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cerebrospinal fluid leakage after Thoracic Decompression

Chinese Medical Journal 2016年第16期129卷 1994-2000页

作者： Pan-Pan Hu Xiao-Guang Liu Miao Yu Department of Orthopaedics Peking University Third Hospital Beijing 100191 China

Objective： The objective of this study is regular and special features. to review cerebrospinal fluid leakage （CSFL） after thoracic decompression and describe its Data Sources： Literature cited in this review was retrieved from PubMed and Medline and was primarily published during the last 10 years. ＂cerebrospinal fluid＂, ＂leakage＂, ＂dural tears＂, and ＂thoracic decompression＂ were the indexed terms. Relevant citations in the retrieved articles were also screened to include more data. Study Selection： All retrieved literature was scrutinized, and tbur categories were recorded： incidence and risk factors, complications, treatment modalities, and prognosis. Results： CSFL is much more frequent after thoracic decompression than after cervical and lumbar spinal surgeries. Its occurrence is related to many clinical factors, especially the presence of ossified ligaments and the adhesion of the dural sac. While its impact on the late neurological recovery is currently controversial, CSFL increases the risk of other perioperative complications, such as low intracranial pressure symptoms, infection, and vascular events. The combined use of primary repairs during the operation and conservative treatment postoperatively is generally effective for most CSFL cases, whereas lumbar drains and reoperations should be implemented as rescue options for refractory cases only. Conclusions： CSFL after thoracic decompression has not been specifically investigated, so the present study provides a systematic and comprehensive review of the issue. CSFL is a multi-factor-related complication, and pathological fators play a decisive role. The importance of CSFL is in its impact on the increased risk of other complications during the postoperative period. Methods to prevent these complications are in need. In addition, though the required treatment resources are not special for CSFL after thoracic decompression, most CSFL cases are conservatively curable, and surgeons should be aware of it.

关键词： cerebrospinal fluid leakage Incidence Systemic Review Thoracic Decompression Treatment

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Safety and biodegradability of a synthetic dural sealant patch(Liqoseal)in a porcine cranial model

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Animal Models and Experimental Medicine 2021年第4期4卷 398-405页

作者： Ahmet Kinaci Wilhelmina Bergmann Sander van Thoor Saskia Redegeld Albert van der Zwan Tristan P.C.van Doormaal Department of Neurology and Neurosurgery Brain CenterUniversity Medical Centre UtrechtUtrechtThe Netherlands Brain Technology Institute UtrechtThe Netherlands Division of Pathology Faculty of Veterinary MedicineUtrecht UniversityUtrechtThe Netherlands Department of Neurosurgery Clinical Neuroscience CenterUniversity Hospital ZurichZurichSwitzerland

Background:Liqoseal consists of a watertight layer of poly(ester)ether urethane and an adhesive layer containing polyethylene glycol-N-hydroxysuccinimide(PEG-NHS).It is designed to prevent cerebrospinal fluid(CSF)leakage after intradural surgery.This study assessed the safety and biodegradability of Liqoseal in a porcine craniotomy model.Methods:In 32 pigs a craniotomy plus durotomy was performed.In 15 pigs Liqoseal was implanted,in 11 control pigs no sealant was implanted and in 6 control pigs a control dural sealant(Duraseal or Tachosil)was implanted.The safety of Liqoseal was evaluated by clinical,MRI and histological assessment.The degradation of Liqoseal was histologically estimated.Results:Liqoseal,2 mm thick before application,did not swell and significantly was at maximum mean thickness of 2.14(±0.37)mm at one month.The foreign body reaction induced by Liqoseal,Duraseal and Tachosil were comparable.Liqoseal showed no adherence to the arachnoid layer and was completely resorbed between 6 and 12 months postoperatively.In one animal with Liqoseal,an epidural fluid collection containing CSF could not be excluded.Conclusion:Liqoseal seems to be safe for intracranial use and is biodegradable.The safety and performance in humans needs to be further assessed in clinical trials.

关键词： cerebrospinal fluid leakage craniotomy dura in vivo model sealant

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Subdural fluid collection rather than meningitis contributes to hydrocephalus after cervical laminoplasty:A case report

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World Journal of Clinical Cases 2021年第22期9卷 6485-6492页

作者： Hao-Han Huang Zhi-Hua Cheng Bao-Zhi Ding Jie Zhao Chang-Qing Zhao Department of Orthopaedics Shanghai Key Laboratory of Orthopaedic ImplantsShanghai Ninth People’s HospitalShanghai Jiao Tong University School of MedicineShanghai 200011China Department of Neurosurgery Shanghai Ninth People’s HospitalShanghai Jiao Tong University School of MedicineShanghai 200011China

BACKGROUND Hydrocephalus following dural tear after spinal surgery is rare.Although a few cases of obstructive hydrocephalus caused by subdural fluid collection and communicating hydrocephalus associated with meningitis have been reported,the mechanism remains uncertain.Herein we describe a patient complicated with hydrocephalus after cervical laminoplasty in whom subdural fluid collection in the cervical spine and posterior cranial fossa rather than chronic meningitis was the main mechanism.CASE SUMMARY A 45-year-old man underwent cervical laminoplasty for cervical spondylotic myelopathy at a local hospital.Ten days postoperatively,a high fever occurred and magnetic resonance imaging(MRI)showed cerebrospinal fluid(CSF)leakage.Pseudomeningocele liquid test showed high levels of protein and white blood cell(WBC)count with negative bacterial culture.The patient was treated with shortterm intravenous antibiotic and discharged with normal body temperature.The patient was uneventful during the first 8 mo follow-up although repeated MRI showed persistent pseudomeningocele.At the 9th mo postoperatively,the patient gradually presented with dizziness and headache accompanied by recurrent weakness of his left arm.Imaging examinations demonstrated hydrocephalus and a cystic lesion around the cervical spinal cord.CSF test from lumbar puncture indicated chronic meningitis.MRI on 1 d after pseudomeningocele drainage showed a significant decrease in the cystic volume,suggesting that the cystic lesion would be subdural fluid collection rather than adhesive arachnoiditis.After dural defect repair,the patient’s symptoms completely resolved and hydrocephalus gradually disappeared.CSF analysis at the 21-mo follow-up revealed significantly decreased protein level and WBC count.CONCLUSION Subdural fluid collection rather than meningitis contributes to the hydrocephalus formation after cervical laminoplasty.

关键词： Hydrocephalus cerebrospinal fluid leakage Cervical laminoplasty Subdural fluid collection Meningitis Case report

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Successful management of depression skull fracture in a boy with dog bite injury:A case report

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Journal of Acute Disease 2022年第5期11卷 202-205页

作者： Abdulkerim Gokoglu Hasan Tahsin Gozdas Selime Ozen Sonay Gokoglu Department of Neurosurgery Private System HospitalKayseriTurkey Department of Infectious Diseases and Clinical Microbiology Abant Izzet Baysal University Faculty of MedicineBoluTurkey Department of Pediatrics Dr.Behcet Uz Children’s Disease and Pediatric Surgery Training and Research HospitalİzmirTurkey Department of Pediatrics Private Huma HospitalKayseriTurkey

Rationale:There are many cases of daily reported dog bite injuries around the world.However,craniofacial fractures owing to dog bites are quite rare.They are frequently seen in the pediatric age group.Here,we report the successful management of a pediatric patient with depression skull fracture due to a dog bite injury.Patient’s concerns:A 3-year-old boy was admitted to the emergency department with a complicated skull fracture due to a dog bite injury.In physical examination,the patient was neurologically intact.He had hemorrhagic scalp wounds.cerebrospinal fluid was leaking on the right temporal and frontal sides.Diagnosis:Cranial computed tomography revealed pneumocephalus,brain edema,and compound fracture associated with right frontal concussion.Intervention:After decompressive craniectomy,duraplasty was performed by placing a galea graft.Depressed fractures were removed and subdural bleeding control was provided.Outcomes:Perioperative and postoperative periods were uneventful.Lessons:Emergency medicine physicians should control possible underlying fracture lines in pediatric head trauma caused by dog bites.

关键词： Craniocerebral trauma Dog bite Skull fracture Pediatric patient Cranial computed tomography cerebrospinal fluid leakage

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