Department of Neurosurgery, Health Sciences University, Gülhane Training and Research Hospital, Ankara-Turkey.
Ulus Travma Acil Cerrahi Derg. 2020 Sep;26(5):784-788. doi: 10.14744/tjtes.2020.26446.
This study aims to investigate the clinical outcomes of patients who underwent closed continuous lumbar drainage (CLD) for post-traumatic cerebrospinal fluid (CSF) fistula and to compare with those of non-traumatic patients.
The data of patients who were treated in the department of neurosurgery between January 2018 and December 2019 and underwent CLD were analyzed. The diagnosis, demographic characteristics, CSF results and clinical outcomes of these patients were evaluated. The outcomes of the patients with dura defect and CSF fistula due to trauma were compared with patients who underwent CLD for other diagnoses.
In this study, 45 patients underwent CLD for 51 times. The mean age was 38.84 years, and 27 (60%) of the patients were male. Seven (15.55%) patients underwent CLD due to post-traumatic CSF fistula and 38 patients after tumor or malformation surgery. While five patients developed CSF fistula due to dura defect after gunshot injury, two patients developed CSF fistula secondary to motor vehicle accident. Staphylococcus Epidermidis was isolated in one patient among post-traumatic CSF fistula patients while Serratia Marcescens was isolated in patients with CSF fistula secondary to posterior fossa tumor surgery. While none of the seven patients died during the follow-up period in post-traumatic group, one of the 38 patients with CLD secondary to tumor surgery was lost due to sepsis in the follow-up period.
CLD in post-traumatic CSF fistulas is a safe and effective treatment method. Especially in patients with gunshot wounds, CLD should be performed before revision surgery in the treatment of CSF fistula. Studies with different parameters are needed in larger trauma populations.
本研究旨在探讨因创伤性脑脊膜漏而行密闭持续腰椎引流（CLD）的患者的临床转归，并与非创伤性患者进行比较。
对 2018 年 1 月至 2019 年 12 月在神经外科治疗且行 CLD 的患者进行数据分析。评估这些患者的诊断、人口统计学特征、CSF 结果和临床转归。比较因外伤导致硬脑膜缺损和 CSF 漏的患者与因其他诊断而行 CLD 的患者的转归。
本研究中，45 例患者共行 51 次 CLD。患者的平均年龄为 38.84 岁，27 例（60%）为男性。7 例（15.55%）因创伤性 CSF 漏而行 CLD，38 例因肿瘤或畸形术后而行 CLD。5 例因枪伤导致硬脑膜缺损后发生 CSF 漏，2 例因机动车事故导致 CSF 漏。1 例创伤性 CSF 漏患者中分离出表皮葡萄球菌，1 例后颅窝肿瘤术后 CSF 漏患者中分离出粘质沙雷氏菌。在创伤性 CSF 漏组中，7 例患者在随访期间均未死亡，而因肿瘤手术后行 CLD 的 38 例患者中，1 例因随访期间脓毒症而失访。
CLD 是治疗创伤性脑脊膜漏的一种安全有效的方法。尤其是在枪伤患者中，在对 CSF 漏进行翻修手术之前，应行 CLD。在更大的创伤人群中需要开展具有不同参数的研究。
