Preventing cerebrospinal fluid leak following transection of a tight filum terminale: Clinical article

Joshua J. Chern, R. Shane Tubbs, Akash J. Patel, Amber S. Gordon, S. Kathleen Bandt, Matthew D. Smyth, Andrew Jea, W. Jerry Oakes

Research output: Contribution to journalArticle

14 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)35-38
Number of pages4
JournalJournal of Neurosurgery: Pediatrics
Volume8
Issue number1
DOIs
StatePublished - Jul 1 2011

Fingerprint

Cauda Equina
Length of Stay
Cerebrospinal Fluid Leak
Pediatrics
Morbidity
Mortality

Keywords

  • Cerebrospinal fluid leak
  • Surgical complication
  • Tight filum terminale

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health
  • Clinical Neurology

Cite this

Chern, Joshua J. ; Tubbs, R. Shane ; Patel, Akash J. ; Gordon, Amber S. ; Bandt, S. Kathleen ; Smyth, Matthew D. ; Jea, Andrew ; Oakes, W. Jerry. / Preventing cerebrospinal fluid leak following transection of a tight filum terminale : Clinical article. In: Journal of Neurosurgery: Pediatrics. 2011 ; Vol. 8, No. 1. pp. 35-38.
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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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Preventing cerebrospinal fluid leak following transection of a tight filum terminale : Clinical article. / Chern, Joshua J.; Tubbs, R. Shane; Patel, Akash J.; Gordon, Amber S.; Bandt, S. Kathleen; Smyth, Matthew D.; Jea, Andrew; Oakes, W. Jerry.

In: Journal of Neurosurgery: Pediatrics, Vol. 8, No. 1, 01.07.2011, p. 35-38.

Research output: Contribution to journalArticle

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AU - Chern, Joshua J.

AU - Tubbs, R. Shane

AU - Patel, Akash J.

AU - Gordon, Amber S.

AU - Bandt, S. Kathleen

AU - Smyth, Matthew D.

AU - Jea, Andrew

AU - Oakes, W. Jerry

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N2 - 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.

AB - 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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