Preventing cerebrospinal fluid leak following transection of a tight filum terminale.

Academic Article

Abstract

  • OBJECT: Tethered cord release for a tight filum terminale is a common pediatric operation associated with low morbidity and mortality rates. While almost all would agree that keeping patients lying flat after the operation will prevent a CSF leak, the optimal period of doing so has not been determined. In this study, the authors examined whether a longer length of stay in the hospital for the sole purpose of maintaining patients flat correlates with a decreased rate of CSF leakage. METHODS: Intraoperative and postoperative data were retrospectively collected in 222 cases of simple tethered cord release at 3 large children's hospitals. Risk factors for postoperative CSF leakage were identified. RESULTS: Thirty-eight patients were maintained lying flat for 24 hours, 86 for 48 hours, and 98 for 72 hours at the individual surgeon's discretion. A CSF leak occurred in 13 patients (5.9%) and pseudomeningocele developed in 9 patients (4.1%). In the univariate analysis, operating time, use of the microscope, use of dural sealant, and duration of remaining flat after surgery failed to correlate with the occurrence of complications. CONCLUSIONS: A longer hospital stay for maintaining patients flat after a simple tethered cord release appears not to prevent CSF leakage. However, a larger patient cohort will be needed to detect small differences in complication rates.
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    Keywords

  • Bed Rest, Cauda Equina, Cerebrospinal Fluid Leak, Cerebrospinal Fluid Rhinorrhea, Child, Preschool, Female, Humans, Infant, Length of Stay, Male, Meningocele, Microsurgery, Neural Tube Defects, Neurologic Examination, Peripheral Nervous System Diseases, Postoperative Complications, Risk Factors, Statistics as Topic, Supine Position
  • Digital Object Identifier (doi)

    Author List

  • Chern JJ; Tubbs RS; Patel AJ; Gordon AS; Bandt SK; Smyth MD; Jea A; Oakes WJ
  • Start Page

  • 35
  • End Page

  • 38
  • Volume

  • 8
  • Issue

  • 1