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16-JUNE-2016 HAYYAN MUHAMED TAYYEM 54 YEARS
RECURRENT CSF LEAK AFTER REPAIR AND APPLICATION OF TISSUEPATCH.
Anamnesis
The patient was operated by me
15-June-2016 for CSF leak. During the night, the
patient felt wet dressing and headache. Several
dressings were done and the CSF persistently
continued to come out through the wound.
The wound was opened. The
patient was given Vit K 10 mg . The CSF came
with huge amount. Inspection of the
TissuePatch revealed that it was in place and
the CSF is coming through it. It was removed and
the attached muscle was removed. Putting
stitches at the dural area with sufficient
thickness was performed and the patient was put
in head up position with Valsalva maneuver
showed absence of CSF leak. Glubran was applied
over the stitched area. Lyodura was put over the
area and more Glubran was dropped around, inside
the lyodura, over it and to the dural areas with
precaution not to reach the nerve roots. The
patient was put several times in head upright
position with Valsalva maneuver and no CSF leak
was noted over several minutes. Routine closure of the
wound.
Smooth postoperative recovery. The
patient was sent to the ward.
TissuePatch still in place, but not effective.
The repaired defect covered with Glubran and lyodura aided with
other layer of Glubran.
Comments
The patient still have an estimated
postoperative recurrence around 7%, because the disc space
is still not shallow.
This case demonstrate that TissuePatch
failed to prevent CSF leak. During the previous surgery, the
wound was all the time bleeding denoting that there is a
problem with his coagulation system. When Vit K was given
the wound was normal and clot formation was noted.
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