Mayeku Julie, Quiceno Esteban, Cannata Christina, Barbagli Giovanni, Hussein Amna, Dholaria Nikhil, Prim Michael, Baaj Ali A
Department of Neurosurgery, University of Arizona, Phoenix/Banner University Medical Center, Arizona, United States.
Department of Neurosurgery, University of Arizona, Phoenix, Arizona, United States.
Surg Neurol Int. 2024 Jan 12;15:8. doi: 10.25259/SNI_934_2023. eCollection 2024.
Delayed cerebrospinal fluid (CSF) leaks are a known complication following intradural spinal tumor surgery. The placement of subfascial drains in these patients undergoing requisite intradural surgery is controversial. Here, we demonstrated that placing a subfascial drain on partial suction for 48 h, with early ambulation, proved to be safe and effective in preventing early/delayed recurrent CSF fistulas.
Medical records of 17 patients undergoing surgery for intradural spinal tumors over a 30-month were reviewed. All patients underwent intradural tumor resection followed by primary dural closure, placement of Gelfoam in a non-compressive fashion, application of fibrin sealant, and utilization of a subfascial drain placed on partial suction for 48 h postoperatively. Patients are mobilized the morning following surgery. We tracked the incidence of postoperative recurrent CSF leaks, over drainage, infection, wound dehiscence, pseudo meningocele formation, and the reoperation rate.
For the 17 patients, our programmed average utilization of subfascial drains was 48 h. Moreover, the average drain output was 165 mL. Over the 1-year follow-up period, no patient developed a recurrent early/ delayed CSF leak, there were no wound complications, nor need for revision surgery.
Utilizing subfascial drains on partial suction following the resection of intradural spinal tumors with primary dural closure proved to be safe and effective.
脑脊液（CSF）漏延迟发生是硬脊膜内脊髓肿瘤手术后已知的并发症。在这些需要进行硬脊膜内手术的患者中放置筋膜下引流管存在争议。在此，我们证明，在早期活动的情况下，将筋膜下引流管置于部分吸引状态48小时，在预防早期/延迟性复发性脑脊液瘘方面是安全有效的。
回顾了17例在30个月内接受硬脊膜内脊髓肿瘤手术患者的病历。所有患者均接受硬脊膜内肿瘤切除术，并进行初次硬脊膜闭合，以非压迫方式放置明胶海绵，应用纤维蛋白密封剂，并在术后将筋膜下引流管置于部分吸引状态48小时。患者在手术后次日早晨即可活动。我们追踪了术后复发性脑脊液漏、过度引流、感染、伤口裂开、假性脑脊膜膨出形成的发生率以及再次手术率。
对于这17例患者，我们设定的筋膜下引流管平均使用时间为48小时。此外，平均引流量为165毫升。在1年的随访期内，没有患者出现早期/延迟性复发性脑脊液漏，没有伤口并发症，也无需进行翻修手术。
在进行初次硬脊膜闭合的硬脊膜内脊髓肿瘤切除术后，使用处于部分吸引状态的筋膜下引流管被证明是安全有效的。
