J Korean Soc Spine Surg.  2016 Sep;23(3):171-176. 10.4184/jkss.2016.23.3.171.

Indirect Repair with Surgicel® and Fibrin Glue for Postoperative Cerebrospinal Fluid Leakage after Cervical Anterior Foraminotomy: A Case Report

• Choi DH
• Lee JW
• Kim CH
• Choi YS

• KMID: 2353908
• DOI: http://doi.org/10.4184/jkss.2016.23.3.171

Abstract

STUDY DESIGN: A case report.
OBJECTIVES
To report a case of indirect repair of cerebrospinal fluid (CSF) leakage after cervical anterior foraminotomy using Surgicel® and fibrin glue. SUMMARY OF LITERATURE REVIEW: There is no single modality that is best practice for this type of case because it is difficult to apply primary repair for a case of CSF leakage after cervical anterior decompression.
MATERIALS AND METHODS
A 49-year-old female patient was diagnosed with CSF leakage on the second day after cervical anterior foraminotomy. We performed coverage with Surgicel® and fibrin glue at the CSF leak site.
RESULTS
The patient was treated with indirect repair of CSF leakage without any complications. The clinical and radiological outcomes were excellent upon follow-up 1 year postoperatively.
CONCLUSIONS
Indirect repair using Surgicel® and fibrin glue is an effective treatment for postoperative CSF leakage after cervical anterior foraminotomy.

Keyword

Cervical spine; Anterior decompression; CSF leakage

MeSH Terms

Cerebrospinal Fluid Leak*
Cerebrospinal Fluid*
Decompression
Female
Fibrin Tissue Adhesive*
Fibrin*
Follow-Up Studies
Foraminotomy*
Humans
Middle Aged
Practice Guidelines as Topic
Fibrin
Fibrin Tissue Adhesive

Figure

• 

  Fig. 1. A preoperative magnetic resonance image showed C5-6 foraminal stenosis and C6-7 herniated nucleus pulposus.

• 

  Fig. 2. A postoperative radiograph showed interbody fusion with a cage at C5-6, total disc replacement (TDR) at C6-7, and notably, extensive pretracheal space widening (arrow).

• 

  Fig. 3. (A) Erythematous swelling occurred at the neck. (B) Postoperative computed tomography revealed a 7.8×1.5-cm fluid collection (white ar-row) at the prevertebral area. ∗Hemovac line (block arrow).

• 

  Fig. 4. No CSF leakage was detectable after coverage with Surgicel® and fibrin glue at C5-6 (arrow).

• 

  Fig. 5. (A) A lateral radiograph on postoperative day 10 shows improvement of the pretracheal space widening (arrow). (B) No specific fluid collection was visible at the prevertebral area on the second postoperative computed tomogram.

Reference

1). Fountas KN., Kapsalaki EZ., Nikolakakos LG, et al. Anterior cervical discectomy and fusion associated complications. Spine (Phila Pa 1976). 2007. 32:2310–7.

2). Fountas KN., Kapsalaki EZ., Johnston KW. Cerebrospinal fluid fistula secondary to dural tear in anterior cervical discectomy and fusion: case report. Spine (Phila Pa 1976). 2005. 30:E277–80.

3). Spennato P., Rapana A., Sannino E, et al. Retropharyngeal cerebrospinal fluid collection as a cause of postoperative dysphagia after anterior cervical discectomy. Surg Neurol. 2007. 67:499–503.

4). Schaberg MR., Altman JI., Shapshay SM, et al. Cerebrospinal fluid leak after anterior cervical disc fusion: an un-usual cause of dysphagia and neck mass. Laryngoscope. 2007. 117:1899–901.

5). Penberthy A., Roberts N. Recurrent acute upper airway obstruction after anterior cervical fusion. Anaesth Intensive Care. 1998. 26:305–7.

6). Hannallah D., Lee J., Khan M, et al. Cerebrospinal fluid leaks following cervical spine surgery. J Bone Joint Surg Am. 2008. 90:1101–5.

7). Hart DJ., Apfelbaum RI. Anterior cervical spinal cord teth-ering after anterior spinal surgery: case report. Neurosurgery. 2005. 56:E414.

8). Thavarajah D., De Lacy P., Hussain R, et al. Postoperative cervical cord compression induced by hydrogel (Du-raSeal): a possible complication. Spine (Phila Pa 1976). 2010. 35:E25–6.

9). Syre P., Bohman LE., Baltuch G, et al. Cerebrospinal fluid leaks and their management after anterior cervical discectomy and fusion: a report of 13 cases and a review of the literature. Spine (Phila Pa 1976). 2014. 39:E936–43.

10). Sawamura Y., Asaoka K., Terasaka S., Tada M., Uchida T. Evaluation of application techniques of fibrin sealant to prevent cerebrospinal fluid leakage: a new device for the application of aerosolized fibrin glue. Neurosurgery. 1999. 44:332–7.