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61st Annual Meeting of the German Society of Neurosurgery (DGNC) as part of the Neurowoche 2010
Joint Meeting with the Brazilian Society of Neurosurgery on the 20 September 2010

German Society of Neurosurgery (DGNC)

21 - 25 September 2010, Mannheim

Postoperative CSF fistulas after spinal procedures - risk factors and clinical implications: 12-month interim results of a multicenter quality-control study

Meeting Abstract

  • Sebastian Spuck - Klinik für Neurochirurgie, UK-SH Campus Lübeck, Germany
  • Günther Kundt - Institut für Medizinischen Informatik und Biometrie, Universität Rostock, Germany
  • Clemens Weber - Abteilung für Neurochirurgie, Universitätsklinikum Rostock, Germany
  • Volker Tronnier - Klinik für Neurochirurgie, UK-SH Campus Lübeck, Germany
  • Jürgen Piek - Abteilung für Neurochirurgie, Universitätsklinikum Rostock, Germany

Deutsche Gesellschaft für Neurochirurgie. 61. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC) im Rahmen der Neurowoche 2010. Mannheim, 21.-25.09.2010. Düsseldorf: German Medical Science GMS Publishing House; 2010. DocV1656

DOI: 10.3205/10dgnc129, URN: urn:nbn:de:0183-10dgnc1293

Published: September 16, 2010

© 2010 Spuck et al.
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Outline

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Objective: The occurrence of a postoperative CSF fistula after spinal surgery is a serious event often resulting in additional medical and surgical interventions, prolonged hospital stay, and increased costs. The current study was designed to evaluate possible risk-factors and the clinical impact of such complications in order to identify risk-factors and to develop surgical strategies for its prevention.

Methods: In this non-interventional study data sampling was prospectively performed for all patients undergoing spinal operations with the potential risk of a CSF fistula (elective or incidental dural opening in degenerative, trauma, or tumor cases). Possible risk factors (previous chemotherapy and operations, radiation) as well as the influence of other factors (type and localisation of the operation, techniques for wound and dural closure, use of drainages) were also evaluated. Patients <14 years were not included. Statistical analysis was done by chi-square-tests. The study had been approved by the local ethical committee.

Results: 847 patients were screened; opening of the dura was noticed in 109 patients. In 27 patients with intradural tumors/vascular malformations the dural opening was intended. 82 patients had accidental lesions (75.2%). The male/female ratio was 58/51. Localisation of the dural leak was cervical in 11%, thoracic in 11.9%, and lumbar in 77.1%. 7 of the 109 patients with a dural opening subsequently developed a CSF fistula (6.4%), most of them located lumbar (p=0.007). Accidental dural lesions were more frequently observed following small spinal accesses (foraminotomy, flavectomy; p=0.002). Other factors (e.g. age, radiation, type of dural and wound closure) had no significant influence. This was also true for additional protection of the dural closure by various grafts (e.g. sponges, fibrin-glue). Outcome was not influenced by the presence of a CSF fistula although these complications had some clinical impact.

Conclusions: The incidence of a CSF fistula in spinal surgery in general is comparably low (0.8%). Procedures with planned or accidental dural opening develop a persistent fistula in 6.4% of all cases, requiring further treatment. Besides localisation (lumbar) we could not detect any significant risk factors for this complication. So far, surgical strategies for prevention of CSF fistulas could also not be identified in our patients, which might be due to the surprisingly low number of fistulas at all.