Frequency of Post-Operative Cerebrospinal Fluid Leak after Infratentorial Surgery

  • Akram Ullah Department of Neurosurgery
  • MUMTAZ ALI Department of Neurosurgery,
  • MUHAMMAD SIDDIQ Department of Neurosurgery,
  • Farooq Azam Department of Neurosurgery
  • Mohammad Ishaq Department of Neurosurgery
Keywords: CSF leak,, Infratentorial surgery, Posterior fossa

Abstract

Introduction: The infratentorial space (posterior fossa) is the region of the brain below the tentorium cerebelli and contains structures like of the midbrain, pons, medulla oblongata and the cerebellum. Cerebellopontine angle (CPA); an extra-axial region between the cerebellar hemisphere and the pons and is the site of exit for the cranial nerves 5th to 12th is also located infratentorialy. Primary brain tumors are commonly located in the posterior cranial fossa in children and approximately 54 – 70% of all intracranial tumors in children are infratentorial. Eighty-eight percent of all tumors fall into one of the 4 categories, astrocytoma, medulloblastoma, ependymoma and craniopharyngioma.
Objective: The objective of the study is to determine the frequency of post-operative Cerebro spinal fluid (CSF) leak after infratentorial surgery.
Material and Methods: This study was conducted at Department of Neurosurgery, PGMI Lady Reading Hospital, Peshawar. Duration of the study was six months and the study design was descriptive case series in which a total of 132 patients were observed by using 21.4% CSF leak11, 95% confidence level and 7% margin of error with the help of WHO software for sample size determination. More over consecutive non probability sampling technique was used for sample collection.
Results: In this study 67% patients were in age range < 20 years, 20% patients were in age range 21 – 35 years, 10% patients were in age range 36 – 50 years while 3% patients were 51 – 60`years. Mean age was 22 years with a standard deviation of ±5.71. Fifty three patients were male and 47% patients were female. More over 7% patients had CSF leak.
Conclusion: Our study concludes that the incidence of CSF leak after infratentorial surgery was 7% which give us an insight into our complication rate so that we should modify our surgical technique such as we can use fibrin glue or artificial dura in case our rate is high

References

1. De-Bont JM, Packer RJ, Michiels EM, Den-Boer ML, Pieters R. Biological background of pediatric medullo-blastoma and ependymoma: A review from a translat-ional research perspective. Oncology, 2008; 10 (6): 1040-60.
2. Nayak PK, Kumar R. Retromastoid-sub occipital: A novel approach to cerebellopontine angle in acoustic neuroma surgery-our experience in 21 cases. J Neurosci Rural Pract. 2011; 2: 23-6.
3. Nasir S, Jamila B, Khaleeq S. A Retrospective Study of Primary Brain Tumors in Children under 14 Years of Age at PIMS, Islamabad. Asian Pacific J Cancer Prev. 2010; 11 (5): 1225-7.
4. Dubey A, Sung WS, Shaya M. Complications of poste-rior cranial fossa surgery; an institutional analysis of 500 patients. Surg Neurol. 2009;72 (4): 369-75. 5. Chen CM, Huang AP, Kuo LT, Tu YK. Contemporary surgical outcome for skull base meningiomas. Neuro-surg Rev. 2011; 34: 281-96.
6. Awadi YA, Saleh H, Sharma BS. Factors affecting out-come following microvascular decompression for trige-minal neuralgia. Panarab J Neurosurg. 2011; 4: 62-9.
7. Rehman AU, Lodhi S, Murad S. Morphological pattern of posterior cranial fossa tumors. Ann KEMU, 2009; 15: 57-9.
8. Coppa ND, Delashaw JB. Reconstruction after posterior cranial fossa surgery—case report of application of a synthetic tissue sealant to augment dural closure. US Neurol. 2009; 7: 85-7.
9. Piek J, Weber C, Kundt G, Tronnier V, Spuck S, Hirdes C, et al. Pharmacoeconomical consequences of post-operative CSF leaks after intracranial surgery — a pros-pective analysis. Cen Eur Neurosurg. 2011.
DOI:10.1055/s-0032-1304501.
10. Kehler U, Hirdes C, Weber C, Spuck S, Tronnier V, Kundt G , Piek J. CSF leaks after cranial surgery — a prospectivemulticenter analysis. Innovative Neurosurg. 2013; 1 (1): 49–53. 11. Maurizio F, Guglielmo R, Nattin A, Mario S. Cerebro-spinal fluid leak after retrosigmoid excision of vesti-bular schwannomas. Otol Neurotol. 2008; 29 (3): 382-4. 12. Gnanalingham KK, Lafuente J, Thompson D, Harkness W, Hayward R. Surgical procedures for posterior fossa tumors in children: does craniotomy lead to fewer com-plications. 13. Kehler U, Hirdes C, Weber C, SpuckS ,Tronnier v, Kundt G. CSF leaks after cranial surgery — a prospec-tive multicenter analysis. Innovative Neurosurgery, 2012: 1-5.
Published
2018-10-04
Section
Original Articles