Patient-specific automated cerebrospinal fluid pressure control to augment spinal wound closure : a case series using the LiquoGuard®
OBJECTIVE: Spinal cerebrospinal fluid (CSF) leaks are common, and their management is heterogeneous. For high-flow leaks, numerous studies advocate for primary dural repair and CSF diversion. The LiquoGuard7® allows automated and precise pressure and volume control, and calculation of patient-specific CSF production rate (prCSF), which is hypothesized to be increased in the context of durotomies and CSF leaks.
METHODS: This single-centre illustrative case series included patients undergoing complex spinal surgery where: 1) a high flow intra-operative and/or post-operative CSF leak was expected and 2) lumbar CSF drainage was performed using a LiquoGuard7®. CSF diversion was tailored to prCSF for each patient, combined with layered spinal wound closure.
RESULTS: Three patients were included, with a variety of pathologies: T7/T8 disc prolapse, T8-T9 meningioma, and T4-T5 metastatic spinal cord compression. The first two patients underwent CSF diversion to prevent post-op CSF leak, whilst the third required this in response to post-op CSF leak. CSF hyperproduction was evident in all cases (mean >/=140ml/hr). With patient-specific CSF diversion regimes, no cases required further intervention for CSF fistulae repair (including for pleural CSF effusion), wound breakdown or infection.
CONCLUSIONS: Patient-specific cerebrospinal fluid drainage may be a useful tool in the management of high-flow intra-operative and post-operative CSF leaks during complex spinal surgery. These systems may reduce post-operative CSF leakage from the wound or into adjacent body cavities. Further larger studies are needed to evaluate the comparative benefits and cost-effectiveness of this approach.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - year:2024 |
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| Enthalten in: |
British journal of neurosurgery - (2024) vom: 04. Jan., Seite 1-9 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Khan, Danyal Z [VerfasserIn] |
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| Links: |
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| Themen: |
CSF leak |
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| Anmerkungen: |
Date Revised 25.04.2024 published: Print-Electronic Citation Status Publisher |
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| doi: |
10.1080/02688697.2023.2290101 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM366653423 |
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| 100 | 1 | |a Khan, Danyal Z |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Patient-specific automated cerebrospinal fluid pressure control to augment spinal wound closure |b a case series using the LiquoGuard® |
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| 500 | |a Date Revised 25.04.2024 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status Publisher | ||
| 520 | |a OBJECTIVE: Spinal cerebrospinal fluid (CSF) leaks are common, and their management is heterogeneous. For high-flow leaks, numerous studies advocate for primary dural repair and CSF diversion. The LiquoGuard7® allows automated and precise pressure and volume control, and calculation of patient-specific CSF production rate (prCSF), which is hypothesized to be increased in the context of durotomies and CSF leaks | ||
| 520 | |a METHODS: This single-centre illustrative case series included patients undergoing complex spinal surgery where: 1) a high flow intra-operative and/or post-operative CSF leak was expected and 2) lumbar CSF drainage was performed using a LiquoGuard7®. CSF diversion was tailored to prCSF for each patient, combined with layered spinal wound closure | ||
| 520 | |a RESULTS: Three patients were included, with a variety of pathologies: T7/T8 disc prolapse, T8-T9 meningioma, and T4-T5 metastatic spinal cord compression. The first two patients underwent CSF diversion to prevent post-op CSF leak, whilst the third required this in response to post-op CSF leak. CSF hyperproduction was evident in all cases (mean >/=140ml/hr). With patient-specific CSF diversion regimes, no cases required further intervention for CSF fistulae repair (including for pleural CSF effusion), wound breakdown or infection | ||
| 520 | |a CONCLUSIONS: Patient-specific cerebrospinal fluid drainage may be a useful tool in the management of high-flow intra-operative and post-operative CSF leaks during complex spinal surgery. These systems may reduce post-operative CSF leakage from the wound or into adjacent body cavities. Further larger studies are needed to evaluate the comparative benefits and cost-effectiveness of this approach | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a CSF leak | |
| 650 | 4 | |a Cerebrospinal fluid production rate | |
| 650 | 4 | |a spinal closure | |
| 650 | 4 | |a surgical innovation | |
| 700 | 1 | |a Tariq, Kanza |e verfasserin |4 aut | |
| 700 | 1 | |a Lee, Keng Siang |e verfasserin |4 aut | |
| 700 | 1 | |a Dyson, Edward W |e verfasserin |4 aut | |
| 700 | 1 | |a Russo, Vittorio |e verfasserin |4 aut | |
| 700 | 1 | |a Watkins, Laurence D |e verfasserin |4 aut | |
| 700 | 1 | |a Russo, Antonino |e verfasserin |4 aut | |
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