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Todd W. Vitaz, Masaki Oishi, William C. Welch, Peter C. Gerszten, Joseph J. Disa and Mark H. Bilsky

T he development of wound dehiscence and infection following spinal decompression and placement of instrumentation for the treatment of tumor and degenerative disease creates complex management issues. Risk factors for wound-related complications include the use of instrumentation, medical comorbidities, malnourishment, high-dose corticosteroid agents, and prior external-beam irradiation. 8, 11, 23 In many patients, little can be done to ameliorate these risk factors; however, timely intervention may decrease the risk of other comorbidities such as septicemia

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Shima Shahjouei, Sara Hanaei, Zohreh Habibi, Mostafa Hoseini, Saeed Ansari and Farideh Nejat

CSF leakage, CSF collection, wound dehiscence, and infection. 19 , 27 , 30 , 31 Despite a vast investigation of preventive interventions for such complications, 4 , 8 , 18 , 21 , 27 no evidenced-based guideline has yet been published. Although prophylactic administration of acetazolamide and/or bed rest following the intradural operation are acceptably used by both neurosurgeons and orthopedic surgeons, no high-level approved evidence exists regarding whether and how to use these measures. To the best of our knowledge, no randomized trial has assessed the

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Hannah M. Carl, A. Karim Ahmed, Nancy Abu-Bonsrah, Rafael De la Garza Ramos, Eric W. Sankey, Zachary Pennington, Ali Bydon, Timothy F. Witham, Jean-Paul Wolinsky, Ziya L. Gokaslan, Justin M. Sacks, C. Rory Goodwin and Daniel M. Sciubba

morbidity and mortality. 15 , 19 , 33 These include wound infections, wound dehiscence, hematomas, neurological impairments, deep venous thrombosis, and instrumentation failure, among others. 15 , 33 In patients with metastatic spine tumors, overall complication rates range between 19% and 28%, 30 , 33 , 34 whereas the incidence of surgical site infection and wound breakdown is 4%–20%. 8 , 20 , 23 , 26 Crucially, the most common reason for reoperation after the resection of spinal metastases is surgical site infection, which commonly leads to wound breakdown. 26

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Heather S. Spader, Robert J. Bollo, Christian A. Bowers and Jay Riva-Cambrin

. Access into the thecal sac was defined as either percutaneous or via laminectomy. The pump model (3 over the course of the study) was also recorded. Postoperative risk factors were abstracted from the inpatient and outpatient medical records. The patient's discharge disposition was recorded as home, nursing facility, inpatient rehabilitation service, or other. The variable wound dehiscence was originally abstracted as none, superficial (suprafascial), deep (subfascial), open erosion, or exposure of the hardware, but it was analyzed in the multivariate model as a

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William R. Cheek, John P. Laurent and David A. Cech

obtained and permits watertight primary dural closure. Skin edges can be drawn together without tension at the suture line. We have carried out 70 repairs in this manner without significant complication. There have been no instances of cerebrospinal fluid leak, meningitis, or wound dehiscence. References 1. Babcock WW : Spina bifida and its surgical treatment, with a description of an efficient osteoplastic operation. Penn Med J 14 : 770 – 781 , 1910 Babcock WW: Spina bifida and its surgical treatment, with a description of an

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Ismail Kürşad Gökce, Hatice Turgut, Ramazan Ozdemir and Selami Cagatay Onal

W hen a baby with a meningomyelocele is born, the ideal approach is to close the meningomyelocele sac and treat accompanying pathologies, if any, within the first 24 hours. 4 , 7 Early and late complications after meningomyelocele surgery are closely associated with wound dehiscence. Cerebrospinal fluid leakage is a common complication following meningomyelocele surgery during the wound-healing period. 4 Hyponatremia related to CSF leakage has been reported to occur in preterm infants following external ventricular drainage to treat posthemorrhagic

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Albert J. Fenoy and Richard K. Simpson Jr.

dehiscences and/or erosions over a long follow-up period. 26 , 38 Given that the number of DBS hardware implants will continue to increase and new applications for this procedure appear on the horizon, we must determine how to prevent as well as manage such complications, if and when they arise, in the most expeditious way possible. In this study we evaluated the incidence and management of peri- and postoperative wound complications related to DBS hardware implantation, including infection, wound dehiscence, and/or erosion in a large series of consecutive patients

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Ashish H. Shah, Michael E. Ivan and Ricardo J. Komotar

cases of near to total occlusion of the SSS, venous congestion may preclude CSF resorption. These meningiomas may partially or completely occlude the SSS, thereby increasing proximal venous pressure and decreasing CSF resorption. We propose that parasagittal meningiomas that invade the posterior third of the parasagittal sinus may be predisposed to develop a pseudotumor-like condition, which may predispose patients to complications associated with high intracranial pressure (ICP). These issues include CSF leak, wound dehiscence, and pseudotumor-related symptoms

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Amr Ammar, Ismail Ughratdar, Gnanamurthy Sivakumar and Michael H. Vloeberghs

I ntrathecal baclofen has been established in the management of spasticity and dystonia in recent decades. 8 , 25 , 26 Continuous infusion of baclofen into CSF concentrates the drug locally where it achieves its therapeutic effect and also provides a constant concentration. 12 Intrathecal baclofen pump implantation techniques have changed noticeably since the advent of the procedure in 1985. 19 Initially, the pump was implanted subcutaneously, but this technique was associated with poor healing and wound dehiscence, resulting in explantation of the

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E. Andrew Stevens, Alexander K. Powers, Thomas A. Sweasey, Stephen B. Tatter and Robert G. Ojemann

. 9 Numerous autogenic, allogenic, xenogenic, absorbable, and nonabsorbable synthetic materials have been used with varying degrees of success in the search for the perfect dural graft. 2 , 8 , 13 , 16 , 18 , 21 Nonautogenous grafts have been associated with a host of complications including hemorrhage, bacteria and virus transmission, fatal Creutzfeldt-Jakob disease transmission, foreign body reaction, systemic immune response, excessive scarring, slower healing, premature graft dissolution, and wound dehiscence. 1–5 , 10 , 11 , 14 , 15 , 18 Current literature