Altaf Imran, Vohra Anjum Habib, Shams Shahzad
Dr. Imran Altaf, MS. Department of Neurosurgery, Khawja Muhammad Safdar Medical College, Sialkot, Pakistan.
Dr. Anjum Habib Vohra, FRCS, Department of Neurosurgery, Post Graduate Medical Institute, Lahore General Hospital, Lahore, Pakistan.
Pak J Med Sci. 2016 Nov-Dec;32(6):1439-1443. doi: 10.12669/pjms.326.9956.
Cerebrospinal fluid leakage remains a significant cause of morbidity following posterior fossa surgery, and its treatment remains a difficult problem. The aim of the study was to propose a treatment algorithm for its management.
A retrospective, single-center study was conducted on 147 patients who underwent elective posterior fossa surgery . Patients with post operative CSF leakage had either been treated initially with conservative measures including re-suturing of the wound, with CSF lumbar drainage to be employed in case the CSF leakage didn't stop, or the initial intervention was the institution of CSF lumbar drainage simultaneously with conservative measures. VP (ventriculo-peritoneal) shunt was done in patients with gross hydrocephalus on postoperative CT brain.
There were 25 (17%) cases of CSF leakage, including 24 incisional CSF leaks and one case of CSF otorrhea. In eight patients with incisional CSF leakage treated initially with conservative measures including re-suturing of the wound, CSF leakage stopped in only two cases. CSF lumbar drainage instituted later on in six cases with persistent leakage stopped the CSF leakage. In fourteen patients managed initially with re-suturing of the wound and concomitant CSF lumbar drainage, CSF leakage settled in all the cases. Two patients with gross hydrocephalus on post operative CT were managed successfully with VP shunt. Re-suturing of the wound with concomitant CSF lumbar drainage was found to be significantly associated (p=0.003) with the stoppage of CSF leakage, and the settlement of meningitis (p= 0.014).
Incisional leaks after posterior fossa surgery should be managed with re-suturing of the wound and concomitant lumbar drainage, instead of an initial trial of conservative therapy alone.
脑脊液漏仍是后颅窝手术后发病的一个重要原因，其治疗仍然是一个难题。本研究的目的是提出一种针对其处理的治疗方案。
对147例行择期后颅窝手术的患者进行了一项回顾性单中心研究。术后发生脑脊液漏的患者，要么最初采用包括伤口重新缝合在内的保守措施治疗，若脑脊液漏未停止则采用脑脊液腰椎引流；要么最初的干预措施是在采取保守措施的同时进行脑脊液腰椎引流。术后头颅CT显示有明显脑积水的患者行脑室-腹腔（VP）分流术。
共有25例（17%）脑脊液漏病例，包括24例切口脑脊液漏和1例脑脊液耳漏。在最初采用包括伤口重新缝合在内的保守措施治疗的8例切口脑脊液漏患者中，只有2例脑脊液漏停止。后来对6例持续漏液的患者进行脑脊液腰椎引流，脑脊液漏停止。在最初采用伤口重新缝合并同时进行脑脊液腰椎引流治疗的14例患者中，所有病例的脑脊液漏均得到解决。术后CT显示有明显脑积水的2例患者通过VP分流术成功治疗。发现伤口重新缝合并同时进行脑脊液腰椎引流与脑脊液漏停止（p = 0.003）以及脑膜炎的解决（p = 0.014）显著相关。
后颅窝手术后的切口漏应采用伤口重新缝合并同时进行腰椎引流处理，而不是仅先进行保守治疗试验。
