Treatment of a symptomatic cervical cerebrospinal fluid fistula after full endoscopic cervical foraminotomy with CT-guided epidural fibrin patch,European Spine Journal

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Treatment of a symptomatic cervical cerebrospinal fluid fistula after full endoscopic cervical foraminotomy with CT-guided epidural fibrin patch
European Spine Journal ( IF 2.6 ) Pub Date : 2023-10-07 , DOI: 10.1007/s00586-023-07973-1
Stefan Motov _{1,

2} , B Stemmer ₂ , P Krauss ₂ , C Maurer ₃ , E Shiban ₂

Affiliation

Background

There is only limited data on the management of cerebrospinal fluid (CSF) fistulas after cervical endoscopic spine surgery. We investigated the current literature for treatment options and present a case of a patient who was treated with CT-guided epidural fibrin patch.

Methods

We present the case of a 47-year-old female patient with a suspected CSF fistula after endoscopic decompression for C7 foraminal stenosis. She was readmitted 8 days after surgery with dysesthesia in both upper extremities, orthostatic headache and neck pain, which worsened during mobilization. A CSF leak was suspected on spinal magnetic resonance imaging. A computer tomography (CT)-guided epidural blood patch was performed with short-term relief. A second CT-guided epidural fibrin patch was executed and the patient improved thereafter and was discharged at home without sensorimotor deficits or sequelae. We investigated the current literature for complications after endoscopic spine surgery and for treatment of postoperative CSF fistulas.

Results

Although endoscopic and open revision surgery with dura repair were described in previous studies, dural tears in endoscopic surgery are frequently treated conservatively. In our case, the patient was severely impaired by a persistent CSF fistula. We opted for a less invasive treatment and performed a CT-guided fibrin patch which resulted in a complete resolution of patient’s symptoms.

Discussion and conclusion

CSF fistulas after cervical endoscopic spine procedures are rare complications. Conservative treatment or revision surgery are the standard of care. CT-guided epidural fibrin patch was an efficient and less invasive option in our case.

中文翻译：

CT引导下硬膜外纤维蛋白补片治疗全内镜颈椎椎间孔切开术后症状性颈脑脊液瘘

背景

关于颈椎内窥镜手术后脑脊液（CSF）瘘管治疗的数据有限。我们调查了当前治疗方案的文献，并介绍了一名接受 CT 引导硬膜外纤维蛋白补片治疗的患者的病例。

方法

我们介绍了一名 47 岁女性患者，因 C7 椎间孔狭窄行内镜减压术后疑似脑脊液瘘。术后 8 天，她因双上肢感觉迟钝、直立性头痛和颈部疼痛再次入院，并在活动期间恶化。脊髓磁共振成像怀疑脑脊液漏。计算机断层扫描 (CT) 引导下的硬膜外血贴进行了短期缓解。在 CT 引导下进行第二次硬膜外纤维蛋白贴片治疗后，患者病情有所改善，出院回家，没有感觉运动缺陷或后遗症。我们调查了有关内窥镜脊柱手术后并发症和术后脑脊液瘘治疗的最新文献。