title: CSF-Related Complications After Intradural Spinal Tumor Surgery: Utility of an Autologous Fat Graft.
abstract: OBJECTIVE
  The incidence of cerebrospinal fluid (CSF)-related complications after intradural spinal tumor (IST) surgery is high and reported in up to 18% of patients. However, no efficient way to prevent those complications has been reported so far. Treating these complications may require prolonged bed rest, re-exploration, external lumbar drain, use of antibiotics, and possible precipitation of other complications. To alleviate the risk of CSF-related complications, we prospectively adopted the intraoperative use of autologous fat grafting after IST surgery.
  
  
  METHODS
  This is a perspective analysis of 37 cases (out of 40 cases series) that a prospective use of abdominal fat autograft was applied during dural closure. After the tumor was resected and the dura closed, we used the Valsalva maneuver to ensure watertight closure. CSF leak was prevented with the enforcement of suture with a fat autograft as necessary. In addition a thin layer of fat tissue was then placed over the dura to obliterate any dead space. Fibrin glue was then applied over the graft. Filling the dead space with the fat graft prevented a low-pressure space in which CSF could pool and form a pseudomeningocele.
  
  
  RESULTS
  After adopting the fat autograft technique, we did not observe any post-surgery CSF-related complications in any of these patients.
  
  
  CONCLUSIONS
  The prospective use of autologous fat grafting can ensure watertight dural closure and obliterate the dead space created during surgical exposure and bone removal. This technique significantly reduces, and may completely eliminate, postoperative CSF-related complications in patients with ISTs.
authors.affiliation: Semmes-Murphey Clinic, Memphis, TN, USA; Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, TN, USA.
authors.forename: Kenan I
authors.initials: KI
authors.lastname: Arnautovic
authors.affiliation: Department of Neurosurgery, Osijek University, Osijek, Croatia.
authors.forename: Marko
authors.initials: M
authors.lastname: Kovacevic
mesh_terms: D000273:Adipose Tissue / Q000637:transplantation*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002559:Cerebrospinal Fluid Rhinorrhea / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D015718:Fibrin Tissue Adhesive / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D011446:Prospective Studies; D013120:Spinal Cord Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D013536:Suture Techniques; D014014:Tissue Adhesives / Q000008:administration & dosage*; D019737:Transplants; D016896:Treatment Outcome
chemical_list: D015718:Fibrin Tissue Adhesive; D014014:Tissue Adhesives
keywords: CSF leak; intradural extramedullary spinal tumor; intradural intramedullary spinal tumor; postoperative complications; pseudomeningocele; spinal cord tumor