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. 2023 Apr;39(4):1013-1019.
doi: 10.1007/s00381-022-05797-w. Epub 2023 Feb 15.

Cerebrospinal fluid leakage after intradural spinal surgery in children

Emma M H Slot  1   2 , Tristan P C van Doormaal  3   4   5 , Kirsten M van Baarsen  6 , Niklaus Krayenbühl  5   7 , Luca Regli  5 , Menno R Germans  5 , Eelco W Hoving  3   6
Affiliations

Cerebrospinal fluid leakage after intradural spinal surgery in children

Emma M H Slot et al. Childs Nerv Syst. 2023 Apr.

Abstract

Purpose: This study aimed to establish the incidence of CSF leakage in children and associated complications after intradural spinal surgery in three tertiary neurosurgical referral centers and to describe the treatment strategies applied.

Methods: Patients of 18 years or younger who underwent intradural spinal surgery between 2015 and 2021 in three tertiary neurosurgical referral centers were included. Patients who died or were lost to follow-up within six weeks after surgery were excluded. The primary outcome measure was CSF leakage within six weeks after surgery, defined as leakage of CSF through the skin. Secondary outcome measures included the presence of pseudomeningocele (PMC), meningitis, and surgical site infection (SSI).

Results: We included a total of 75 procedures, representing 66 individual patients. The median age in this cohort was 5 (IQR = 0-13 years. CSF leakage occurred in 2.7% (2/75) of procedures. It occurred on days 3 and 21 after the index procedure, respectively. One patient was treated with a pressure bandage and an external lumbar drain on day 4 after diagnosis of the leak, and the other was treated with wound revision surgery on day 1 after the leak occurred. In total, 1 patient developed a PMC without a CSF leak which was treated with wound revision surgery. SSI occurred in 10.7%, which included both cases of CSF leak.

Conclusions: CSF leakage after intradural spinal surgery in the pediatric population is relatively rare (2.7%). Nevertheless, the clinical consequences with respect to secondary complications such as infection and the necessity for invasive treatment are serious.

Keywords: Cerebrospinal fluid leakage; Infection; Pediatrics; Spina bifida; Spinal surgery.

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Conflict of interest statement

Tristan van Doormaal is a consultant for Polyganics B.V.

Figures

Fig. 1
Fig. 1
Flowchart of the study population. CSF, cerebrospinal fluid; ELD, external lumbar drainage; KiSpi, University Children’s Hospital Zurich; PMC, Princess Máxima Center for Pediatric Oncology; WKZ, Wilhelmina Children’s Hospital
See this image and copyright information in PMC

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