Intractable Cerebrospinal Fluid Fistula Following Anterior Decompression in a Patient with Ossifiation of the Posterior Longitudinal Ligament of the Cervical Spine.

Park, Chun Kun; Kang, Joon Ki; Choi, Chang Rak

Original Article

Journal of Korean Neurosurgical Society 1992;21(7): 884-889.

Chun Kun Park, Joon Ki Kang, Chang Rak Choi

Department of Neurosurgery, Catholic University Medical College, Seoul, Korea.

ABSTRACT

In cases that the ossified posterior longitudinal ligament(OPLL) is so adherent to the dura, operator has no choice but to extirpate the ossified portion and the dura as a whole, and CSF leaks out through the dura defect during anterior decompression in the cervical spine. However, a postoperative CSF fistula in operative wound in the neck has not been reported yet. The authors have experienced a case that the ossified mass was so incorporated with the dura in a wide extent that a large defect had to be left in the dura and intractable CSF leakage occurred eventually. The leakage had been managed with over 10-day-long lumar drainage of CSF, however, the leakage had got even worse. In the second operation for the CSF leakage, fibrin glue(Tissel(R) was used to enhance the result of CSF leakage repair, with packing of muscle in the dura defect. Postoperatively the patient was managed with another 2-week-long lumbar drainage, followed by complete repair of the CSF fistula. The experiences we gained with this case herald that CSF fistula can be another candidate for postoperative complication in the anterior decompression for OPLL, and fibrin glue has an excellent sealing property in the management of CSF fistula.

Key Words: Ossification; Posterior longitudinal ligament; Cervical spine; Anterior decompression; Cerebrospinal fulid; Fibrin glue; Lumbar drainage