Analysis of the clinical characteristics of 8 cases of spontaneous intracranial hypotension / 中华全科医师杂志

Objective:To analyze the clinical characteristics of patients with spontaneous low intracranial pressure (SIH).Methods:The study is a retrospective series. The clinical data of patients with SIH who visited Beijing Hospital from May 2017 to March 2022, including gender, age, symptoms, signs, imaging findings, treatment and outcome, were collected and their clinical characteristics were analyzed.Results:Finally, 8 patients with SIH, 6 females and 2 males, aged (33.5±7.3) years, were included. There were 6 cases of acute onset, 1 case of subacute onset, and 1 case of chronic onset. Four cases had pre-onset triggers, 3 cases were exertional and 1 case was exercise. All 8 cases had orthostatic headache. Three cases were accompanied by neck pain. Six cases were accompanied by autonomic dysfunction, 1 case with blurred vision and neck resistance, and 1 case with tinnitus in both ears. There were no obvious abnormalities in blood routine, liver and kidney function, electrolytes, and coagulation function in 8 cases. The results of the lumbar puncture showed that the cerebrospinal fluid pressure was≤60 mmH 2O(1 mmH 2O=0.009 8 kPa) in 7 cases, and 2 cases were so low that they were undetectable. One patient had normal cerebrospinal fluid pressure (90 mmH 2O). The routine results of cerebrospinal fluid showed 4 cases of an increased number of red blood cells and 2 cases of leukocytosis. The biochemical results of cerebrospinal fluid in all 8 cases were normal. All 8 patients underwent non-contrast MRI scan of the head, and 6 cases found abnormalities, including 2 cases of subdural hematoma, 1 case of subarachnoid hemorrhage, 1 case of brain tissue sinking, and 3 cases of intracranial venous sinus dilation (including 1 case with subdural hematoma). All 8 patients underwent MRI enhancement scan of the head, and 5 patients showed diffuse dural enhancement. Three patients underwent digital subtraction angiography myelogram and computed tomography myelogram, and 2 cases found dural cerebrospinal fluid leakage. One patient underwent magnetic resonance water imaging and no cerebrospinal fluid leakage was found. Eight patients were followed up for 38.5 (10.3, 63.0) months, after conservative treatment, 6 cases of headache relief or disappearance, 1 case relapsed and was admitted 1 week after discharge, non-targeted epidural blood patching (EBP) did not relapse, 1 case underwent non-targeted EBP after conservative treatment failure, headache relief, recurrence after 2 months, thoracic spine 3-4 space targeted EBP, headache disappeared, did not recur. Conclusions:The present study indicate that SIH prevalence in young age is common, the main symptom is orthostatic headache, accommodated with multiple clinical symptoms with various imaging abnormalities. Most patients with SIH can be treated conservatively, if the effect is not good, non-targeted or targeted EBP is feasible.

Research progress of treatment for cerebrospinal fluid leak in spine surgeries / 国际外科学杂志

Cerebrospinal fluid leakage is one of the common complications of spinal surgeries. The causes of the leak can be dural tears during surgery procedure and this is a medical problem.Cerebrospinal fluid is a physiological fluid that protects the brain and maintains intracranial pressure. If it's not handled properly, it will cause persistent headaches, nausea, vomiting, and carry an increased risk of meningitis. Correct and effective dural suture and repair are the basis of recovery. The repair of dura mater is difficult to be alleviated by medicine, so it is very important to identify and repair cerebrospinal fluid leakage in time. In this review, the relevant studies in recent years are summarized. We discuss the pathogenesis of dural tears, diagnosis, repair methods. We provide references for clinicians to avoid delayed wound healing, wound infection, spinal canal and intracranial infection, pseudodural cyst, spinal cord nerve compression and other serious complications. This paper aims to assist in delivering efficacious treatment and recovery for patients.

A makeshift blue light filter for endoscopic identification of traumatic cerebrospinal fluid leak using fluorescein

Objective@#To describe a makeshift blue light filter for endoscopic visualization of a traumatic cerebrospinal fluid leak repair using intrathecal fluorescein and its application in one patient.@*Methods@# Study Design:Surgical Instrumentation Setting:Tertiary Government Training Hospital Patient:One @*Results@#Intra-operative endoscopic identification of fistulae sites was achieved using intrathecal injection of fluorescein that fluoresced using our makeshift blue light filter in a 43-year-old man who presented with a 3-month history of rhinorrhea due to skull base fractures along with multiple facial and upper extremity fractures he sustained after a fall from a standing height of 6 feet. He underwent transnasal endoscopic repair of cerebrospinal fluid fistulae in the planum sphenoidale, clivus and sellar floor. Post-operatively, there was complete resolution of rhinorrhea with no complications noted. @*Conclusion@#Our makeshift blue light filter made from readily available materials may be useful for endoscopic identification of CSF leaks using fluorescein in a low- to middle-income country setting like ours.

Effect of thrombin concentration on the prevention of postoperative cerebrospinal leakage by fibrin glue / 中国组织工程研究

BACKGROUND: Fibrin glue is commonly used to prevent postoperative cerebrospinal fluid leakage from dural injuries. However, fibrin glue with standard-concentration thrombin coagulates too fast, resulting in poor adhesion of dural mater. Effect of low-concentration thrombin fibrin glue on sealing dural injuries to prevent cerebrospinal fluid leakage is unclear. OBJECTIVE: To compare the effect of low-concentration thrombin and standard-concentration thrombin on the prevention of cerebrospinal fluid leakage from dural injuries by fibrin glue. METHODS: Forty patients including 25 males and 15 females with dural injuries admitted at Fifth People’s Hospital of Chengdu from May 2017 to December 2019 were enrolled. Patients were randomly divided into two groups, 20 patients in each group. In low-concentration thrombin group, dural injuries were sealed with fibrin glue prepared with low-concentration thrombin solution (100 IU/mL). In standard-concentration thrombin group, dural injuries were sealed with fibrin glue prepared with standard-concentration thrombin solution (500 IU/mL). All patients were followed up for 2 months. The incidence of cerebrospinal fluid leakage, cumulative drainage flow, drainage duration and incision complications were compared between the two groups. The study was approved by Ethics Committee of Fifth People’s Hospital of Chengdu. RESULTS AND CONCLUSION: (1) The incidence of cerebrospinal leakage, accumulative volume and duration of drainage in the low-concentration thrombin group were lower than those of standard-concentration thrombin group (P 0.05). (3) These results indicate that fibrin glue prepared with low-concentration thrombin solution decreases the rate of cerebrospinal leakage, reduces the drainage volume and shortens the duration of drainage, which is demonstrated to be an effective strategy for sealing dural injuries.

Analysis of risk factors for intracranial infection after endoscopic transnasal pituitary adenoma resection and strategies for reconstructing skull base defects / 中国肿瘤临床

To investigate the risk factors for the occurrence of intracranial infection (ICI) after endoscopic transnasal resection of a pituitary adenoma and to select the best strategy for reconstructing skull base defects. Method: The clinical data of 162 patients with pituitary adenoma admitted into First Hospital of Shanxi Medical University between December 2016 and December 2019 were analyzed retrospectively. The incidence rate of ICI after surgery was analyzed. According to the occurrence of ICI, patients were stratified into ICI and non-ICI groups. The infected and non-infected groups of clinical data were collected and the independent risk factors for ICI after surgery were analyzed. Result: Among the 162 patients, 11 patients (6.79%) developed ICI, whereas 151 patients (93.21%) did not develop ICI. Body mass index (BMI), intraoperative cerebrospinal fluid leakage, postoperative cerebrospinal fluid leakage, and Kelly grades were significantly higher in the ICI group than in the non-ICI group (P<0.05). Logistic regression analysis showed that BMI, intraoperative cerebrospinal fluid leakage, postoperative cerebrospinal fluid leakage, and Kelly grades were independent risk factors for ICI after surgery (P<0.05). Conclusions: The incidence of ICI after endoscopic endonasal surgery is related to BMI, intraoperative cerebrospinal fluid leakage, postoperative cerebrospinal fluid leakage, and Kelly grades. Furthermore, reasonable strategies for skull-base reconstruction should be developed according to the Kelly grading system.

Predictors of the Response to an Epidural Blood Patch in Patients with Spinal Leakage of Cerebrospinal Fluid

Cervical Cerebrospinal Fluid Leakage Concomitant with a Thoracic Spinal Intradural Arachnoid Cyst / 대한신경손상학회지

We encountered a very rare case of spontaneous spinal cerebrospinal fluid (CSF) leakage and a spinal intradural arachnoid cyst (AC) that were diagnosed at different sites in the same patient. These two lesions were thought to have interfered with the disease onset and deterioration. A 30-year-old man presented with sudden neck pain and orthostatic headache. Diplopia, ophthalmic pain, and headache deteriorated. CSF leakage was confirmed in C2 by radioisotope cisternography, and an epidural blood patch was performed. While his symptoms improved gradually, paraparesis suddenly progressed. Thoracolumbar magnetic resonance imaging (MRI) revealed an upper thoracic spinal intradural AC, which was compressing the spinal cord. We removed the outer membrane of the AC and performed fenestration of the inner membrane after T3-4 laminectomy. Postoperative MRI showed complete removal of the AC and normalized lumbar subarachnoid space. All neurological deficits including motor weakness, sensory impairment, and voiding function improved to normal. We present a case of spontaneous spinal CSF leakage and consecutive intracranial hypotension in a patient with a spinal AC. Our report suggests that if spinal CSF leakage and a spinal AC are diagnosed in one patient, even if they are located at different sites, they may affect disease progression and aggravation.

Experience in the treatment of postoperative cerebrospinal fluid leakage followed by surgical management of a spinal meningocele combined with infection / 中华整形外科杂志

A 37-year-old woman presented with a congenital spinal meningocele for 37 years and ruptured for 6 months. She was admitted to the Plastic Surgery Hospital of the Chinese Academy of Medical Sciences in March 2018. The diameter of the lesion was about 10 cm, with purulent secretion and malodor. The superior gluteal artery perforator propeller flap was used to reconstruct the defect after the lesion resection. Part of the wound didn’t heal and cerebrospinal fluid leaked from the wound postoperatively. The wound eventually healed after wound debridement and drainage changing. Cerebrospinal fluid retention under the flap could result in wound dehiscence and cerebrospinal fluid leakage. The author introduced the treatment process and operative method. The preliminary experience in treating cerebrospinal fluid leakage after surgical management of the spinal meningocele was also summarized.

Therapeutic effect of pedicled nasal septum mucosal flap on cerebrospinal fluid leakage in transsphenoidal approach / 中国医师进修杂志

Objective To explore the therapeutic effect of pedicled nasal septum mucosal flap on high-flow cerebrospinal fluid leakage in transsphenoidal approach. Methods The clinical data of 31 patients with high-flow cerebrospinal fluid leakage during neuroendoscope transsphenoidal approach from January 2012 to April 2018 were analyzed retrospectively. Among them, skull base of 18 patients was reconstructed with pedicled nasal septum mucosal flap technique (observation group), and skull base of 13 patients was reconstructed with the'sandwich'method (control group). The postoperative cerebrospinal fluid leakage and complications were compared between 2 groups. Results Postoperative cerebrospinal fluid leakage occurred in 6 cases in control group, and 1 case in observation group, and there was statistical difference between 2 groups (P<0.05). Postoperative olfactory loss occurred in 2 cases in control group, and 3 cases in observation group, and there was no statistical difference between 2 groups (P>0.05). Conclusions Multilayer skull base reconstruction with pedicled nasal septum mucosal flap can significantly reduce the incidence of cerebrospinal fluid leakage after transsphenoidal tumor resection, and is a safe and reliable method to treat the high flow cerebrospinal fluid leakage in operation.

El rol de la proteína beta trace en distintas áreas de la Medicina / The role of beta trace protein in different areas of Medicine / O papel da proteína beta trace em diferentes áreas da Medicina

La proteína beta trace (PBT), también llamada Prostaglandina D2 Sintasa de tipo lipocalina, es una glicoproteína de peso molecular entre 23 y 29 kDa que convierte la prostaglandina H2 en prostaglandina D2. La misma está asociada a diferentes entidades clínicas. Por sus características moleculares puede ser un indicador útil de la alteración precoz en la filtración glomerular; por el aumento de su síntesis y su concomitante elevación en suero, un predictor de riesgo cardiovascular; y por su alta concentración en líquido cefalorraquídeo (LCR), un biomarcador de fístula de LCR. Puede medirse en distintos líquidos biológicos, como suero, orina y LCR. El objetivo de esta revisión fue actualizar los conocimientos de esta proteína para evaluar su utilidad en distintas áreas de la Medicina. La trascendencia de PBT en el campo de la bioquímica como posible biomarcador dependerá de la patología de base del paciente.

The beta trace protein (BTP), also called Prostaglandin D2 Synthase lipocalin type PGDS, is a glycoprotein between 23 and 29 kDa of low molecular weight that converts prostaglandin H2 in prostaglandin D2. BTP is a protein that has multiple clinical associations. Due to the characteristics of the molecule, it may indicate an early alteration in glomerular filtration; by the serum increase of its synthesis, it is a predictor of cardiovascular risk, and for its high concentration in cerebrospinal fluid (CSF), it is a marker of leakage. This protein can be measured in different biological fluids such as serum, urine, and CSF. The objective of this review is to update the knowledge about this protein as a biomarker. The significance of BTP in the field of biochemistry as a possible biomarker will depend on the patient's underlying pathology.

A proteína beta trace (PBT), também chamada de Prostaglandina D2, sintase de lipocalina é uma glicoproteína de peso molecular entre 23 e 29 kDa, que converte prostaglandina H2 em prostaglandina D2. PBT é uma proteína que está associada a várias entidades clínicas. Devido às características moleculares, pode ser uma indicação útil da alteração precoce na filtração glomerular, devido ao aumento de sua síntese e sua concomitante elevação em soro, um preditor de risco cardiovascular e, devido à sua alta concentração no líquido cefalorraquidiano (LCR), é um biomarcador da fístula LCR. É uma proteína que pode ser medida em diferentes fluidos biológicos, como soro, urina e LCR, e o objetivo desta revisão foi atualizar os conhecimentos desta proteína para avaliar sua utilidade em diversas áreas da medicina. A importância de PBT no campo da bioquímica como possível biomarcador dependerá da patologia subjacente do paciente.

Risk factors for surgical site infection in patients undergoing selective brain tumor resection / 中国感染控制杂志

Objective To explore the risk factors of surgical site infection(SSI)in patients undergoing selective brain tumor resection,and provide reference for clinical prevention and treatment.Methods Patients who under-went selective brain tumor resection in the neurosurgery department of a hospital during April-September 2013 and April-September 2014 were monitored prospectively,monitoring programme and individualized questionnaire were formulated,the basic data,operation condition,postoperative symptoms/signs,laboratory test results,infection-related factors,and antimicrobial use in patients were collected,risk factors for infection were analyzed.Results A total of 205 patients were investigated,23 (11 .22%)of whom had SSI;univariate analysis showed that body mass index (BMI),NNIS score,and cerebrospinal fluid leakage were related to the occurrence of SSI(all P<0.05);lo-gistic regression analysis showed that high NNIS score and cerebrospinal fluid leakage were independent risk factors for SSI in patients undergoing selective brain tumor resection(both P<0.05).Conclusion Incidence of SSI is high-er in patients with selective brain tumor resection,corresponding preventive measures should be taken according to different risk factors including cerebrospinal fluid leakage.

Clinical management of skull base fracture and cerebrospinal fluid leakage by primary surgery in severe craniocerebral trauma / 天津医药

Objective To investigate the technique and outcome of primary management of skull base fracture and cerebrospinal fluid (CSF) leakage by emergency surgery in patients with severe craniocerebral trauma. Methods A total of 16 patients with severe brain injury, skull base fracture and CSF leakage hospitalized in Department of Neurosurgery, Tianjin Medical University General Hospital from January 2014 to December 2015 were retrospectively analyzed. All of patients underwent emergency surgery to remove the hematoma and repair the skull base fracture, including anterior skull base repair in 12 patients and middle temporal skull base repair in 4 patients. During the surgery, the inner wall of the frontal sinus was managed by electrocautery, then removal of frontal sinus mucosa, hydrogen peroxide and iodophor rinse were used. The repairing and forming of the orbital roof were performed for the severe deformation cases. All bone fractures and fissures were filled with muscle blocks and biological glue and covered with a pedicled muscle flap. In addition, after close suturing of epidural, the intact periosteum under the skin flap was used to tile the skull base. No external material was used in the whole process. Results Among the 16 patients, 14 (87.5%) patients were successfully repaired by emergency surgery, and 2 cases (12.5%) failed. One of the patients who failed to repair the fracture was with the middle skull base fracture, severe fracture of skull base and mastoid, and extensive exposure of mastoid air chamber with large bone mass. This patient failed secondary surgical repair and died with severe infection. Another one case who failed primary surgery was with severe bone fractures in the anterior, middle and posterior skull base, which could not be completely repaired. This patient was also combined with infection and dead ultimately. Conclusion Primary repair in patient with severe head injury combined with skull base fracture, which needs surgical intervention can reduce further injury and save the patient's life. The key to the operation is to determine the operative principle and to repair the skull base tightly.

Causes prevention and treatment for cerebrospinal leak after lumbar revision surgery / 中国骨伤

<p><b>OBJECTIVE</b>To analyze the causes and explore the measures of prevention and treatment of the cerebrospinal leak after lumbar revision surgery.</p><p><b>METHODS</b>The clinical data of 24 patients(17.78%) with cerebrospinal leak among 135 cases after lumbar revision surgery from January 2011 to January 2016 was retrospectively studied. Of them, 12 cases due to severe adhesion caused by scar formation; 4 cases due to yellow ligament hyperplasia adhesion with dura mater occurred dural tears when separating adhesion; 2 cases with severe hyperplasia and ossification of lumbar posterior longitudinal ligament occurred dural tears when revealing intervertebral disk; 2 cases due to improper nailing happened dural tears during operation. And the other 4 cases without obvious dural tears in surgery, occurred cerebrospinal leak one to two days after surgery. And the 24 patients were treated with the measures of prevention and treatment preoperatively, intraoperatively, and postoperatively.</p><p><b>RESULTS</b>Twenty-four patients with cerebrospinal leak were cured after treatment and were follow-up for 6 to 30 months. No recurrence of cerebrospinal leake or local and systemic complications were found.</p><p><b>CONCLUSIONS</b>Scar formation is the main cause of cerebrospinal leak in lumbar revision surgery. As for lumbar revision surgery, as long as the standard control measures are taken, it can significantly reduce the incidence of cerebrospinal leak, achieve better clinical efficacy, and fundamentally solve the cerebrospinal leak problem that has plagued both doctors and patients for a long time.</p>

Incarceration of Spinal Nerve Root through Incidental Durotomy as a Cause of Sciatica

Incidental durotomies are a frequent complication during spinal surgery. Cerebrospinal fluid (CSF) leakage from a dural tear may be visually apparent intraoperatively, but occasionally, a tear may not be recognized during the procedure. We report our experience in 2 cases of postoperative incarceration of nerve root as a cause of sciatica, without CSF leakage intraoperatively. When durotomy attributable to surgical manipulation does occur, intraoperative identification is mandated. If a patient develops unexplainable postoperative pain and neurological deficits after lumbar discectomy, incarceration of nerve root should be considered in the differential diagnosis.

Subfrontal Schwannoma Extended Broadly to Nasal Cavity Treated by Gamma Knife Radiosurgery Following Surgical Excision: A Case Report

Subfrontal schwannomas are rarely reported. They are usually found only in the subfrontal area, but some extend to the nasal cavity. In these cases, prevention of postoperative cerebrospinal fluid (CSF) leakage through thinned or eroded anterior skull base is important. A 51-year-old female with anosmia and mild nausea was diagnosed as subfrontal extraaxial mass with nasal cavity extension. This mass was initially thought to be an olfactory groove meningioma. We performed a bifrontal craniotomy for surgical excision. We did not totally remove the tumor, as we wanted to prevent a skull base defect. The histopathological diagnosis was a schwannoma. There was no postoperative complication such as CSF leakage. The residual tumor was treated with gamma knife radiosurgery. The nasal cavity mass has not grown as of five years after radiosurgery.

Intraoperative lumbar cathetering for prevention of postoperative cerebrospinal fluid leakage in lumbosacral vertebral canal / 局解手术学杂志

Objective To study the technique of lumbar cathetering in lumbosacral vertebral canal operation and its effect on prevention of postoperative cerebrospinal fluid leakage.Methods Retrospectively analyzed the clinical data of patients who underwent lumbosacral ver-tebral canal surgery and suffered from difficult dural repair during the operation in Department of Neurosurgery from August 2015 to October 2015.These patients were divided into the observation group (11 cases)and the control group (12 cases)according to whether lumbar cathe-ter were placed during the operation or not.Volume of drainage was strictly controlled after surgery.Remove the epidural drainage after primi-tive healing of the dura mater.The lumbar catheter was removed after 7 to 10 days.The indwelling time of each patient was collected and sta-tistical analyzed.Results The observation group got obvious shorter epidural drainage indwelling time than the control group(P <0.05). Short-term postoperative complications did occur in some cases in observation group,however,there was no obvious increase of infection rate in patients with lumbar continuous drainage indwelling.Conclusion Lumbar cathetering during the operation could be an effective method to solve difficult problem of placeing a lumbar drainage after lumbar puncture and to prevent cerebrospinal fluid leakage after operations of lum-bosacral vertebral canal.But it can not replace the delicate operation and tight dural suture.Drainage should be used only as a remedial measure of dural repair failure.

Cerebrospinal Fluid Leakage after Surgeries on the Thoracic Spine: A Review of 362 Cases

STUDY DESIGN: A retrospective clinical review. PURPOSE: To describe the incidence of cerebrospinal fluid leakage (CSFL) after thoracic decompression and examine the CSFL predisposing clinical factors. OVERVIEW OF LITERATURE: CSFL is a common complication following thoracic decompression but has not been sufficiently addressed in former studies. METHODS: A cohort of 362 cases of thoracic decompression from February of 2005 to June of 2013 was examined. The case medical records were reviewed and the occurrence of CSFL and the related clinical parameters were noted. The incidence of CSFL for the entire cohort and each surgical approach were described. Besides, the relationship between CSFL and other clinical parameters were assessed, of which odds ratio values of all CSFL-associated parameters were calculated using multivariate logistic regression analysis. RESULTS: The incidence of CSFL for the entire cohort was 32.3%. Different surgical approaches had different incidences of CSFL, and circumferential decompression had the highest incidence. Though many different clinical parameters were related to the occurrences of CSFL, being older than 52 years, having ossification of the posterior longitudinal ligament or having longer operative segments than 3 vertebrae were significant risk factors for CSFL (p <0.05). Besides, surgeries on the mid-thoracic spine had an increased risk of CSFL (p <0.05). CONCLUSIONS: From our analysis, CSFL was a common complication after thoracic decompression with the incidence of up to 32.3%. This study identified the predisposing clinical factors, and spinal surgeons should be aware of these risk factors to reduce its incidence.

Cerebrospinal Fluid Leakage after Surgeries on the Thoracic Spine: A Review of 362 Cases

STUDY DESIGN: A retrospective clinical review. PURPOSE: To describe the incidence of cerebrospinal fluid leakage (CSFL) after thoracic decompression and examine the CSFL predisposing clinical factors. OVERVIEW OF LITERATURE: CSFL is a common complication following thoracic decompression but has not been sufficiently addressed in former studies. METHODS: A cohort of 362 cases of thoracic decompression from February of 2005 to June of 2013 was examined. The case medical records were reviewed and the occurrence of CSFL and the related clinical parameters were noted. The incidence of CSFL for the entire cohort and each surgical approach were described. Besides, the relationship between CSFL and other clinical parameters were assessed, of which odds ratio values of all CSFL-associated parameters were calculated using multivariate logistic regression analysis. RESULTS: The incidence of CSFL for the entire cohort was 32.3%. Different surgical approaches had different incidences of CSFL, and circumferential decompression had the highest incidence. Though many different clinical parameters were related to the occurrences of CSFL, being older than 52 years, having ossification of the posterior longitudinal ligament or having longer operative segments than 3 vertebrae were significant risk factors for CSFL (p <0.05). Besides, surgeries on the mid-thoracic spine had an increased risk of CSFL (p <0.05). CONCLUSIONS: From our analysis, CSFL was a common complication after thoracic decompression with the incidence of up to 32.3%. This study identified the predisposing clinical factors, and spinal surgeons should be aware of these risk factors to reduce its incidence.

Subarachnoid Hemorrhage Presenting with Seizure due to Cerebrospinal Fluid Leakage after Spinal Surgery

Cerebrospinal fluid leakage may commonly occur during spinal surgeries and it may cause dural tears. These tears may result in hemorrhage in the entire compartments of the brain. Most common site of such hemorrhages are the veins in the cerebellar region. We report a case of hemorrhage, mimicking aneurysmal subarachnoid hemorrhage due to a cerebrospinal fluid leakage following lumbar spinal surgery and discuss the possible mechanisms of action.

Clinical effect of lumbar catheter drainage combined with intrathecal injection on patients with cerebrospinal fluid leakage and intracranial infection / 中国综合临床

Objective To investigate the clinical effect of lumbar catheter drainage combined with intrathecal injection on patients with cerebrospinal fluid leakage and intracranial infection.Methods A retrospective study was conducted.One hundred and fifty-two cases with cerebrospinal fluid leakage and intracranial infection were selected as our subjects who were hospitalized in the First Hospital of Yuncheng from 2006 to 2014.The patients were divided into lumbar puncture + intrathecal group (A),lumbar (group B) and lumbar intrathecal large pool + group (group C) based on post-processing methods.A experimental data were recorded and compared in terms of the total efficiency of treatment,the therapeutically effective time,bacterial clearance and security differences.Results After treatment,the levels of white blood cells,protein,glucose and intracranial pressure were changed compared with that of before treatment in three group(P ＜ 0.01),but there was no significant difference among the three groups(P ＞ 0.05).The therapy periods in group A,group B and group C were (12.80 ± 2.25) d,(12.64 ± 2.00) d and (9.44 ± 1.50) d respectively and the difference was significant(F =25.94,P ＜ 0.05).Compared with Group C,the therapy periods in group A and B were significant different(t =2.769,2.854;P ＜ 0.05),but there was no significant difference between group A and B (t =0.119,P =0.908).The cases with success.effect was 45 (89.1％) in group A,53 (94.6％) in group B,46 (95.8％) in group C,and there was no significant difference among three groups (P ＞ 0.05).In terms of bacterial clearance rate,33 cases(68.75％) was in group A,35 cases(72.91％) in group C and 23 cases (41.07％) in group B and the effective rate in group A or C were higher than that in group B (x2 =9.478,10.63 ; P ＜ 0.05).Conclusion The methods of lumbar catheter drainage combinedwith intrathecal injection is proved with a high clinical value of therapy,effective treatment can effectively shorten the time and improve the overall treatment effect.