Factors associated with spinal fluid leakage after scheduled durotomy

Abstract

Introduction: We conducted an investigation on cerebrospinal fluid leakage after planned dural incision in our department and compared the results.

Subjects and Methods: The study included 75 cases (37 males, 38 females) with a mean age of 56.2 years and a mean follow-up period of 37.1 months. We examined the disease, laminectomy method (bilateral or unilateral), dural treatment method, and postoperative MRI.

Results: The diseases comprised 72 cases of spinal cord tumors and 3 other spinal conditions. Laminectomy methods consisted of bilateral in 46 cases and unilateral in 29 cases. Dural treatment methods included suturing in 54 cases and the Vascular Closure System clips (VCS) in 21 cases. Cerebrospinal fluid leakage was observed in 20 cases (26.6%) overall on the first MRI at an average of 3 months postoperatively. With regard to laminectomy, no significant differences were found between bilateral (34.7%) and unilateral (13.7%) cases (NS). For dural treatment, suturing was observed in 29.6% and VCS in 19.0% (NS). In particular, leakage was significantly less (6.2%) in cases of unilateral laminectomy using VCS compared to three cases of bilateral laminectomy with VCS (60%) (P=0.03).

Conclusions: Reducing dead space is crucial in the prevention of cerebrospinal fluid leakage. The combination of the less invasive unilateral laminectomy and VCS could help reduce postoperative cerebrospinal fluid leakage compared to bilateral laminectomy.