Surgical treatment of subdural tumors, repair of dura mater, and the treatment of postoperative cerebrospinal fluid leakage
HUANG Xue-liang, ZHU Shuang-fang, LIN Yu-cong, ZHOU Chu-song
Chinese Journal of Clinical Anatomy ›› 2018, Vol. 36 ›› Issue (4) : 436-439.
Surgical treatment of subdural tumors, repair of dura mater, and the treatment of postoperative cerebrospinal fluid leakage
Objective To analyze the relationship between the repair method of dura mater after and cerebrospinal fluid leakage(CSFL). Methods From Jan. 2010 to Dec. 2016, 200 patients with subdural tumors were treated by posterior surgery, including 89 males and 111 females, with an average age of 46.2 years (4 months -82 years). Radiological images of fractures, internal fixation, repair method of dura mater, occurrence of CSFL and its treatment were recorded and analyzed after follow-up. Results CSFL was found in 26 of the 200 patients after operation. 85 cases were treated with internal fixation, of which 22 cases had CSFL (25.9%). 115 cases did not place internal fixation, of which 4 cases had CSFL (3.5%). There were 30 cases of simple suture of dura, of which 8 cases had CSFL (26.7%). 136 cases had spinal membrane sutured and covered, of which 16 cases had CSFL (11.8%); 29 cases had spinal membrane sutured and covered with protein glue, of which 2 cases had CSFL (6.9%). 5 cases were repaired by myofascial or fat because of dural defects, and did not show CSFL. The incidence of CSFL in patients with coverage of the spinal membrane or (and) biological protein gum, myofascia or fat after suture of the dura was statistically significant (P<0.05). In 10 patients with leakage of cerebrospinal fluid that underwent extended drainage time, there was no incision complications, and the average time for stitch removal was 11.8±1.7 days; and 2 cases in 16 patientswith early removal of drainage tube developed intracranial infection, 1 cases sinus tract, 1 cases dural pseudocyst formation, the average time for stitch removal was 18.5±8.5 days, and the difference were statistically significant (P<0.05). Conclusion Placement of internal fixation in the surgery of subdural tumor can increase the incidence of CSFL. Spinal dura mater, fibrin glue, myofascial or fat repair dura can reduce CSFL. The proper extension of the drainage time after the CSFL after operation can promote the healing of the incision and reduce the incidence of related complications.
Subdural tumor; / Cerebrospinal fluid leakage; / Internal fixation; Surgery; / Drainage tube
[1] 李海峰，阮狄克，王德利，等. 椎管内神经鞘瘤的手术治疗及术后脑脊液漏的处理[J]. 中国脊柱脊髓杂志, 2008, 18(6): 411-414.
[2] 于淼，江晓兵，姚珍松，等. 氰基丙烯酸酯医用胶预防脑脊液漏的疗效观察[J]. 中国修复重建外科杂志, 2013, 27(12): 1471-1474.
[3] McCudden CR, Senior BA, Hainsworth S, et al. Evaluation of high resolution gel beta(2)-transferrin for detection of cerebrospinal fluid leak[J]. Clin Chem Lab Med, 2013, 51(2): 311-315.
[4] 吴玉仙，纪玉清，李建民，等. 椎管内肿瘤切除术后切口并发症的相关因素分析[J]. 中国骨与关节损伤杂志, 2016, 31(3): 251-253.
[5] 张阳德，向忠，彭健. 硬脊膜损伤分度及预防脑脊液漏的临床研究[J]. 中国现代医学杂志, 2007, 17(11): 1349-1351.
[6] 王锐，田增民. 脊柱膜在临床脊髓手术中的应用[J]. 海军总医院学报, 2007, 20(1): 44-45.
[7] Van Aken MO, Feelders RA, de Marie S, et al. Cerebrospinal fluid leakage during transsphenoidal surgery: postoperative external lumbar drainage reduces the risk for meningitis[J]. Pituitary, 2004, 7(2): 89-93.
[8] Eross EJ, Dodick DW, Nelson KD, et al. Orthostatic headache syndrome with CSF leak secondary to bony pathology of the cervical spine[J]. Cephalalgia, 2002, 22(6): 439-443.
[9] 肖继伟，彭俊平. 脊柱手术并发脑脊液漏的处理体会[J]. 中国矫形外科杂志, 2008, 16(8): 629-630.
[10] 于滨生，郑召民，庄新明，等. 脊柱手术后脑脊液漏的治疗[J]. 中国脊柱脊 髓杂志, 2009，19(2): 113-116.
[11] 曲绍东，苏庆军，海涌，等. 加压包扎早期拔管治疗胸腰椎术后脑脊液漏[J]. 实用骨科杂志, 2012, 18(11): 1009-1011.
[12] 初同伟，周跃，王建，等. 脊柱术后脑脊液漏的处理[J]. 重庆医学, 2008, 37(10): 1041-1042.
[13] 程增银，马文海，崔建平，等. 延长引流时间并间断夹闭引流管治疗脊柱术后脑脊液漏的疗效观察[J]. 中国脊柱脊髓杂志, 2010, 20(12): 985-987.
[14] 张志平，郭昭庆，孙垂国，等. 退变性腰椎疾患后路减压术后脑脊液漏的相关因素分析及处理[J]. 中国脊柱脊髓杂志, 2014, 24(10): 906-911.
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