Biomaterial repair combined with continuous lumbar subarachnoid drainage for management of cerebrospinal fluid leakage and meningitis after spinal surgery / 中国组织工程研究

ABSTRACT

BACKGROUND:Traumatic or iatrogenic dural defects can cause persistent cerebrospinal fluid leakage, even progressing to life-threatening purulent meningitis. In patients with meningitis combined with cerebrospinal fluid leakage, most antibiotics are unable to enter the cerebrospinal fluid, as the cerebrospinal fluid is a good medium for bacteria and there is the presence of blood-brain barrier. So meningitis presents with acute onset, rapid development and infection difficult to control. OBJECTIVE:To evaluate the outcome of continuous lumbar subarachnoid drainage plus intrathecal administration of antibiotics for postoperative cerebrospinal fluid leakage combined with meningitis after biomaterial repair of dural defects. METHODS: A retrospective study was carried out to review the 12 cases of cerebrospinal fluid leakage combined with meningitis among 126 of 2 266 cases who developed cerebrospinal fluid leakage (5.56%) undergoing spinal surgery from June 2008 to June 2013. During the operation, dural defects were directly sutured or repaired with autologous fascial sheet. Al cases underwent thorough debridement and intravenous injection of sensitive antibiotics folowed by continuous lumbar drainage and intrathecal administration of sensitive antibiotics (usualy vancomycin), and then the incision was closed at stage I. RESULTS AND CONCLUSION:The cerebrospinal fluid leakage was found in the 12 cases at 24-72 hours after surgery, averagely 48 hours; the infection was found at 812 days days after surgery, averagely 9.5 days. Headache and fever were significantly relieved at the 2nd day of intrathecal administration of antibiotics, and intracranial infection disappeared at 7-14 days after continuous lumbar drainage. Biochemical test of the cerebrospinal fluid and routine examination were done thrice, and the results were al normal. No bacterial growth was found in bacterial culture test, and the drainage tube was removed. There was no intraspinal infection, intracranial hypotension headache and hernia caused by the drainage tube. These findings indicate that autologous fascia repair combined with continuous lumbar subarachnoid drainage plus intrathecal administration of antibiotics is an effective method in the treatment of cerebrospinal fluid leakage with meningitis.