title: Management of cerebrospinal fluid leakage after anterior decompression for ossification of posterior longitudinal ligament in the thoracic spine: the utilization of a volume-controlled pseudomeningocele.
abstract: METHODS
  Retrospective review
  
  
  OBJECTIVE
  To determine the efficacy of management of cerebrospinal fluid (CSF) leakage after the anterior thoracic approach.
  
  
  BACKGROUND
  CSF leakage after incidental durotomy commonly occurs after anterior thoracic ossification of posterior longitudinal ligament (OPLL) surgery. Pseudomeningocele will invariably form under such circumstances. Among them, uncontrolled CSF leakage with a fistulous condition is problematic. As a solution, we have managed these durotomies with chest drains alone without any CSF drainage by the concept of a "volume-controlled pseudomeningocele."
  
  
  METHODS
  Between 2001 and 2009, CSF leakage occurred in 26 patients (37.7%) of the total 69 patients who underwent anterior decompression for thoracic OPLL. In the initial 11 cases, subarachnoid drainage was utilized as an augmentive measure in combination with chest tube drainage in the postoperative period (group A). In the subsequent 15 cases, the durotomy was managed in a similar manner but in the absence of any subarachnoid drainage (group B). Various parameters such as the duration of postoperative hospital stay, clinical outcome score, drainage output, resolution of CSF leakage, complications, and additional surgery performed were analyzed and compared between the 2 groups. A resolution of the CSF leakage grading system was also proposed for the residual pseudomeningocele that formed in each group.
  
  
  RESULTS
  There were statistically no significant differences in the outcome parameters between the 2 groups and also in patients with grade I or grade II residual pseudomeningocele of the new grading system. Two complications occurred in group A. No reexploration for persistent CSF leakage was required in both groups.
  
  
  CONCLUSIONS
  CSF leakage managed with controlled chest tube drainage can produce a comparable result with those with additional subarachnoid drainage when watertight dural repair is impossible. The concept of controlled pseudomeningocele may be a useful and practical technique for the treatment of CSF leakage after anterior thoracic OPLL surgery.
authors.affiliation: Department of Neurosurgery, Wooridul Spine Hospital, Seoul, Korea.
authors.forename: Ji Young
authors.initials: JY
authors.lastname: Cho
authors.forename: Chee Keong
authors.initials: CK
authors.lastname: Chan
authors.forename: Sang-Ho
authors.initials: SH
authors.lastname: Lee
authors.forename: Won-Chul
authors.initials: WC
authors.lastname: Choi
authors.forename: Dae Hyeon
authors.initials: DH
authors.lastname: Maeng
authors.forename: Ho-Yeon
authors.initials: HY
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D002555:Cerebrospinal Fluid; D019299:Decompression, Surgical / Q000009:adverse effects*; D004322:Drainage / Q000379:methods*; D004388:Dura Mater / Q000293:injuries*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017887:Ossification of Posterior Longitudinal Ligament / Q000601:surgery*; D012189:Retrospective Studies; D013904:Thoracic Vertebrae / Q000601:surgery*