![]() ![]() Many who are leaking are not even aware that they are leaking. Other times, especially (but not always) in the case of chronic leaks, the positional symptoms either lessen or go away altogether, including the headache. Imaging and other tests used to attempt to find leaks are often read as “normal” even when there is a leak present. Approximately 50% of leaks cannot be found on imaging. Rare signs or complications of CSF leaks can include: quadriplegia, dementia (often mimicking Frontotemporal Lobe Dementia), Parkinsonism, other movement disorders, ataxia (unsteady gait), hypersomnolence, stupor, coma, stroke (hemorrhagic or ischemic), and even death.ĬSF leaks are often very hard to locate, if ever. Cranial leak specific symptoms can vary even more and can include: fluid discharge from ears, nose (usually only one side) and to back of throat often reported as salty or metallic tasting, recurring or chronic meningitis, loss of sense of smell, change in hearing or ringing in the ears, and less frequently cognitive changes. Other leak symptoms can include, but are not limited to: nausea, vomiting, neck pain or stiffness, heaviness of head, pain between the shoulder blades, feeling of pressure within the head, changes in hearing (muffled or underwater sensation), tinnitus (ringing, buzzing, or pulsatile), feeling of liquid in the ears, sense of imbalance, sensitivity to light, sensitivity to sound, pain or numbness in the arms, changes in cognition (“ brain fog,” memory loss, or loss of concentration), dizziness or vertigo, scalp sensitivity or tingling sensation within the scalp, visual changes (blurring, double vision, visual field defects), pain behind the eyes or when moving eyes, facial numbness or pain, sinus pressure, temporomandibular joint pain and stiffness, and subdural hematoma. Symptoms often worsen as the day goes on. This is particularly the case in the chronic (vs acute) phase of CSF leaks, where the “positional” or “orthostatic” characteristic of symptoms may become more constant, lessen, or disappear entirely, including headache. However, not all positional headaches can be attributed to a CSF leak, and not all CSF leak headaches are positional. This is sometimes called a “positional” or “orthostatic” headache. ![]() All rights reserved.The main symptom of a CSF leak is a headache that is worse when upright and improves when lying down horizontally. Primary repair of the leak and use of fibrin sealant upon discovery, with consideration of lumbar drain, should be performed whenever possible, as they are associated with shorter hospital stays, fewer hospital admissions, and lower rates of reoperation and infection.Ĭerebrospinal fluid leak Durotomy Meningitis Meningocele Spinal drain.Ĭopyright © 2018 Elsevier B.V. 0).ĬSF leaks are fraught with complications requiring reexploration for repair in 27.4% of cases. Patients who were treated with delayed exploration had statistically significant increase in length of stay (19.6 vs. ![]() Patients in whom primary closure could not be achieved and did not have a lumbar drain placed had a 39.5% reexploration rate. Delayed exploration of the surgical wound was required in 34 patients. Lumbar drain placement (±primary closure) was performed in 49, with success in 43 (87.8%). ![]() Primary dural closure (±lumbar drain) was attempted in 64 patients, with successful repair in 47 (73.4%). Our cohort consisted of 124 patients who suffered intraoperative iatrogenic CSF leak out of 3965 procedures, for a rate of 3.1%. Information regarding patient demographics, surgical characteristics, and postoperative course was gathered, including whether primary closure (with nonabsorbable suture) was achieved, lumbar drain placement at initial surgery, use of fibrin sealant, number of subsequent explorations, rate of infection, length of stay, and number of hospital admissions. Excluded were patients who had primarily intradural procedures such as tethered cord release, tumor resection, and posterior fossa decompression. We queried our institutional database for postoperative spinal CSF leaks between and using Current Procedural Terminology (CPT) and International Classification of Disease (ICD) codes. Using a retrospective cohort, the authors aim to identify the appropriate management of iatrogenic spinal cerebrospinal fluid (CSF) leaks. Treatment options include primary or delayed repair, with or without spinal drainage. Management is highly variable and dependent on comorbidities, complexity of the index procedure, and surgeons' experience. Cerebrospinal fluid leaks are a frequent complication of spinal surgery, with reported rates between 2 and 20%. ![]()
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