LUMBAR PUNCTURE IN THE MANAGEMENT OF POSTOPERATIVE CEREBROSPINAL FLUID (CSF) LEAKS FOLLOWING ENDOSCOPIC THIRD VENTRICULOSTOMY. | ||||
| Ain Shams Medical Journal | ||||
| Article 17, Volume 73, Issue 3, September 2022, Page 657-667 PDF (658.39 K) | ||||
| Document Type: Original Article | ||||
| DOI: 10.21608/asmj.2022.270244 | ||||
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| Authors | ||||
| Assem M. Abdel-Latif; Ahmed A. El Sabaa | ||||
| Department of Neurological Surgery, Ain Shams University, Cairo, Egypt. | ||||
| Abstract | ||||
| Introduction: Endoscopic third ventriculostomy (ETV) has become an established treatment for obstructive hydrocephalus. Success and failure criteria are, sometimes, debatable. Postoperative cerebrospinal fluid (CSF) wound leak is considered, by most, a clinical criterion of failure subsequently recommending revision surgery or shunt implantation. Aim of Work: to elucidate the impact of repeated lumbar puncture for postoperative CSF wound drainage on the final ETV outcome Patients and Methods: From a prospectively maintained registry of endoscopic ventricular surgery; clinical, radiographic and, operative data are compiled to calculate the ETV success score and an intraoperative score. Patients with symptomatic postoperative wound collection and/or CSF leak were identified and managed by repeated lumbar punctures. Clinical and imaging follow up was established to evaluate final outcome. Results: From a total of 75 patients with endoscopic interventions for hydrocephalus, 57 patients underwent ETV. Fifteen patients (26%) had postoperative CSF leak and/or wound bulge requiring a median of 3 lumbar punctures. This group had a mean ETV success score of 61 and a favorable intraoperative score in 93% of the cases. The scores were not different from those of the whole cohort. Repeated lumbar puncture was successful in 7 out 15 patients (47%). The difference between patients with successful and failed serial lumbar punctures in both the ETV success score and intraoperative score was not statistically significant. Conclusion: Partaking serial lumbar punctures in patients with CSF wound drainage or signs of potential ETV failure in the early postoperative period was successful in half of the instances. This could be recommended in presence of favorable ETV success score and intraoperative score to avoid premature shunting. | ||||
| Keywords | ||||
| Lumbar puncture; Cerebrospinal fluid leak; endoscopic third ventriculostomy; hydrocephalus | ||||
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