Kitchel S H, Eismont F J, Green B A
Jackson Memorial Hospital, Miami, Florida.
J Bone Joint Surg Am. 1989 Aug;71(7):984-7.
A retrospective review was conducted to assess the effectiveness and safety of a temporary subarachnoid shunt to treat patients who have a leak of cerebrospinal fluid after a spinal operation. The shunt is percutaneously inserted in the lumbar spine and is removed after four days. This technique was used in nineteen patients over a ten-year period. Of the seventeen patients who had the shunt in place for the full four days, fourteen had resolution of the drainage of cerebrospinal fluid from the wound. One of two patients whose shunt was removed early also had a successful result. Eleven of the fifteen patients who were successfully treated were available for follow-up, and none had any adverse effects related to the original cerebrospinal-fluid leak or its treatment. The four patients who had a persistent leak were successfully treated with reoperation and direct repair of the dura. Eleven (58 per cent) of the nineteen patients had transient complaints of nausea and vomiting while being treated with subarachnoid drainage. Two of the nineteen patients had evidence of an intradural infection after placement of the catheter; the infection resolved in both patients after removal of the catheter and treatment with appropriate antibiotics. Closed subarachnoid drainage, when properly performed and monitored, is a reasonably effective and safe method for treating dural-cutaneous cerebrospinal-fluid leaks after a spinal operation. It may be considered as a non-operative alternative to the standard procedure of reoperation and direct repair of the dura. A good result is still possible in patients in whom this technique fails and who eventually need surgical management.
进行了一项回顾性研究，以评估临时蛛网膜下腔分流术治疗脊柱手术后脑脊液漏患者的有效性和安全性。该分流器经皮插入腰椎，4天后取出。在十年期间，该技术应用于19例患者。在17例放置分流器满4天的患者中，14例伤口脑脊液引流得到解决。2例早期取出分流器的患者中有1例也取得了成功。15例成功治疗的患者中有11例可供随访，且均未出现与原脑脊液漏或其治疗相关的不良反应。4例持续渗漏的患者通过再次手术和直接修补硬脑膜成功治愈。19例患者中有11例（58%）在接受蛛网膜下腔引流治疗时出现短暂的恶心和呕吐症状。19例患者中有2例在放置导管后出现硬膜内感染迹象；拔除导管并使用适当抗生素治疗后，两名患者的感染均得到解决。当操作得当并进行监测时，封闭式蛛网膜下腔引流是治疗脊柱手术后硬脑膜皮肤脑脊液漏的一种相当有效且安全的方法。它可被视为硬膜再次手术和直接修补标准程序的非手术替代方法。对于该技术失败最终需要手术治疗的患者，仍有可能取得良好效果。
