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The Journal of Bone and Joint Surgery, Vol 71, Issue 7 984-987, Copyright © 1989 by Journal of Bone and Joint Surgery, Inc
Closed subarachnoid drainage for management of cerebrospinal fluid leakage after an operation on the spine
SH Kitchel, FJ Eismont and BA Green
Jackson Memorial Hospital, Miami, Florida.
A retrospective review was conducted to assess the effectiveness and safety
of a temporary subarachnoid shunt to treat patients who have a leak of
cerebrospinal fluid after a spinal operation. The shunt is percutaneously
inserted in the lumbar spine and is removed after four days. This technique
was used in nineteen patients over a ten-year period. Of the seventeen
patients who had the shunt in place for the full four days, fourteen had
resolution of the drainage of cerebrospinal fluid from the wound. One of
two patients whose shunt was removed early also had a successful result.
Eleven of the fifteen patients who were successfully treated were available
for follow-up, and none had any adverse effects related to the original
cerebrospinal-fluid leak or its treatment. The four patients who had a
persistent leak were successfully treated with reoperation and direct
repair of the dura. Eleven (58 per cent) of the nineteen patients had
transient complaints of nausea and vomiting while being treated with
subarachnoid drainage. Two of the nineteen patients had evidence of an
intradural infection after placement of the catheter; the infection
resolved in both patients after removal of the catheter and treatment with
appropriate antibiotics. Closed subarachnoid drainage, when properly
performed and monitored, is a reasonably effective and safe method for
treating dural-cutaneous cerebrospinal-fluid leaks after a spinal
operation. It may be considered as a non-operative alternative to the
standard procedure of reoperation and direct repair of the dura. A good
result is still possible in patients in whom this technique fails and who
eventually need surgical management.
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