title: Management of cerebrospinal fluid leaks after anterior decompression for ossification of the posterior longitudinal ligament: a review of the literature.
abstract: OBJECTIVE
  Anterior decompression is an effective way to treat cervical myelopathy associated with ossification of the posterior longitudinal ligament (OPLL); however, this approach is associated with an increased risk of a dural tear and resultant CSF leak because fusion of the dura with the ossified PLL is common in these cases. The authors review the literature and present an algorithm for treatment of CSF leaks in these patients.
  
  
  METHODS
  A MEDLINE review was performed to identify papers related to CSF leak after anterior decompression for OPLL, and data were summarized to identify treatment options for various situations. A treatment algorithm was identified based on these findings and the experience of the authors.
  
  
  RESULTS
  Eleven studies were identified that presented data on intra- and postoperative management of a CSF leak during ventral surgery for OPLL. The incidence of cervical dural tears and CSF leaks after anterior decompression procedures for OPLL ranged from 4.3% to 32%. Techniques including preventative measures, intraoperative dural repair with various materials, and postoperative drainage or shunt placement have all been used.
  
  
  CONCLUSIONS
  Although direct dural repair is the preferred treatment for CSF leak, this technique is not always technically possible. In these cases, intraoperative adjuncts in combination with postoperative measures can be used to decrease the pressure gradient across the dural tear.
authors.affiliation: Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, 175 N. Medical Drive East, Salt Lake City, UT 84132, USA.
authors.forename: Marcus
authors.initials: M
authors.lastname: Mazur
authors.forename: Gregory F
authors.initials: GF
authors.lastname: Jost
authors.forename: Meic H
authors.initials: MH
authors.lastname: Schmidt
authors.forename: Erica F
authors.initials: EF
authors.lastname: Bisson
mesh_terms: D065634:Cerebrospinal Fluid Leak; D002559:Cerebrospinal Fluid Rhinorrhea / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D002557:Cerebrospinal Fluid Shunts / Q000379:methods; D019299:Decompression, Surgical / Q000009:adverse effects*; D019468:Disease Management; D004322:Drainage / Q000379:methods; D004388:Dura Mater / Q000473:pathology / Q000601:surgery; D006801:Humans; D017846:Longitudinal Ligaments / Q000473:pathology / Q000601:surgery; D017887:Ossification of Posterior Longitudinal Ligament / Q000150:complications* / Q000601:surgery* / Q000628:therapy; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D013117:Spinal Cord Compression / Q000473:pathology / Q000601:surgery