{"id":"6c22d67d-901a-4699-8ab7-46d18dd36981","slug":"a-review-article-on-the-diagnosis-and-treatment-of-cerebrospinal-fluid-fistulas-and-dural-tears-occurring-during-spinal-surgery","title":"A review article on the diagnosis and treatment of cerebrospinal fluid fistulas and dural tears occurring during spinal surgery","authors":["Nancy E. Epstein"],"abstract":"Background: In spinal surgery, cerebrospinal fluid (CSF) fistulas attributed to deliberate dural opening (e.g., for tumors, shunts, marsupialization of cysts) or inadvertent/traumatic dural tears (DTs) need to be readily recognized, and appropriately treated. Methods: During spinal surgery, the dura may be deliberately opened to resect intradural lesions/tumors, to perform shunts, or to open/marsupialize cysts. DTs, however, may inadvertently occur during primary, but are seen more frequently during revision spinal surgery often attributed to epidural scarring. Other etiologies of CSF fistulas/DTs include; epidural steroid injections, and resection of ossification of the posterior longitudinal ligament (OPLL) or ossification of the yellow ligament (OYL). Whatever the etiology of CSF fistulas or DTs, they must be diagnosed utilizing radioisotope cisternography (RIC), magnetic resonance imaging (MRI), computed axial tomography (CT) studies, and expeditiously repaired. Results: DTs should be repaired utilizing interrupted 7-0 Gore-Tex (W.L. Gore and Associates Inc., Elkton, MD, USA) sutures, as the suture itself is larger than the needle; the larger suture occludes the dural puncture site. Closure may also include muscle patch grafts, dural patches/substitutes (bovine pericardium), microfibrillar collagen (Duragen: Integra Life Sciences Holdings Corporation, Plainsboro, NJ), and fibrin glues or dural sealants (Tisseel: Baxter Healthcare Corporation, Deerfield, IL, USA). Only rarely are lumbar drains and wound-peritoneal and/or lumboperitoneal shunts warranted. Conclusion: DTs or CSF fistulas attributed to primary/secondary spinal surgery, trauma, epidural injections, OPLL, OYL, and other factors, require timely diagnosis (MRI/CT/Cisternography), and appropriate reconstruction. ACF Anterior Corpectomy and Fusion BMP Bone Morphogenetic Protein COPD Chronic Obstructive Pulmonary Disease CSF Cerebrospinal Fluid CT Computed Axial Tomography CTM Computed Axial Tomography Myelography FDA Food and Drug Administration JP Jackson Pratt Drain LP-shunt Lumboperitoneal shunt METRx Medtronic MicroDiskectomy System MIS Minimally Invasive Surgery MISS Minimally Invasive Spine surgery MR Magnetic Resonance Imaging MRSA Methicillin Resistant Staphylococcus Aureus Myelo-CT Myelogram Computed Tomography OPLL Ossification Posterior Longitudinal Ligament OYL Ossification Yellow Ligament PLIF Posterior Lumbar Interbody Fusion RIC Radioisotope Cisternography RIS Radionuclide Cisternography SIH Spontaneous Intracranial Hypotension SPORT Spine Patient Outcomes Research Trial 3-D Three Dimensional TE/MR Echo Time: Time After Excitation Pulses: Echo Time in Magnetic Resonance Imaging TLIF Transforaminal Lumbar Interbody Fusion TR/MR Relaxation Times on MR Scans (T1, T2 Weighted Studies) WP-Shunt Wound-Peritoneal Shunt","thumbnailUrl":"https://sni-digital-videos.s3.amazonaws.com/articles/6c22d67d-901a-4699-8ab7-46d18dd36981/featured/hero-1782420839014.png","publishDate":"2013-05-06T00:00:00.000Z","doi":"10.4103/2152-7806.111427","categories":["Original Article"],"fullTextUrl":"http://sni.wpengine.com/wp-content/uploads/2015/04/3882/SNI-4-301.pdf"}