Bayatli Eyup, Ozgural Onur, Erdin Engin, Karadagoglu Ümit, Kahilogullari Gokmen, Ugur Hasan Caglar, Tuna Hakan, Attar Ayhan, Unlu Agahan, Caglar Y Sukru, Dogan Ihsan
Neurosurg Focus. 2025 Feb 1;58(2):E7. doi: 10.3171/2024.11.FOCUS24661.
The aim of this study was to review a series of patients who underwent open cranial surgeries to evaluate the incidence of iatrogenic incisional CSF leaks and discuss its prevention and management. The authors also discuss the utility of the "folding technique" used in duraplasty as an alternative to conventional dural reconstruction techniques.
All patients undergoing open cranial surgery were reviewed, and those with incisional CSF leak were included in this study. CSF leakage was managed using either conservative nonsurgical methods or surgical interventions. When the conservative nonsurgical methods failed to curb the leak, surgical procedures such as lumbar external drainage (LED) using lumbar subarachnoid drainage, external ventricular drainage (EVD), a lumboperitoneal or ventriculoperitoneal shunt (VPS), and reexploration of the surgical site were considered.
Between 2019 and 2024, 2149 patients underwent open cranial surgeries at our hospital for any cranial pathology; 39 (1.8%) of these patients experienced postoperative incisional CSF leakage. The majority of the pathologies requiring surgeries were located in the supratentorial region (76.9%). Patients were classified according to the type of dural closure technique used. Primary stitching, the patient's fascia, or synthetic dura (resorbable, nonresorbable, or both) were used for dural reconstruction. The median interval between the surgery and the start of the leakage was 19 (IQR 1-79) days in patients with no history of radiotherapy; however, this duration was longer in patients who received radiotherapy (median 45 [IQR 10-540] days). The surgical interventions for CSF leakage were classified as wound resuturing (combined with other conservative approaches such as tightened dressing and elevating the head end of the bed), LED or EVD, or surgical reexploration. The folding technique in duraplasty is a simple way to achieve watertight duraplasty even with autograft or synthetic material.
Incisional CSF leakage is a potentially preventable complication with high morbidity. Such cases could be managed via conservative approaches including wound resuturing, LED or EVD, and surgical reexploration. However, the management strategy is beyond any strict algorithm. This folding technique for duraplasty is a worthy replacement for conventional primary suturing for dural repair or reconstruction in cranial and even spinal defects. This study highlights the importance of regaining the watertight nature of the dura in the primary surgery to prevent any further intervention and lower the overall morbidity.
本研究旨在回顾一系列接受开颅手术的患者，以评估医源性切口脑脊液漏的发生率，并讨论其预防和处理方法。作者还讨论了硬膜成形术中使用的“折叠技术”作为传统硬脑膜重建技术替代方法的实用性。
对所有接受开颅手术的患者进行回顾，将发生切口脑脊液漏的患者纳入本研究。脑脊液漏采用保守非手术方法或手术干预进行处理。当保守非手术方法无法控制漏液时，考虑采用腰蛛网膜下腔引流进行腰大池外引流（LED）、脑室外引流（EVD）、腰大池-腹腔或脑室-腹腔分流术（VPS）以及手术部位再次探查等手术方法。
2019年至2024年期间，我院2149例患者因各种颅脑疾病接受了开颅手术；其中39例（1.8%）患者术后发生切口脑脊液漏。需要手术治疗的大多数病变位于幕上区域（76.9%）。根据所使用的硬脑膜缝合技术类型对患者进行分类。硬脑膜重建采用初次缝合、患者自身筋膜或合成硬脑膜（可吸收、不可吸收或两者皆用）。无放疗史患者手术至漏液开始的中位间隔时间为19（四分位间距1-79）天；然而，接受放疗的患者此间隔时间更长（中位45[四分位间距10-540]天）。脑脊液漏的手术干预措施分为伤口重新缝合（结合其他保守方法，如收紧敷料和抬高床头）、LED或EVD，或手术再次探查。硬膜成形术中的折叠技术是一种即使使用自体移植物或合成材料也能实现防水硬膜成形术的简单方法。
切口脑脊液漏是一种具有较高发病率的潜在可预防并发症。此类病例可通过包括伤口重新缝合、LED或EVD以及手术再次探查在内的保守方法进行处理。然而，处理策略并无严格的算法可循。这种硬膜成形术的折叠技术是颅骨甚至脊柱缺损硬脑膜修复或重建中传统初次缝合的值得替代的方法。本研究强调了在初次手术中恢复硬脑膜防水特性以避免进一步干预并降低总体发病率的重要性。
