Post Spinal CSF leak

[yogenbhatt1]

Got a case of post spinal CSF leak.
A patient of Ca Cervix. H/0 Asthma, HT, age 62, H/O Lumber laminectomy done twice.
Anaesthesiologist decided to try and get away with a spinal and a high epidural, if space can be located.
Space could be located but the cath did not go in. Probably fibrosis in the space. He decided to push the needle and cath intrathecal.
Surgery went perfectly ok.
Third morning the catheter was removed and by evening the patient had a CSF leak.
Now what??? Has any one seen one like this??
   Post laminectomy CSF  leak, due to dura tear, is seen after surgery. At times the ortho surgeon requests us to put in an intrathecal epidural cath to give an alternate drainage till the leak heals. Can this be tried here? or Will it give one more site of leak??
and worsen the problem???
Think.

[jafo1964]

Is the CSF leaking out of the skin

How did this tract develop so easily
How long was the catheter insitu

I think you now have a subarachnoid - cutaneous fistula. Through this tract CSF has a continuous channel to come out and so conversely infection must have a continuous channel to get in.
Very scary thought.

I have never heard of anything like this.
but 2 previous surgeries would have made the dura scared, fibrosed and incapable of further healing. The same may be true for all the ligaments and subcutaneous tissue.

I would get a neurosurgeon consult and explore the options of surgical closure of the tract.
Broad spectrum antibiotics till then

My 2 bits on the problem
but do keep me posted on how you all managed this rare, but really scary problem

regs

[yogenbhatt1]

Sir,
I was scared too.
I spoke to various ppl of many branches. No one liked it either.
I spoke to mu Guru, Dr. Sunil Pandya, of Hydrabad, Jr. to me by many yrs, but still I call him Guru.
His opinion was that, it is not CSF leak. He has seen a few cases where he was called upon.
It is edema fluid leak, especially, these malignancy and hypoprotenaemic patients. He said you may see it as a leaking tap at times. Even from the IV sites.
After this I saw the paitent again in a different light. There was no more leak. Patient was discharged home on fifth day of surgery, now going for further chemo management.
Thanks for your kind support.

[anaesami]

csf leak was a common shortlived problem in the good old days when i was a student. we used 19g and 18G spinal needles then to do LP and at the end of the surgery one could see a pool of csf at the small of the back it was always a short lived problem and many did not even complain of headache or backache