Delayed symptomatic cerebrospinal fluid leakage after spine surgery with an intraoperative occult dural tear: An institutional experience and literature review

• Main Authors: Shinji Kotaka, Yasushi Fujiwara, Ryo Ota, Hideki Manabe, Nobuo Adachi
• Format: Article
• Language: English
• Published: Elsevier 2020-12-01
• Series: Interdisciplinary Neurosurgery
• Subjects: Cerebrospinal fluid leakage; Complications; Occult dural tear; Spinal surgery
• Online Access: http://www.sciencedirect.com/science/article/pii/S2214751920304096

Background: Cerebrospinal fluid (CSF) leakage is a hazardous complication after spine surgeries. Although most CSF leakages occur because of intraoperative dural tears, there are several reports that delayed CSF leakage occurred with undetected dural tears during surgery, which is known as occult dural tears (ODT).In this paper, we investigate ODT resulting in delayed CSF leakage following spinal surgery in our institute. Methods: A retrospective review was conducted of 12,346 consecutive patients who underwent spinal surgery in order to identify ODT cases that underwent revision surgery. Results: Among the 12,346 patient, 6 patients (0.049%) underwent revision surgery due to ODT resulting in delayed CSF leakage.In all surgeries, no dural tears were detected during primary surgery. However, 5 patients complained of headaches, 5 patients had CSF leakage through the skin and/or pseudomeningocele and 3 patients complained of nausea. The period between primary surgery and the diagnosis of ODT was an average of 2.7 days (range 1–4 days) after surgery.In revision surgeries, dural tears were found in all cases, although, at the time of primary surgery, there were no apparent dural tears. Direct dural suturing was performed in 5 cases and dural patching using fascia was performed in one case. In all cases, fibrin glue was used. The symptoms of all cases got better after surgery. Conclusions: Although the incidence of delayed CSF leakage due to occult dural tears was not high, caution is necessary when patients complain of headaches or nausea after spine surgery.