title: Preventing cerebrospinal fluid leak following transection of a tight filum terminale.
abstract: OBJECTIVE
  Tethered cord release for a tight filum terminale is a common pediatric operation associated with low morbidity and mortality rates. While almost all would agree that keeping patients lying flat after the operation will prevent a CSF leak, the optimal period of doing so has not been determined. In this study, the authors examined whether a longer length of stay in the hospital for the sole purpose of maintaining patients flat correlates with a decreased rate of CSF leakage.
  
  
  METHODS
  Intraoperative and postoperative data were retrospectively collected in 222 cases of simple tethered cord release at 3 large children's hospitals. Risk factors for postoperative CSF leakage were identified.
  
  
  RESULTS
  Thirty-eight patients were maintained lying flat for 24 hours, 86 for 48 hours, and 98 for 72 hours at the individual surgeon's discretion. A CSF leak occurred in 13 patients (5.9%) and pseudomeningocele developed in 9 patients (4.1%). In the univariate analysis, operating time, use of the microscope, use of dural sealant, and duration of remaining flat after surgery failed to correlate with the occurrence of complications.
  
  
  CONCLUSIONS
  A longer hospital stay for maintaining patients flat after a simple tethered cord release appears not to prevent CSF leakage. However, a larger patient cohort will be needed to detect small differences in complication rates.
authors: Pediatric Neurosurgery, Children's Hospital, Birmingham, Alabama, USA.
authors: Joshua J
authors: JJ
authors: Chern
authors: R Shane
authors: RS
authors: Tubbs
authors: Akash J
authors: AJ
authors: Patel
authors: Amber S
authors: AS
authors: Gordon
authors: S Kathleen
authors: SK
authors: Bandt
authors: Matthew D
authors: MD
authors: Smyth
authors: Andrew
authors: A
authors: Jea
authors: W Jerry
authors: WJ
authors: Oakes
mesh_terms: D001510:Bed Rest; D002420:Cauda Equina / Q000601:surgery*; D065634:Cerebrospinal Fluid Leak; D002559:Cerebrospinal Fluid Rhinorrhea / Q000175:diagnosis / Q000517:prevention & control; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007902:Length of Stay; D008297:Male; D008588:Meningocele / Q000517:prevention & control; D008866:Microsurgery; D009436:Neural Tube Defects / Q000175:diagnosis / Q000601:surgery*; D009460:Neurologic Examination; D010523:Peripheral Nervous System Diseases / Q000175:diagnosis / Q000601:surgery*; D011183:Postoperative Complications / Q000175:diagnosis / Q000517:prevention & control*; D012307:Risk Factors; D013223:Statistics as Topic; D016683:Supine Position