title: CSF complications following intradural spinal surgeries in children.
abstract: BACKGROUND
  Cerebrospinal fluid (CSF) leakage is a complication of intradural spinal surgery and is associated with poor wound healing and infection. The incidence of CSF leak is reported at ∼16% in adults, but little information is available in children.
  
  
  OBJECTIVE
  The aim of this study is to determine the CSF leak rate and predisposing factors after intradural pediatric spinal surgeries.
  
  
  METHODS
  This study was a retrospective chart review of 638 intradural spinal operations at BC Children's Hospital. CSF leak was defined as pseudomeningocele or CSF leak through incision. Primary operations to untether lipomyelomeningoceles, myelomeningocele/meningocele closure, and Chiari decompressions were excluded.
  
  
  RESULTS
  CSF leaks occurred in 7.1%, with 3% having overt CSF leaks through skin (OCSF leak). CSF leaks, specifically OCSF leaks, were associated with postoperative wound infection (P = 0.0016). Sixteen of 45 cases of CSF leak required reoperation. The type of dural suture used, site of operation, or use of fibrin glue did not affect CSF leak rates. Previous spinal surgery (P < 0.0001), use of dural graft (P = 0.0043), method of dural suturing (P = 0.0023), and procedure performed (P < 0.001) were associated with postoperative CSF leakage. Patients with CSF leak were older than those without leak (98 vs. 72 months, P = 0.002).
  
  
  CONCLUSIONS
  Our results provide evidence on intraoperative factors that may predispose to CSF leaks after spinal intradural surgery and may help guide surgical practice. This study confirms that the pediatric population shares many of the same risk factors for CSF leak as in adult populations. Further research is needed to explain how specific factors are associated with CSF leaks.
authors.affiliation: Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Victor
authors.initials: V
authors.lastname: Liu
authors.forename: Christopher
authors.initials: C
authors.lastname: Gillis
authors.forename: Doug
authors.initials: D
authors.lastname: Cochrane
authors.forename: Ash
authors.initials: A
authors.lastname: Singhal
authors.forename: Paul
authors.initials: P
authors.lastname: Steinbok
mesh_terms: D000293:Adolescent; D065634:Cerebrospinal Fluid Leak; D002559:Cerebrospinal Fluid Rhinorrhea / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D004388:Dura Mater / Q000601:surgery*; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000453:epidemiology; D055815:Young Adult