title: Analysis of risk factors and management of cerebrospinal fluid morbidity in the treatment of spinal dysraphism.
abstract: OBJECTIVE
  Spinal dysraphism defects span wide spectrum. Wound dehiscence is a common postoperative complication, and is a challenge in the current management of cerebrospinal fluid (CSF) leaks and wound healing. The purpose of this study is to evaluate the risks of CSF-related morbidity in the surgical treatment of spinal dysraphism.
  
  
  METHODS
  Ten patients with spinal dysraphism were included in this retrospective study. The median age of the cohort was 4.8 months. To assess the risk of CSF morbidity, we measured the skin lesion area and the percentage of the skin lesion area relative to the back surface for each patient. We then analyzed the relationship between morbidity and the measured skin lesion area or related factors.
  
  
  RESULTS
  The overall median skin lesion area was 36.2 cm(2) (n=10). The percentage of the skin lesion area relative to the back surface ranged from 0.6% to 18.1%. During surgical reconstruction, 4 patients required subsequent operations to repair CSF morbidity. The comparison of the mean area of skin lesions between the CSF morbidity group and the non-CSF morbidity group was statistically significant (average volume skin lesion of 64.4±32.5 cm(2) versus 27.7±27.8 cm(2), p<0.05). CSF morbidity tended to occur either when the skin lesion area was up to 44.2 cm(2) or there was preexisting fibrosis before revision with an accompanying broad-based dural defect.
  
  
  CONCLUSIONS
  Measuring the lesion area, including the skin, dura, and related surgical parameters, offers useful information for predicting wound challenges and selecting appropriate reconstructive surgery methods.
authors.affiliation: Department of Neurosurgery, Inje University Ilsan Paik Hospital, College of Medicine, Goyang, Korea.
authors.forename: Byung-Jou
authors.initials: BJ
authors.lastname: Lee
authors.forename: Moon-Jun
authors.initials: MJ
authors.lastname: Sohn
authors.forename: Seong-Rok
authors.initials: SR
authors.lastname: Han
authors.forename: Chan-Young
authors.initials: CY
authors.lastname: Choi
authors.forename: Dong-Joon
authors.initials: DJ
authors.lastname: Lee
authors.forename: Jae Heon
authors.initials: JH
authors.lastname: Kang
keywords: CSF morbidity; Lipomyelomeningocele; Meningomyelocele; Spinal dysraphism; Surgical reconstruction; Tethered cord syndrome