gms | German Medical Science

Objective: A possible, rather rare complication after spinal surgery is known as cerebrospinal fluid fistula. It is the result of the incidental dural tear when the dura, despite best efforts cannot be sutured or glued entirely or when the cerebrospinal fluid partially leaks after the closure during the surgery. Another rare consequence of the CSF fistula, is when the cerebrospinal fluid collects into a pool under the skin suture, known as pseudomeningocele, both possibilities can lead into persistent headache and infection. Considering there are several opinions in literature regarding the methods used to treat postoperative cerebrospinal fluid fistula, this retrospective study will focus on determining the best method to treat the CSF fistula post surgery at our institution.

Method: Between 2005 and 2013, 27 patients developed CSF fistula after undergoing spinal surgery at our institution. A database was used to retrospectively analyze the cases when the CSF fistula occurred, the causes of the CSF fistula, the treatment method used and the final outcome of the treatment.

Results: One patient did not need any treatment. 14 of the 27 patients were initially treated by a lumbar drainage, bed rest, tapping and pressure dressings but only one case deemed successful, 13 patients still needed surgery. 25 patients needed surgery in order to eliminate the fistula. Depending on the size of the leaks we either used direct sutures with or without dural patch or fibrin sealants and tissue adhesives to glue the dural surface mostly combined with simultaneous lumbar drain during the operation. In one patient, although treated with surgery, a lumbar peritoneal shunt was still needed.

Conclusions: The success rate from initial lumbar drain, bed rest, tapping and pressure dressing treatment was as low as 4%, therefore these manoeuvres result in a prolonged length of hospital stay and costs to the system. In order to avoid repetitive treatments and its associated costs and morbidity, cerebrospinal fluid fistula post spinal surgery should be treated with surgery including simultaneous lumbar drain during the operation.