Department of Neuroscience, Neurosurgery Section, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
Surg Technol Int. 2022 May 19;40:399-403. doi: 10.52198/22.STI.40.NS1577.
Cerebro-spinal fluid (CSF) leak in cranial and spinal surgery seriously threatens the clinical prognosis of surgical cases exposing the patients to higher risk of infection, prolonged hospital stay, and need of reoperation. Ultimately, this cascade of events may lead to life-threatening complications, as in cases of meningitis/encephalitis, spondylodiscitis, subdural hematomas, and severe pneumocephalus. Moreover, CSF leak causes a consistent rise in healthcare-related costs which are nearly doubled in CSF leak cases after craniotomy or in spinal surgery. The risk of CSF leak tends to be higher in patients undergoing transnasal endoscopic surgery, posterior fossa craniotomies, and spinal surgery, while being considered a quite rare finding in supratentorial brain surgery. Here we analyzed the different implications of this issue focusing on the usefulness of new technologies and surgical strategies to prevent it. CSF leak rate may vary from 4% in transsphenoidal procedures to 32% in posterior fossa craniotomies. In spinal surgery, CSF leak may be a consequence of elective intradural surgery, accounting for 18% of the procedures, or being a result of incidental durotomies, ranging from 1 to 17% in different surgical series. Dural closure's reinforcement using different new dural sealants plays an important role in preventing these events. Moreover, the use of neuronavigation systems in skull base and posterior fossa surgery can help to minimize the size of approach and reduce the incidence of CSF leak. New minimally invasive spinal approaches, such as minimally invasive decompression for spinal degenerative disorders or performing selective laminotomies over laminectomies for intradural spinal pathology are very useful techniques to prevent CSF leak in this kind of surgery. In conclusion, although CSF leak remains a risky complication in neurosurgery, its prevention and treatment significantly benefited from advances in biomaterials and surgical technique.
脑脊液（CSF）漏在颅脑和脊柱手术中严重威胁手术病例的临床预后，使患者面临更高的感染风险、住院时间延长和需要再次手术。最终，这一系列事件可能导致危及生命的并发症，如脑膜炎/脑炎、脊椎炎、硬脑膜下血肿和严重的气颅。此外，CSF 漏会导致医疗相关成本的持续增加，在开颅或脊柱手术后发生 CSF 漏的病例中，这一成本几乎翻了一番。CSF 漏的风险在接受经鼻内镜手术、后颅窝开颅术和脊柱手术的患者中较高，而在前脑手术中被认为是一种相当罕见的发现。在这里，我们分析了这一问题的不同影响，重点研究了新技术和手术策略在预防 CSF 漏方面的作用。CSF 漏发生率从经蝶窦手术的 4%到后颅窝开颅术的 32%不等。在脊柱手术中，CSF 漏可能是选择性硬脊膜内手术的结果，占手术的 18%，也可能是偶然的硬脊膜切开术的结果，在不同的手术系列中占 1%至 17%。使用不同的新型硬脑膜密封剂来加强硬脑膜缝合在预防这些事件中起着重要作用。此外，在颅底和后颅窝手术中使用神经导航系统有助于最大限度地减少手术入路的大小，降低 CSF 漏的发生率。新的微创脊柱入路，如治疗脊柱退行性疾病的微创减压术，或对硬脊膜内病变进行选择性椎板切开术而不是全椎板切除术，是预防此类手术中 CSF 漏的非常有用的技术。总之，尽管 CSF 漏仍然是神经外科的一种风险并发症，但它的预防和治疗已经从生物材料和手术技术的进步中显著受益。
