Csf leakage?

Hello everyone, …IM relatively new to to this group and I just had surgery on April 1st. I had a craniectomy, a duraplasty, and c1-c2 laminectomy. I started leaking csf last week, was admitted to the hospital for two days and since it was a small leak with no infection they sent me home. Last Friday my pt came to work with me and noticed that I am getting weaker and he looked at the scar and immediately called my neurosurgeon office. Since the dr was in surgery they told him to get me to the er again. So off I go for them to just order a cbc to check the white counts. Since thy came out okay they sent me home saying to just keep an eye out for it…well last night I started really leaking…well at least to me it’s really leaking. I soaked three of my bed pillows along with several gauze bandages. I called the dr office yet again and they said that it was up to me whether or not I wanted to go back to the er. Is this kind of thing normal? Or am I just going crazy and worrying too much.

You need treatment.

Aside from all the symptoms you are probably suffering due to the CSF leak, if fluid can leak through the skin, bacteria can get in. If bacteria get to the surgical site, it is meningitis, which, among other things, increases the risk of surgical failure due to increased scarring.

Many MDs don't have clinic availability and use the ER as their way of screening patients.

With the volume of leak you have, I would not leave the ER without a treatment plan.

In my practice, the treatment plan would be:

1. Admit to ICU

2. Take to OR to re-explore craniotomy and close CSF leak(the most common reason for a CSF leak is a stitch pulling out of the dura, which tends to be thinned in the Chiari patient population). If all you do is place a stitch at the leak, there is no reason to think it will work any better than the original stitch. Therefore, I always place a lumbar drain as well.

3. Continuous drain CSF at umbilicus(belly button) level for 3 days(allowing the new stitches to heal).

4. Clamp lumbar drain and monitor intracranial pressure(make sure there is no other reason for the leak, e.g. idiopathic intracranial hypertension) for 24-48 hours

5. If ICP is OK, pull lumbar drain and observe in hospital for 1 day I typically treat with anti-biotics for 24 hours(until initial CSF cultures return from OR) and with acetazolamide for several weeks(to reduce production of CSF).

I hope these thoughts have been of some assistance. With a national incidence of about 10% CSF leak rate after intradural Chiari decompression, most Chiari MDs will have their own treatment protocol.

It sounds like it is time for you to be a little more pushy in the ER.

Many dissolving stitches(which you will have had placed) take 4-6 weeks to dissolve, which may be why you are leaking more now.