Primary treatment with temporary subcutaneous peritoneal shunts for postoperative spinal cerebrospinal fluid fistulas.
OBJECTIVE
The authors describe a series of attempts to treat with minimally invasive surgery cerebrospinal fluid (CSF) fistulas that develop following operations of the spine for congenital anomalies.


METHODS
Sixteen patients in whom CSF fistulas developed following repair of congenital spinal disorders (nine lipomeningoceles, one arachnoid cyst, two myelocystoceles, three tethered cords after myelomeningocele repair, and one scoliosis surgery) underwent placement of a temporary subcutaneous peritoneal shunt. The CSF fistulas resolved in all instances. Two patients required revision of the shunts prior to resolution of the fistula and subsequent shunt removal. Three patients suffered a lumbar wound or shunt infection, which necessitated shunt removal. Subsequent to the removal, the infection resolved and there was no recurrence of the CSF leak. Fourteen patients had their shunts completely removed within 1 year of placement. Two patients did not have their shunts removed because parental consent for the additional surgery was not given.


CONCLUSIONS
Postoperative subcutaneous CSF fistulas of the spine can be successfully treated using temporary subcutaneous peritoneal shunts. This procedure reduces hospital stay and obviates the need for more extensive or multiple surgical interventions.
James
Hector E
HE
Lucy Gooding Pediatric Neurosurgery Center, University of Florida Jacksonville and Wolfson Children's Hospital, Jacksonville, FL 32207, USA. pedneurosurgery@aol.com
Postlethwait
Richard
R
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D017577:Cutaneous Fistula / Q000601:surgery*; D020878:Device Removal; D005260:Female; D005402:Fistula / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D019060:Minimally Invasive Surgical Procedures; D009436:Neural Tube Defects / Q000601:surgery*; D011183:Postoperative Complications / Q000601:surgery*; D012086:Reoperation; D013122:Spinal Diseases / Q000601:surgery*; D017287:Ventriculoperitoneal Shunt / Q000379:methods*