gms | German Medical Science

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 cranial intradural procedures – risk factors and clinical implications: 12-month results of a multicenter quality-control study

Meeting Abstract

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

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. DocV1687

DOI: 10.3205/10dgnc158, URN: urn:nbn:de:0183-10dgnc1580

Published: September 16, 2010

© 2010 Spuck et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

Text

Objective: The occurrence of a postoperative CSF fistula after cranial surgery is a serious event often resulting in additional and prolonged treatment. The current study evaluates possible risk factors and the clinical impact of such complications in order to develop surgical strategies for its prevention.

Methods: In this non-interventional study data sampling was prospectively performed for all patients undergoing cranial, intradural operations for all kind of pathologies. Exclusion criteria were: age <14 years and burr-hole trephinations. Possible risk factors as well as the influence of techniques for wound, dural closure, type of intracranial pathology, location of the trephination, use of drainages, were evaluated. Statistical analysis was done by chi-square-tests.

Results: 344 cases, range of age: 14–89 years. The overall incidence of CSF fistulas was 6.4%. In 14 cases they occurred before discharge (4.1%), in 8 patients thereafter (2.3%). Mainly affected grouped age is from 51–65y in 8.3% (p=0.029). The localisation of the trephination had a significant influence (p=0.033; suboccipital midline: 20%, suboccipital hemispheric: 8.3%, frontobasal: 6.3%, >1 region supratentorial (including pterional): 8.2%, temporal: 2.8%, parietal: 2.4%). Craniectomies (9.1%; p=0.042) had a higher rate than craniotomies (2.9%). Dural closure with large defects >1 cm or resected dura had the highest risk of a fistula (p=0.028), no significant differences were observed in patients with a complete dural closure, with small dural gaps, or gaps up to 1cm. A support of the dural closure significantly reduced the occurrence only in the presence of larger defects (p<0.001) independently from the material used. Risk factors had no significant influence, which was also true for the pathologies, types of sutures used for dural and skin closure. Outcome was not influenced but had clinical impact like prolonged hospital stay, re-operations and lumbar drainage.

Conclusions: The occurrence of a CSF fistula mainly depends on age (51–65 years), location of the trephination and is also significantly increased in patients with craniectomies and large dural defects (> 1 cm). Surgical strategies to lower complication rates include meticulous dural closure to avoid defects larger than 1 cm, and suture support by any graft. Further studies should focus on various surgical strategies for prevention of such CSF fistulas.