Computed tomography–guided epidural patching of postoperative cerebrospinal fluid leaks

Clinical article

View More View Less
  • Department of Radiology, Duke University Medical Center, Durham, North Carolina
Restricted access

Purchase Now

USD  $45.00

Spine - 1 year subscription bundle (Individuals Only)

USD  $369.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00
Print or Print + Online

Object

Cerebrospinal fluid leaks due to unrecognized durotomy during spinal surgery are often managed with a second surgery for dural closure. CT-guided percutaneous patching targeted to the dural defect offers an alternative to surgery since it can be performed in a minimally invasive fashion without the need for general anesthesia. This case series describes the authors' experience using targeted CT-guided percutaneous patching to repair incidental durotomies incurred during spinal surgery.

Methods

This investigation is a retrospective case series involving patients who underwent CT-guided percutaneous patching of surgical incidental durotomies and were referred between January 2007 and June 2013. Their presenting clinical history, myelographic findings, and clinical outcomes, including the need for eventual surgical duraplasty, were reviewed.

Results

Nine cases were identified, including 7 durotomies incurred during lumbar discectomy, one due to a medial transpedicular screw breach, and one incurred during vertebrectomy for spinal osteosarcoma. All patients who had favorable outcomes with percutaneous intervention alone had 2 common features: dural defect of 4 mm or smaller and absence of a pseudomeningocele. Patients with CSF leaks complicated by pseudomeningocele and those with a dural defect of 6 mm or more all required eventual surgical management.

Conclusions

The authors' results suggest that findings on CT myelography may help predict which patients with postsurgical durotomy can be treated with percutaneous intervention. In particular, CT-guided patching may be more likely to be successful in those patients with dural defects of less than 5 mm and without pseudomeningocele. In patients with larger dural defects or pseudomeningoceles, percutaneous blood patching alone is unlikely to be successful.

Abbreviation used in this paper:CTF = CT fluoroscopy.

Spine - 1 year subscription bundle (Individuals Only)

USD  $369.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Contributor Notes

Address correspondence to: Linda Gray, M.D., DUMC Box 3808, Durham, NC 27710. email: linda.leithe@dm.duke.edu.

Please include this information when citing this paper: published online August 15, 2014; DOI: 10.3171/2014.7.SPINE13965.

  • 1

    Bosacco SJ, , Gardner MJ, & Guille JT: Evaluation and treatment of dural tears in lumbar spine surgery: a review. Clin Orthop Relat Res 389 238247, 2001

    • Search Google Scholar
    • Export Citation
  • 2

    Guerin P, , El Fegoun AB, , Obeid I, , Gille O, , Lelong L, & Luc S, : Incidental durotomy during spine surgery: incidence, management and complications. A retrospective review. Injury 43:397401, 2012

    • Search Google Scholar
    • Export Citation
  • 3

    Patel MR, , Caruso PA, , Yousuf N, & Rachlin J: CT-guided percutaneous fibrin glue therapy of cerebrospinal fluid leaks in the spine after surgery. AJR Am J Roentgenol 175:443446, 2000

    • Search Google Scholar
    • Export Citation
  • 4

    Patel MR, , Louie W, & Rachlin J: Postoperative cerebrospinal fluid leaks of the lumbosacral spine: management with percutaneous fibrin glue. AJNR Am J Neuroradiol 17:495500, 1996

    • Search Google Scholar
    • Export Citation
  • 5

    Sencakova D, , Mokri B, & McClelland RL: The efficacy of epidural blood patch in spontaneous CSF leaks. Neurology 57:19211923, 2001

  • 6

    Tafazal SI, & Sell PJ: Incidental durotomy in lumbar spine surgery: incidence and management. Eur Spine J 14:287290, 2005

  • 7

    Than KD, , Wang AC, , Etame AB, , La Marca F, & Park P: Postoperative management of incidental durotomy in minimally invasive lumbar spinal surgery. Minim Invasive Neurosurg 51:263266, 2008

    • Search Google Scholar
    • Export Citation
  • 8

    Tosun B, , Ilbay K, , Kim MS, & Selek O: Management of persistent cerebrospinal fluid leakage following thoraco-lumbar surgery. Asian Spine J 6:157162, 2012

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 200 116 15
Full Text Views 581 20 6
PDF Downloads 238 18 5
EPUB Downloads 0 0 0