[Surgical management of dural injuries and postoperative cerebrospinal fluid fistulas in spinal surgeries].
OBJECTIVE
To investigate the surgical management of dural injuries and postoperative cerebrospinal fluid (CSF) fistulas in spinal surgeries and to observe clinical outcomes, since intraoperative injury of dura mater and postoperative CSF fistulas are common complications of spinal surgeries.


METHODS
A retrospective research was designed and 405 patients with complete data who underwent spinal surgeries between June 2002 and March 2006 were acquired, including 298 cases of male and 107 cases of female, with the mean age of 46.2 years (ranging from 11 years to 78 years). The course of disease lasted from 3 months to 5 years. A total of 28 cases of intraoperative dural injuries and durotomies (28/405, 6.91%) were recorded, including 3 cases of cervical spinal surgery (3/152, 1.97%), 19 cases of thoracic and lumbar spinal surgery (19/239, 7.95%) and 6 cases of sacral surgery (6/14, 42.86%). CSF fistulas occurred in 6 cases of 28 patients. There were 2 cases in which no intraoperative dural injury was detected but CSF fistulas occurred after operation. The incidence of postoperative CSF fistula was 1.98% (8/405). Surgical management included closure of breach in the dura mater, oversewing every layer of the wound, bed rest and compression dressing and so on. Clinical outcomes of surgical management were recorded.


RESULTS
The average follow-up lasted for 1 year and 5 months (ranging from 3 months to 4 years). Preoperative symptoms remitted to different extents. There were 8 cases of postoperative CSF fistula which were cured ultimately. A total of 6 cases of CSF fistulas from dorsal injuries of dura mater were treated mainly by bed rest, compression dressing and reoperations, while 2 cases of fistulas from ventral and lateral injuries of dura mater were treated by additional continuous cerebrospinal fluid drainage using a lumbar subarachnoid catheter. One case of central nervous system infection occurred and was treated successfully by multi-disciplinary disposal.


CONCLUSIONS
Timely and correct surgical intervention and postoperative management can help to heal dural injuries in spinal surgeries and can prevent occurrence of postoperative CSF fistulas.
Liu
Peng
P
Department of Orthopaedics, Daping Hospital and Institute of Surgery, the Third Military Medical University, Chongqing, 400042, P.R.China.
Zeng
Xiaobin
X
Liu
Feng
F
Zhao
Jianhua
J
Liu
Mingyong
M
Fan
Weili
W
D000293:Adolescent; D000328:Adult; D000368:Aged; D002558:Cerebrospinal Fluid Otorrhea / Q000209:etiology / Q000517:prevention & control*; D002559:Cerebrospinal Fluid Rhinorrhea / Q000209:etiology / Q000517:prevention & control*; D002648:Child; D004388:Dura Mater / Q000293:injuries*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007431:Intraoperative Complications / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control*; D012189:Retrospective Studies; D013131:Spine / Q000601:surgery*