Neurospine

THE KOREAN SPINAL NEUROSURGERY SOCIETY (대한척추신경외과학회)
권호 표지
DOI QR코드

DOI QR Code

Intraoperative Cerebrospinal Fluid Leak in Extradural Spinal Tumor Surgery

  • Ropper, Alexander E. (Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School) ;
  • Huang, Kevin T. (Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School) ;
  • Ho, Allen L. (Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School) ;
  • Wong, Judith M. (Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School) ;
  • Nalbach, Stephen V. (Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School) ;
  • Chi, John H. (Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School)
  • Received : 2018.02.19
  • Accepted : 2018.08.28
  • Published : 2018.12.31
⟨ Previous Next ⟩

Abstract

Objective: Patients with extradural spine tumors are at an increased risk for intraoperative cerebrospinal fluid (CSF) leaks and postoperative wound dehiscence due to radiotherapy and other comorbidities related to systemic cancer treatment. In this case series, we discuss our experience with the management of intraoperative durotomies and wound closure strategies for this complex surgical patient population. Methods: We reviewed our recent single-center experience with spine surgery for primarily extradural tumors, with attention to intraoperative durotomy occurrence and postoperative wound-related complications. Results: A total of 105 patients underwent tumor resection and spinal reconstruction with instrumented fusion for a multitude of pathologies. Twelve of the 105 patients (11.4%) reviewed had intraoperative durotomies. Of these, 3 underwent reoperation for a delayed complication, including 1 epidural hematoma, 1 retained drain, and 1 wound infection. Of the 93 uncomplicated index operations, there were a total of 9 reoperations: 2 for epidural hematoma, 3 for wound infection, 2 for wound dehiscence, and 2 for recurrent primary disease. One patient was readmitted for a delayed spinal fluid leak. The average length of stay for patients with and without intraoperative durotomy was 7.3 and 5.9 days, respectively, with a nonsignificant trend for an increased length of stay in the durotomy cases (p=0.098). Conclusion: Surgery for extradural tumor resections can be complicated by CSF leaks due to the proximity of the tumor to the dura. When encountered, a variety of strategies may be employed to minimize subsequent morbidity.

Keywords

References

  1. McMahon P, Dididze M, Levi AD. Incidental durotomy after spinal surgery: a prospective study in an academic institution. J Neurosurg Spine 2012;17:30-6. https://doi.org/10.3171/2012.3.SPINE11939
  2. Takahashi Y, Sato T, Hyodo H, et al. Incidental durotomy during lumbar spine surgery: risk factors and anatomic locations: clinical article. J Neurosurg Spine 2013;18:165-9. https://doi.org/10.3171/2012.10.SPINE12271
  3. Baker GA, Cizik AM, Bransford RJ, et al. Risk factors for unintended durotomy during spine surgery: a multivariate analysis. Spine J 2012;12:121-6. https://doi.org/10.1016/j.spinee.2012.01.012
  4. Khan MH, Rihn J, Steele G, et al. Postoperative management protocol for incidental dural tears during degenerative lumbar spine surgery: a review of 3,183 consecutive degenerative lumbar cases. Spine (Phila Pa 1976) 2006;31:2609-13. https://doi.org/10.1097/01.brs.0000241066.55849.41
  5. Williams BJ, Sansur CA, Smith JS, et al. Incidence of unintended durotomy in spine surgery based on 108,478 cases. Neurosurgery 2011;68:117-23. https://doi.org/10.1227/NEU.0b013e3181fcf14e
  6. Weber C, Piek J, Gunawan D. Health care costs of incidental durotomies and postoperative cerebrospinal fluid leaks after elective spinal surgery. Eur Spine J 2015;24:2065-8. https://doi.org/10.1007/s00586-014-3504-7
  7. Bilsky MH, Fraser JF. Complication avoidance in vertebral column spine tumors. Neurosurg Clin N Am 2006;17:317-29, vii. https://doi.org/10.1016/j.nec.2006.04.007
  8. Cammisa FP Jr, Girardi FP, Sangani PK, et al. Incidental durotomy in spine surgery. Spine (Phila Pa 1976) 2000;25:2663-7. https://doi.org/10.1097/00007632-200010150-00019
  9. Couture D, Branch CL Jr. Spinal pseudomeningoceles and cerebrospinal fluid fistulas. Neurosurg Focus 2003;15:E6.
  10. deFreitas DJ, McCabe JP. Acinetobacter baumanii meningitis: a rare complication of incidental durotomy. J Spinal Disord Tech 2004;17:115-6. https://doi.org/10.1097/00024720-200404000-00007
  11. Lu CH, Ho ST, Kong SS, et al. Intracranial subdural hematoma after unintended durotomy during spine surgery. Can J Anaesth 2002;49:100-2. https://doi.org/10.1007/BF03020428
  12. Karaeminogullari O, Atalay B, Sahin O, et al. Remote cerebellar hemorrhage after a spinal surgery complicated by dural tear: case report and literature review. Neurosurgery 2005;57(1 Suppl):E215.
  13. Chang DW, Friel MT, Youssef AA. Reconstructive strategies in soft tissue reconstruction after resection of spinal neoplasms. Spine (Phila Pa 1976) 2007;32:1101-6. https://doi.org/10.1097/01.brs.0000261555.72265.3f
  14. Olsen MA, Mayfield J, Lauryssen C, et al. Risk factors for surgical site infection in spinal surgery. J Neurosurg 2003;98(2 Suppl):149-55.
  15. Chaichana KL, Pendleton C, Sciubba DM, et al. Outcome following decompressive surgery for different histological types of metastatic tumors causing epidural spinal cord compression. J Neurosurg Spine 2009;11:56-63. https://doi.org/10.3171/2009.1.SPINE08657
  16. Arrigo RT, Kalanithi P, Cheng I, et al. Charlson score is a robust predictor of 30-day complications following spinal metastasis surgery. Spine (Phila Pa 1976) 2011;36:E1274-80. https://doi.org/10.1097/BRS.0b013e318206cda3
  17. Ghogawala Z, Mansfield FL, Borges LF. Spinal radiation before surgical decompression adversely affects outcomes of surgery for symptomatic metastatic spinal cord compression. Spine (Phila Pa 1976) 2001;26:818-24. https://doi.org/10.1097/00007632-200104010-00025
  18. Hsieh PC, Xu R, Sciubba DM, et al. Long-term clinical outcomes following en bloc resections for sacral chordomas and chondrosarcomas: a series of twenty consecutive patients. Spine (Phila Pa 1976) 2009;34:2233-9. https://doi.org/10.1097/BRS.0b013e3181b61b90
  19. Chen KW, Yang HL, Lu J, et al. Risk factors for postoperative wound infections of sacral chordoma after surgical excision. J Spinal Disord Tech 2011;24:230-4. https://doi.org/10.1097/BSD.0b013e3181ea478a
  20. Sciubba DM, Nelson C, Gok B, et al. Evaluation of factors associated with postoperative infection following sacral tumor resection. J Neurosurg Spine 2008;9:593-9. https://doi.org/10.3171/SPI.2008.9.0861
  21. Shapiro SA, Scully T. Closed continuous drainage of cerebrospinal fluid via a lumbar subarachnoid catheter for treatment or prevention of cranial/spinal cerebrospinal fluid fistula. Neurosurgery 1992;30:241-5. https://doi.org/10.1227/00006123-199202000-00015
  22. Acikbas SC, Akyuz M, Kazan S, et al. Complications of closed continuous lumbar drainage of cerebrospinal fluid. Acta Neurochir (Wien) 2002;144:475-80. https://doi.org/10.1007/s007010200068
  23. Kitchel SH, Eismont FJ, Green BA. Closed subarachnoid drainage for management of cerebrospinal fluid leakage after an operation on the spine. J Bone Joint Surg Am 1989;71:984-7. https://doi.org/10.2106/00004623-198971070-00004
  24. Hannallah D, Lee J, Khan M, et al. Cerebrospinal fluid leaks following cervical spine surgery. J Bone Joint Surg Am 2008;90:1101-5. https://doi.org/10.2106/JBJS.F.01114
  25. Kim KD, Wright NM. Polyethylene glycol hydrogel spinal sealant (DuraSeal Spinal Sealant) as an adjunct to sutured dural repair in the spine: results of a prospective, multicenter, randomized controlled study. Spine (Phila Pa 1976) 2011;36:1906-12. https://doi.org/10.1097/BRS.0b013e3181fdb4db
  26. Disa JJ, Smith AW, Bilsky MH. Management of radiated reoperative wounds of the cervicothoracic spine: the role of the trapezius turnover flap. Ann Plast Surg 2001;47:394-7. https://doi.org/10.1097/00000637-200110000-00006
  27. Mericli AF, Tarola NA, Moore JH Jr, et al. Paraspinous muscle flap reconstruction of complex midline back wounds: risk factors and postreconstruction complications. Ann Plast Surg 2010;65:219-24. https://doi.org/10.1097/SAP.0b013e3181c47ef4
  28. Garvey PB, Rhines LD, Dong W, et al. Immediate soft-tissue reconstruction for complex defects of the spine following surgery for spinal neoplasms. Plast Reconstr Surg 2010;125:1460-6. https://doi.org/10.1097/PRS.0b013e3181d5125e
  29. Jones GA, Butler J, Lieberman I, et al. Negative-pressure wound therapy in the treatment of complex postoperative spinal wound infections: complications and lessons learned using vacuum-assisted closure. J Neurosurg Spine 2007;6:407-11. https://doi.org/10.3171/spi.2007.6.5.407
  30. Mehbod AA, Ogilvie JW, Pinto MR, et al. Postoperative deep wound infections in adults after spinal fusion: management with vacuum-assisted wound closure. J Spinal Disord Tech 2005;18:14-7. https://doi.org/10.1097/01.bsd.0000133493.32503.d3
  31. Awad JN, Kebaish KM, Donigan J, et al. Analysis of the risk factors for the development of post-operative spinal epidural haematoma. J Bone Joint Surg Br 2005;87:1248-52.
  32. Payne DH, Fischgrund JS, Herkowitz HN, et al. Efficacy of closed wound suction drainage after single-level lumbar laminectomy. J Spinal Disord 1996;9:401-3.
  33. Reynolds KD, Franklin FA, Leviton LC, et al. Methods, results, and lessons learned from process evaluation of the high 5 school-based nutrition intervention. Health Educ Behav 2000;27:177-86. https://doi.org/10.1177/109019810002700204
  34. Todorovic V. Food and wounds: nutritional factors in wound formation and healing. Br J Community Nurs 2002:43-4, 46, 48 passim.
  35. Anderson B. Nutrition and wound healing: the necessity of assessment. Br J Nurs 2005;14:S30, S32, S34 passim.
  36. Itshayek E, Yamada J, Bilsky M, et al. Timing of surgery and radiotherapy in the management of metastatic spine disease: a systematic review. Int J Oncol 2010;36:533-44.

Cited by

  1. Surgical Strategy for Sacral Tumor Resection vol.62, pp.1, 2018, https://doi.org/10.3349/ymj.2021.62.1.59