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Surgical Nuances to Reduce and Manage Cerebrospinal Fluid Leaks after Microvascular Decompression

Background: No dural substitute has proven to be complication-free in a large clinical trial, even suggesting some benefit during watertight closure. However, primary dural closure is not always possible due to dural shrinkage from electrocautery for dural bleeding. Objective: This study is performe...

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Autores principales: Go, Kyeong-O, Hwang, Kihwan, Han, Jung Ho
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7230255/
https://www.ncbi.nlm.nih.gov/pubmed/32218220
http://dx.doi.org/10.3390/jcm9040902
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author Go, Kyeong-O
Hwang, Kihwan
Han, Jung Ho
author_facet Go, Kyeong-O
Hwang, Kihwan
Han, Jung Ho
author_sort Go, Kyeong-O
collection PubMed
description Background: No dural substitute has proven to be complication-free in a large clinical trial, even suggesting some benefit during watertight closure. However, primary dural closure is not always possible due to dural shrinkage from electrocautery for dural bleeding. Objective: This study is performed to analyze the clinical outcomes related to cerebrospinal fluid (CSF) leakage after microvascular decompression (MVD) using a simple surgical technique. Methods: Three hundred and sixty consecutive cases were treated with MVD and followed up for more than one month after surgery. Bleeding from the cut veins during dural incision was controlled by pulling stay sutures instead of electrocautery to avoid dural shrinkage. Additionally, a wet cottonoid was placed on the cerebellar side dural flap to prevent dural dehydration. During dural closure, primary dural closure was always attempted. If not possible, a “plugging muscle” method was used for watertight dural closure. Results: The mean age was 54.1 ± 10.8 years (range, 24–85 years), and 238 (66.1%) were female. Primary MVD was performed in 345 (95.8%) patients. The mean operation time (from skin incision to skin closure) was 96.7 ± 33.0 min (range, 38–301 min). Primary dural closure was possible in 344 (95.6%) patients. The “plugging muscle method” was performed more frequently in patients older than 60 years (8 of 99 cases, 8.08%) than in younger cases (8 of 261 cases, 3.07%) (p = 0.039; chi-squared test). After surgery, 5 (1.4%) patients were treated for middle ear effusion, and another 5 (1.4%) patients experienced transient CSF rhinorrhea, which was spontaneously resolved within 1 to 7 days. No patients required additional treatments for CSF leakage. Conclusion: A simple technique using pulling stay sutures to stop bleeding from the dural edges and placing a wet cottonoid on the exposed dura can make primary dural closure easier.
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spelling pubmed-72302552020-05-28 Surgical Nuances to Reduce and Manage Cerebrospinal Fluid Leaks after Microvascular Decompression Go, Kyeong-O Hwang, Kihwan Han, Jung Ho J Clin Med Article Background: No dural substitute has proven to be complication-free in a large clinical trial, even suggesting some benefit during watertight closure. However, primary dural closure is not always possible due to dural shrinkage from electrocautery for dural bleeding. Objective: This study is performed to analyze the clinical outcomes related to cerebrospinal fluid (CSF) leakage after microvascular decompression (MVD) using a simple surgical technique. Methods: Three hundred and sixty consecutive cases were treated with MVD and followed up for more than one month after surgery. Bleeding from the cut veins during dural incision was controlled by pulling stay sutures instead of electrocautery to avoid dural shrinkage. Additionally, a wet cottonoid was placed on the cerebellar side dural flap to prevent dural dehydration. During dural closure, primary dural closure was always attempted. If not possible, a “plugging muscle” method was used for watertight dural closure. Results: The mean age was 54.1 ± 10.8 years (range, 24–85 years), and 238 (66.1%) were female. Primary MVD was performed in 345 (95.8%) patients. The mean operation time (from skin incision to skin closure) was 96.7 ± 33.0 min (range, 38–301 min). Primary dural closure was possible in 344 (95.6%) patients. The “plugging muscle method” was performed more frequently in patients older than 60 years (8 of 99 cases, 8.08%) than in younger cases (8 of 261 cases, 3.07%) (p = 0.039; chi-squared test). After surgery, 5 (1.4%) patients were treated for middle ear effusion, and another 5 (1.4%) patients experienced transient CSF rhinorrhea, which was spontaneously resolved within 1 to 7 days. No patients required additional treatments for CSF leakage. Conclusion: A simple technique using pulling stay sutures to stop bleeding from the dural edges and placing a wet cottonoid on the exposed dura can make primary dural closure easier. MDPI 2020-03-25 /pmc/articles/PMC7230255/ /pubmed/32218220 http://dx.doi.org/10.3390/jcm9040902 Text en © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Go, Kyeong-O
Hwang, Kihwan
Han, Jung Ho
Surgical Nuances to Reduce and Manage Cerebrospinal Fluid Leaks after Microvascular Decompression
title Surgical Nuances to Reduce and Manage Cerebrospinal Fluid Leaks after Microvascular Decompression
title_full Surgical Nuances to Reduce and Manage Cerebrospinal Fluid Leaks after Microvascular Decompression
title_fullStr Surgical Nuances to Reduce and Manage Cerebrospinal Fluid Leaks after Microvascular Decompression
title_full_unstemmed Surgical Nuances to Reduce and Manage Cerebrospinal Fluid Leaks after Microvascular Decompression
title_short Surgical Nuances to Reduce and Manage Cerebrospinal Fluid Leaks after Microvascular Decompression
title_sort surgical nuances to reduce and manage cerebrospinal fluid leaks after microvascular decompression
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7230255/
https://www.ncbi.nlm.nih.gov/pubmed/32218220
http://dx.doi.org/10.3390/jcm9040902
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