12/9/2023 0 Comments Dangers of spinal fluid leak![]() One well-known and widely accepted management option is surgical repair by either meticulous direct primary closure of the dura or augmented closure by means of fat, muscle tissue, or a fascia graft. Several methods are used for the management of CSF leak including direct suturing 1, 6 ), percutaneous injection 7, 8 ), drainage therapy 9- 11 ), and blood patch 9, 12- 14 ). All our patients were advised to have a day of bed rest following the blood patch injection, and CSF leak did not recur in any of the patients. Our current results demonstrate that this simple procedure for postoperative CSF leaks provides a good alternative to reoperation. The symptoms of intracranial hypotension resolved, and no complications such as worsening back pain, lower limb pain, or fever occurred. CSF leak did not recur after the procedure in any of the patients. The patient's clinical status was assessed following the blood injection and was based on the presence of the following: evidence of recurrence of CSF leak, intracranial hypotension symptoms, low back pain, lower limb symptoms, and fever.Īll patients were advised to take a day of bed rest and all patients could stand and walk reassuringly the next morning. 1a, b) until we saw overflowed blood from the tract. We removed the silicone drain and injected about 4-5 ml of blood into the drain tract with an indwelling needle ( Fig. Blood is injected slowly while checking the patient’s clinical state.Īfter diagnosing a CSF leak, we performed venesection from the patient's medial cubital vein. An indwelling plastic needle is inserted into the drain tract, and blood from the patient is injected into the needle. We diagnosed CSF leak when the glucose concentration was less than 100 mg/dl 1 ).Ī. In addition, we measured the glucose concentration of the exudate using urine dip test paper. 1a), and they had intracranial hypotension syndrome with symptoms such as postural headaches caused when moving from a lying to standing position. In all cases, the lumbar dressings of the patients were saturated with clear fluid ( Fig. We also used soft fluted silicone drain (Blake drains, Ethicon, Somerville, N.J.) 5 ) in all surgeries (drain size: 19 French in 6 cases, 10 French in 1 case), and all were drained at the same pressure. After repairing the dural tear, we checked the CSF leak using the Valsalva maneuver. In microendoscopic decompression, we used a small piece of polyglactin 910 and fibrin glue without suturing the dura. In four out of five cases, we sutured the dura and reinforced it using a small piece of polyglactin 910 (Vicryl Knitted Mesh, Ethicon, Somerville, New Jersey) and fibrin glue (Bolheal, Astellas, Tokyo, Japan) 4 ). In five cases, CSF leak from dural tears was noted. ![]() The surgeries performed included decompression in two patients (one microendoscopic surgery), fusion in four, and an epidural cyst resection in one. The patients and/or their families provided informed consent that data from their case would be submitted for publication. We enrolled 7 consecutive patients undergoing lumbar spine surgery at our institution, none of whom suffered from diabetes (1 male, 6 female mean age, 67.4 years) ( Table 1).
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