reconstruction of the anterior cranial base should be meticulous to avoid cerebrospinal fluid leaks and subsequent meningitis. Loss of smell is a sequel to this approach. The possible risks and some important technical details are highlighted.

Microsurgical Removal of Olfactory Groove Meningiomas via the Pterional Approach

Commonly used frontobasal approaches for microsurgical removal of olfactory groove meningiomas have certain disadvantages, such as late exposure of the neurovascular complex located dorsal to the tumor, namely, the internal carotid artery, middle cerebral artery, anterior cerebral artery, and the optic nerves. In addition, the frontal sinuses are frequently opened and there can be compression of the frontal lobes from significant spatula pressure. We report our experience with the pterional approach for these tumors in 28 patients. All patients presented with hyposmia/anosmia; 20 had personality changes and 8 had visual deficits. At surgery, after dissection of the sylvian fissure, the internal carotid artery, middle cerebral artery, anterior cerebral artery, and the homolateral optic nerve were exposed before removal of the posterior tumor parts. Reduction of focal pressure was achieved by removal of the contralateral tumor following partial resection of the falx and crista galli. Total tumor removal was obtained in all but 1 patient. One patient died of pulmonary embolism. The psychoorganic syndrome resolved in all but 1 patient; visual deficits improved in 6 patients. There were no postoperative infections. We consider the pterional approach to be superior to others for these lesions because it provides early exposure of the neurovascular complex, preservation of the frontal venous drainage, and avoidance of postoperative cerebrospinal fluid fistulae.

Closure of extensive and complicated laminectomy wounds. Operative technique.

Fifty-eight patients with previously irradiated intramedullary spinal cord astrocytomas underwent laminectomy for radical excision of their tumors. A high incidence of postoperative cutaneous cerebrospinal fluid fistulas and large pseudomeningoceles following routine closure prompted the development of an alternative method of wound closure using mobilized musculofascial flaps. The authors describe the surgical techniques and pitfalls to be avoided during the closure of complicated laminectomy wounds.

Radical Removal of Lipomas of the Conus and Cauda Equina with Laser Microneurosurgery

Ten patients with ages ranging from 4 weeks to 21 years presented with a subcutaneous lumbosacral mass noted at birth. After spinal high resolution ultrasonography or computed tomography to determine the extent of neural involvement and the length of the tumor mass in the spinal canal, the patients underwent operation. Rectal electromyographic continuous monitoring was used in all for assessment of the S-2 and S-3 function during dissection. Carbon dioxide laser microneurosurgery was used in all operations. Radiating energy was used for the subcutaneous mass removal (40 to 60 W), the intracanalicular dissection (1 to 5 W), and the intraconus dissection (1 to 3 W). A radical removal was obtained in all. Postoperative cerebrospinal fluid fistula occurred in 1 patient and was successfully treated. Wound dehiscence that healed with secondary closure occurred in 2 patients. Would infection that required treatment with systemic antibiotics and topical therapy occurred in 1 patient. Paraplegia occurred in 1 patient. This was the single very significant complication of this series. It was thought to have occurred because of the polymer used to seal the tenuous dura mater at the time of closure. We conclude that, with carbon dioxide laser microneurosurgery, the lipomatous tumors can be removed safely from the neural structures of the conus and cauda.

Treatment of postoperative cerebrospinal fluid fistulas by subarachnoid drainage.

✓ The authors report the details of the successful treatment of 11 of 12 patients with postoperative cerebrospinal fluid fistulas. Continuous lumbar or ventricular fluid drainage was used.