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71. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
9. Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

21.06. - 24.06.2020

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Development of cerebrospinal fluid fistula after incidental durotomy in decompressive spine surgery

Entwicklung spinaler Liquorfisteln nach inzidenteller Durotomie bei spinal dekompressiven Eingriffen

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  • presenting/speaker Chrsitoph Hohenberger - Universitätsklinikum Regensburg, Klinik und Poliklinik für Neurochirurgie, Regensburg, Deutschland
  • Alexander Brawanski - Universitätsklinikum Regensburg, Klinik und Poliklinik für Neurochirurgie, Regensburg, Deutschland
  • Florian Zeman - Universitätsklinikum Regensburg, Zentrum für Klinische Studien, Regensburg, Deutschland
  • Karl-Michael Schebesch - Universitätsklinikum Regensburg, Klinik und Poliklinik für Neurochirurgie, Regensburg, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 71. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 9. Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie. sine loco [digital], 21.-24.06.2020. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocP046

doi: 10.3205/20dgnc336, urn:nbn:de:0183-20dgnc3363

Published: June 26, 2020

© 2020 Hohenberger et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objective: Incidental durotomy (ID) during spinal surgery is a risk factor for the development of cerebrospinal fluid (CSF) fistula. The rates of ID with or without consecutive CSF fistula vary according to the extent of the surgical procedure. Revision surgery has the highest rates of dural tears. However, not every case of ID leads to CSF fistula requiring revision surgery. The objective of this study was to analyze the predictors for the development of CSF fistula after ID.

Methods: This retrospective study included 6024 consecutive patients who had been surgically treated for degenerative spinal disease at our clinic over the past 15 years. Patients who had undergone surgical revision for CSF fistula were assigned to the CSF fistula group. A matched 3:1 control group (ID group) was formed of patients with ID but without CSF fistula. Charts, surgical reports, and radiographic data were reviewed and statistically analyzed for demographics, duration of symptoms, co-morbidities, surgical strategy, and pre- and postoperative neurological performance.

Results: The 15-year incidence of CSF fistula in the overall population was 0.36% (n=22). The following anatomic locations were affected: n=18 lumbar (81.8%), n=2 cervical (9.1%), and n=2 thoracic (9.1%). The extent of ID was similar in both groups. The two groups did not significantly differ with regard to the intraoperative management of dural repair with primary suturing (p=0.345), dural patches, sealant, or collagen matrix (p=0.228; p=0.081; p=0.081).In the postoperative period, bed rest in supine position for 48 hours (p=0.037) and laxative therapy (p=0.034) were the most beneficial treatment modalities for preventing CSF fistula.Patients with CSF fistula were hospitalized significantly longer (21 days vs. 10 days in the control group; p<0.001).

Conclusion: This large test group showed a low incidence of postoperative CSF fistula after intraoperative ID. Bed rest and laxative treatment were important approaches towards preventing CSF fistula.