J Korean Neurosurg Soc.  2013 Sep;54(3):225-231. 10.3340/jkns.2013.54.3.225.

Analysis of Risk Factors and Management of Cerebrospinal Fluid Morbidity in the Treatment of Spinal Dysraphism

• Lee BJ
• Sohn MJ
• Han SR
• Choi CY
• Lee DJ
• Kang JH

• KMID: 2190902
• DOI: http://doi.org/10.3340/jkns.2013.54.3.225

Abstract

OBJECTIVE
Spinal dysraphism defects span wide spectrum. Wound dehiscence is a common postoperative complication, and is a challenge in the current management of cerebrospinal fluid (CSF) leaks and wound healing. The purpose of this study is to evaluate the risks of CSF-related morbidity in the surgical treatment of spinal dysraphism.
METHODS
Ten patients with spinal dysraphism were included in this retrospective study. The median age of the cohort was 4.8 months. To assess the risk of CSF morbidity, we measured the skin lesion area and the percentage of the skin lesion area relative to the back surface for each patient. We then analyzed the relationship between morbidity and the measured skin lesion area or related factors.
RESULTS
The overall median skin lesion area was 36.2 cm2 (n=10). The percentage of the skin lesion area relative to the back surface ranged from 0.6% to 18.1%. During surgical reconstruction, 4 patients required subsequent operations to repair CSF morbidity. The comparison of the mean area of skin lesions between the CSF morbidity group and the non-CSF morbidity group was statistically significant (average volume skin lesion of 64.4+/-32.5 cm2 versus 27.7+/-27.8 cm2, p<0.05). CSF morbidity tended to occur either when the skin lesion area was up to 44.2 cm2 or there was preexisting fibrosis before revision with an accompanying broad-based dural defect.
CONCLUSION
Measuring the lesion area, including the skin, dura, and related surgical parameters, offers useful information for predicting wound challenges and selecting appropriate reconstructive surgery methods.

Keyword

Spinal dysraphism; Tethered cord syndrome; Meningomyelocele; Lipomyelomeningocele; CSF morbidity; Surgical reconstruction

MeSH Terms

Cohort Studies
Fibrosis
Humans
Meningomyelocele
Neural Tube Defects
Postoperative Complications
Retrospective Studies
Risk Factors*
Skin
Spinal Dysraphism*
Wound Healing

Figure

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  Fig. 1 Measurement of elliptical skin lesion area (R is the long radius, and r is the short radius).

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  Fig. 2 Case 6. A : Gross finding of myelomeningocele (the asterisk with the closed black arrow denotes the neural placode). B : Incise and dissect between the neural placode and intermediate epithelial layer to identify the neural placode, intermediate epithelial layer, skin, and the pia, arachnoid, and dura mater. C : Approximating paraspinal muscle fascia. D : Skin closure with S-plasty.

• 

  Fig. 3 Graph of box and whisker plot in comparison of two groups; CSF morbidity versus non-CSF morbidity. CSF morbidity group shows significantly larger skin lesion area than that of non-CSF morbidity group (The average skin lesion area of 64.4±32.5 cm2 versus 27.7±27.8 cm2, respectively, p=0.045, one tailed unpaired Student t-test). CSF : cerebrospinal fluid.

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