Managing The Cerebrospinal Fluid Leaks After Spinal Surgery By Prolonged Subfascial Drainage

摘要

Background: Cerebrospinal fluid (CSF) leaks are a potential complication resulting from a dural violation during spinal surgery. Persistent CSF leakage leads to either pseudomeningocele formation or a CSF fistula, which can result in poor wound healing, infection, and meningitis. Diagnosis of a CSF leak during surgery necessitates direct surgical repair of the dural violation. In instances in which the dural breach cannot be primarily closed, several techniques involving dural sealants, muscle or fat graft, or complex muscle closure can be performed to decrease the risk for forming a CSF fistula. We aimed to manage the CSF leaks with prolonged subfascial drains.Methods: A retrospective review of 914 spinal surgery cases, spanning a 5 years period performed by 5 attending neurosurgeons was analyzed. Among 57 traumatic or incidental dural tears, CSF leakage was seen in 27 patients despite primary repairment of dural tear. All of the patients were treated by leaving the subfascial drain for avarage 15 days. Cefazoline 1gr/day was given all of the patients. The drains were removed after complete wound healing.Results: No patients suffered complications arising from prolonged drain presence and there was no persistent CSF leak after drain removal.Conclusion: Despite primary dural repair, CSF leak after spinal surgery can be treated by prolonged subfascial drains.