Perez-Roman Roberto J, Bryant Jean-Paul, Tapamo Harold J, Luther Evan, Levene Howard B
Neurological Surgery, University of Miami Miller School of Medicine, Miami, USA.
Neurological Surgery, Levene Neurosurgical Consulting Inc., Boca Raton, USA.
Cureus. 2022 Apr 12;14(4):e24066. doi: 10.7759/cureus.24066. eCollection 2022 Apr.
Post-operative cerebrospinal fluid (CSF) leak is a known complication in spine surgery. This mostly iatrogenic issue is typically treated using a variety of modalities (i.e., bed rest, epidural patch), CSF diversion methods, or primary repair. The use of an external ventricular drain to treat this post-operative complication has been infrequently reported. We describe a case of a CSF leak after thoraco-lumbar surgery treated using an external ventricular drain and a review of the literature regarding this treatment modality. A 70-year-old man presented to our clinic with a recent diagnosis of multiple myeloma with progressive thoracic kyphosis and spinal stenosis. He developed progressive neurological deficits over the course of several weeks. Radiological studies showed significant thoracic kyphosis and severe cord compression in the thoraco-lumbar area. The patient underwent a T9-L4 posterior instrumentation and fusion with decompression surgery that developed post-operative wound infection and a CSF leak. An external ventricular drain (EVD) was used successfully as a CSF diversion method where direct thoracolumbar approaches were not feasible. Given the effectiveness of EVD placement in treating this post-operative complication, we concluded that the use of an EVD can be a potentially safe and effective way to treat thoracolumbar CSF leakage when lumbar or cervical drainage is not feasible.
术后脑脊液漏是脊柱手术中一种已知的并发症。这种主要由医源性导致的问题通常采用多种方式进行治疗（如卧床休息、硬膜外修补）、脑脊液分流方法或一期修复。使用外部脑室引流管治疗这种术后并发症的报道较少。我们描述了一例使用外部脑室引流管治疗胸腰椎手术后脑脊液漏的病例，并对有关这种治疗方式的文献进行了综述。一名70岁男性因近期诊断为多发性骨髓瘤伴进行性胸椎后凸和椎管狭窄前来我们诊所就诊。在数周内他出现了进行性神经功能缺损。影像学检查显示胸椎明显后凸，胸腰段脊髓严重受压。该患者接受了T9 - L4后路内固定融合减压手术，术后出现伤口感染和脑脊液漏。当直接的胸腰椎入路不可行时，外部脑室引流管（EVD）作为一种脑脊液分流方法被成功使用。鉴于EVD置入在治疗这种术后并发症方面的有效性，我们得出结论，当腰椎或颈椎引流不可行时，使用EVD可能是治疗胸腰椎脑脊液漏的一种安全有效的方法。
