PDF(Pubmed)
Abstract：
UNASSIGNED: Our review of 12 articles for this perspective showed the frequency of intraoperative thoracic and/or lumbar CSF fistulas/dural tears (DT) ranged from 2.6% - 8% for primary surgical procedures. Delayed postoperative CSF leak/DT were also diagnosed in 0.83% (17/2052 patients) to 14.3% (2/14 patients) of patients undergoing thoracic and/or lumbar procedures. Further, the rate of recurrent postoperative CSF leaks/DT varied from 13.3% (2/15 patients) to 33.3% (4/12 patients).
UNASSIGNED: Intraoperative, postoperative delayed, and recurrent postoperative traumatic postsurgical thorac CSF leaks/DT can be limited by performing initially sufficient operative decompressions and/or decompressions/fusions (i.e., utilizing adequate open exposures vs. inadequate minimally invasive (MI) approaches). The incidence of CSF leaks/DT can be further reduced by spine surgeons\' utilization of operating microscopes, and their avoiding routine attempts at total synovial cyst excision and/or complete resection of hypertrophied/ossified yellow ligament in the presence of significant dural adhesions.
UNASSIGNED: Multiple CSF leak/CT repair techniques included; using interrupted, non-resorbable sutures for direct dural repairs (i.e. 7-0 Gore-Tex sutures where the suture is larger than the needle thus plugging needle holes), and adding where needed muscle patch grafts, microfibrillar collagen, the rotation of Multifidus muscle pedicle flaps, fibrin sealants (FS)/fibrin glues (FG), lumbar drains (LD), and/or lumbo-peritoneal (LP) shunts.
UNASSIGNED: Intraoperative, postopertive delayed, and/or recurrent postoperative thorac and/or lumbar traumatic surgical CSF leaks can be reduced by choosing to initially perform the appropriately extensive open operative decompressions and/or decompresssions/fusions. It is critical to use an operating microscope, non-resorbable interrupted sutures, and where necessary, muscle patch grafts, microfibrillar collagen, the rotation of Multifidus Muscle Pedicle Flaps, FS/FG, LD, and/or LP shunts.
UNASSIGNED: Intraoperative, postoperative delayed, and recurrent postoperative traumatic postsurgical thorac CSF leaks/DT can be limited by performing initially sufficient operative decompressions and/or decompressions/fusions (i.e., utilizing adequate open exposures vs. inadequate minimally invasive (MI) approaches). The incidence of CSF leaks/DT can be further reduced by spine surgeons\' utilization of operating microscopes, and their avoiding routine attempts at total synovial cyst excision and/or complete resection of hypertrophied/ossified yellow ligament in the presence of significant dural adhesions.
UNASSIGNED: Multiple CSF leak/CT repair techniques included; using interrupted, non-resorbable sutures for direct dural repairs (i.e. 7-0 Gore-Tex sutures where the suture is larger than the needle thus plugging needle holes), and adding where needed muscle patch grafts, microfibrillar collagen, the rotation of Multifidus muscle pedicle flaps, fibrin sealants (FS)/fibrin glues (FG), lumbar drains (LD), and/or lumbo-peritoneal (LP) shunts.
UNASSIGNED: Intraoperative, postopertive delayed, and/or recurrent postoperative thorac and/or lumbar traumatic surgical CSF leaks can be reduced by choosing to initially perform the appropriately extensive open operative decompressions and/or decompresssions/fusions. It is critical to use an operating microscope, non-resorbable interrupted sutures, and where necessary, muscle patch grafts, microfibrillar collagen, the rotation of Multifidus Muscle Pedicle Flaps, FS/FG, LD, and/or LP shunts.
摘要：
■我们对这一观点的12篇文章的回顾显示，在初级外科手术中，术中胸和/或腰椎CSF瘘/硬脑膜撕裂（DT）的频率为2.6％-8％。在接受胸和/或腰椎手术的患者中，有0.83％（17/2052例）至14.3％（2/14例）也诊断出延迟的术后CSF泄漏/DT。Further,术后CSF漏/DT的复发率从13.3%(2/15)到33.3%(4/12)不等.
■术中,术后延迟，并且可以通过最初进行足够的手术减压和/或减压/融合（即，利用足够的开放暴露与微创(MI)方法不足)。脊柱外科医生使用手术显微镜可以进一步降低脑脊液渗漏/DT的发生率，并避免在存在明显硬脑膜粘连的情况下进行全滑膜囊肿切除和/或完全切除肥大/骨化黄韧带的常规尝试。
■包括多次CSF泄漏/CT修复技术；使用中断，用于直接硬脑膜修复的不可再吸收缝合线（即7-0Gore-Tex缝合线，其中缝合线大于针头，从而堵塞针孔），并在需要的地方添加肌肉贴片移植物，微原纤维胶原蛋白，多裂肌蒂皮瓣的旋转，纤维蛋白密封剂（FS）/纤维蛋白胶（FG），腰排水管(LD),和/或腰腹膜（LP）分流。
■术中,术后延迟，和/或术后复发性胸腔和/或腰椎创伤性手术脑脊液漏可以通过选择最初进行适当的广泛的开放手术减压和/或减压/融合来减少。使用手术显微镜至关重要，不可吸收的间断缝合,必要时,肌肉贴片移植物，微原纤维胶原蛋白，多裂肌蒂皮瓣的旋转,FS/FG,LD,和/或LP分流器。
■术中,术后延迟，并且可以通过最初进行足够的手术减压和/或减压/融合（即，利用足够的开放暴露与微创(MI)方法不足)。脊柱外科医生使用手术显微镜可以进一步降低脑脊液渗漏/DT的发生率，并避免在存在明显硬脑膜粘连的情况下进行全滑膜囊肿切除和/或完全切除肥大/骨化黄韧带的常规尝试。
■包括多次CSF泄漏/CT修复技术；使用中断，用于直接硬脑膜修复的不可再吸收缝合线（即7-0Gore-Tex缝合线，其中缝合线大于针头，从而堵塞针孔），并在需要的地方添加肌肉贴片移植物，微原纤维胶原蛋白，多裂肌蒂皮瓣的旋转，纤维蛋白密封剂（FS）/纤维蛋白胶（FG），腰排水管(LD),和/或腰腹膜（LP）分流。
■术中,术后延迟，和/或术后复发性胸腔和/或腰椎创伤性手术脑脊液漏可以通过选择最初进行适当的广泛的开放手术减压和/或减压/融合来减少。使用手术显微镜至关重要，不可吸收的间断缝合,必要时,肌肉贴片移植物，微原纤维胶原蛋白，多裂肌蒂皮瓣的旋转,FS/FG,LD,和/或LP分流器。
