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Published on: February 29, 2020
Preventing cerebrospinal fluid leak following transection of a tight filum terminale
Joshua J Chern1, R Shane Tubbs, Akash J Patel
1Pediatric Neurosurgery, Children's Hospital, Birmingham, Alabama, USA.
Insights
Extended bed rest after tethered cord release surgery does not appear to prevent cerebrospinal fluid (CSF) leaks. This study suggests longer hospital stays for this purpose may not be beneficial for pediatric patients.
Area of Science:
- Pediatric Neurosurgery
- Spinal Surgery
- Surgical Outcomes
Background:
- Tethered cord release for tight filum terminale is a common pediatric procedure.
- Preventing cerebrospinal fluid (CSF) leaks post-surgery is a priority, often managed by keeping patients flat.
- The optimal duration for post-operative flat positioning remains undetermined.
Purpose of the Study:
- To investigate if a longer hospital stay for maintaining a flat position after simple tethered cord release reduces CSF leakage rates.
- To identify risk factors associated with postoperative CSF leakage in pediatric patients undergoing tethered cord release.
Main Methods:
- Retrospective analysis of 222 cases of simple tethered cord release from three children's hospitals.
- Data collected included intraoperative and postoperative details.
- Patients were categorized by the duration they remained flat post-surgery (24, 48, or 72 hours).
Main Results:
- CSF leak occurred in 5.9% of patients and pseudomeningocele in 4.1%.
- No significant correlation was found between the duration of remaining flat and the occurrence of complications.
- Operating time, microscope use, dural sealant, and duration of flat positioning did not correlate with complications in univariate analysis.
Conclusions:
- Prolonged bed rest in a flat position after simple tethered cord release does not appear to prevent CSF leakage.
- Larger patient cohorts are necessary to detect potentially small differences in complication rates.
- Current evidence does not support extended hospital stays solely for maintaining a flat position post-tethered cord release.
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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