Objective To investigate the therapeutic effect of artificial dura mater on the prevention and treatment of cerebrospinal fluid (CSF) leakage associated with thoracolumbar fracture and dislocation. Methods A total of 58 patients with thoracolumbar fracture and dislocation combined with dura mater injury and CSF leakage were treated in Affiliated Hospital of Southwest Medical University from January 2011 to December 2016, including 30 males and 28 females, aged from 15 to 86 years, with an average of (51.8±16.3) years. All patients were treated with posterior pedicle screw system for decompression, reduction fixation and fusion, dura mater and spinal cord injury were investigated, and external nerve roots or caudate nerves were exposed. At the same time; the dura mater was sutured and repaired and partially covered with gelatinous sponge (group A, 24 cases), or after dura mater was sutured and repaired, the artificial dura mater was partially covered (group B, 34 cases). The curative effect and complications of the two different treatment methods were evaluated. Results All operations were successfully completed. The operative time was 110–340 minutes, with an average of (195.0±10.4) minutes; the intraoperative blood loss was 200–2 800 mL, with an average of (845.0±26.5) mL. In group A, 13 patients (54.1%) acquired wound healing, and the average CSF leakage duration was (13.4±1.6) days postoperatively, among whom 3 cases were complicated with pseudomeningocele; 11 cases (45.9%) failed and necessitated additional management. Among the 11 cases, 6 case had no decreasing tendency of CSF leakage after 10-day drainage, and after subarachnoid drainage was performed, CSF leakage disappeared about 15 days after operation; 3 (12.5%) with wound infection underwent operative incision debridement, after the repair of the dura sac, the subarachnoid CSF was drainage at the lumbar part combined with the systemic situation with antibiotics and other symptomatic treatment, and the patients were cured about 16 days after the operation; 2 (8.3%) with spinal meningitis underwent subarachnoid CSF drainage and administration of antibiotics, and the CSF leakage ceased about 14 days after operation. In group B, 27 patients (79.4%) acquired wound healing, and the average CSF leakage duration was (9.1±1.7) days postoperatively; among whom, 4 cases were complicated with pseudomeningocele; 7 cases (20.6%) failed and necessitated additional management. Among the 7 cases, 5 cases had no decreasing tendency of CSF leakage after 10-day drainage, and CSF leakage disappeared around 12 days after treatment; 1 case (2.9%) with wound infection and 1 case (2.9%) with spinal meningitis, both were cured after the treatment as in group A. Conclusion Dural suture repair combined with artificial dura mater mulch repair can more effectively repair the dura tears associated with thoracolumbar vertebral fracture dislocation and reduce the incidence of CSF leakage.
Abstract： Objective To study the spinal cord protection effect of cerebrospinal fluid drainage （CSFD）for patients undergoing thoracoabdominal aortic aneurysm surgery. Methods We randomly allocated 30 patients undergoing thoracoabdominal aortic aneurysm surgery in Beijing Anzhen Hospital from December 2008 to August 2009 into a CSFD group with 15 patients（12 males, 3 females; average age of 45.0 years） and a control group with 15 patients（11 males, 4 females; average age at 45.8 years）by computer. All the patients underwent replacement of ascending aorta and aortic arch, implantation of descending aorta stent, or thoracoabdominal aorta replacement. Some patients underwent Bentall operation or replacement of half aortic arch. Patients in the CSFD group also underwent CSFD. Serum S100B, glial fibrillary acidic protein and neuron-specific enolase were measured at set intraoperative and postoperative times. All the patients were scored preoperatively, 72 hours postoperatively, and before discharge according to the National Institutes of Health Stroke Scale and International Standards for Neurological Classification of Spinal Cord Injury. Results Central nervous system injury occurred in four patients in the control group： one died of both brain damage and spinal cord damage; one patient had spinal cord injury and became better after treatment by early CSFD; two patients had brain damage（one patient died, another patient had concomitant acute renal failure and acute respiratory failure, recovered and was discharged after treatment）. In the CSFD group, only one patient died of acute respiratory failure and subsequent multiple organ system failure, and all other patients recovered very well. There was no late death during three months follow-up in both groups. The average serum S100B, glial fibrillary acidic protein，and neuron-specific enolase concentrations of the CSFD group patients were significantly lower than those of the control group （F=7.153，P=0.012；F=3.263，P=0.082；F=4.927，P=0.035）. Conclusion Selected CSFD is a safe, effective and feasible procedure to protect the spinal cord from ischemic damage during the perioperative period of thoracoabdominal aortic aneurysm surgery.
ObjectiveTo review the research on the reasons of unplanned reoperation (URP) for degenerative lumbar spine diseases, and to provide new ideas for improving the quality of surgery for degenerative lumbar spine diseases. Methods The literature about the URP of degenerative lumbar spine diseases at home and abroad in recent years was reviewed and analyzed. Results At present, the reasons for URP include surgical site infection (SSI), hematoma formation, cerebrospinal fluid leakage (CSFL), poor results of surgery, and implant complications. SSI and hematoma formation are the most common causes of URP, which happen in a short time after surgery; CSFL also occurs shortly after surgery but is relatively rare. Poor surgical results and implant complications occurred for a long time after surgery. Factors such as primary disease and surgical procedures have an important impact on the incidence of URP. ConclusionThe main reasons for URP are different in various periods after lumbar spine surgery. Interventions should be given to patients with high-risk URP, which thus can reduce the incidence of URP and improve the surgery quality and patients’ satisfaction.
Objective To explore the effectiveness of cyanoacrylates (Fuaile) for spinal subdural benign tumorectomy to prevent the cerebrospinal fluid leakage. Methods Between January 2009 and March 2013, 35 patients underwent spinal subdural benign tumorectomy. Of 35 patients, Fuaile and gelatin sponge were used after stitch suture for a watertight closure of the dura in 19 cases (trial group), and only gelatin sponge was used after stitch suture in 16 cases (control group). There was no significant difference in gender, age, disease duration, types of tumors, and sites of tumors between 2 groups (P gt; 0.05). The ratio of watertight closure, incision healing, and relative complications were compared between 2 groups. Results All patients in 2 groups achieved watertight closure of the dura intraoperatively. There was no significant difference in operation time, intraoperative blood loss, length of dura incision, hospitalization time, total drainage volume, and drainage time between 2 groups (P gt; 0.05). Primary incision healing was obtained; no delayed healing, infection, or nerve compression occurred in all patients. At last follow-up, the ratios of successful watertight closure of trial and control groups were 89.5% (17/19) and 50.0% (8/16) respectively, showing significant difference (P=0.02). No delayed cerebrospinal fluid leakage or incision infection was found at 1 and 3 months after operation. Conclusion The application of cyanoacrylates for watertight closure of dura in spinal subdural benign tumorectomy is safe and effective.
Objective To explore the effectiveness and safety of exchange of cerebrospinal fluid in the treatment of subarachnoid hemorrhage （SAH）. Methods Sixty SAH patients diagnosed by CT and lumbarpuncture were randomly assigned into a control group （n =30, received conventional treatment） and a treatment group （n =30, received exchange of cerebrospinal fluid plus conventional treatment）. The main complications and effectiveness between the two groups were compared. SPSS 10.0 was used for statistical analysis. Results Compared with the control group, complications of persistent headache （ P =0.002 and 0. 007 respectively）, cerebral vasospasm （ P =0. 028 ） and hydrocephalus （ P =0. 038 ） were fewer in the treatment group. No significant difference in the incidence of rehaemorrhagia was found between the two groups （P = 1. 000）. Better effectiveness was observed in the treatment group （RR. 3.00, 95% CI 1. 014 to 8. 880, P = 0. 044 ）. Conclusions Exchange of cerebrospinal fluid plus conventional treatment is more effective than conventional treatment alone in the treatment of SAH.
方法 2008年9月-2009年11月，将20例颅脑外伤后颅内感染患者分为脑脊液外引流组和抗生素组各10例，外引流组进行持续腰池置管脑脊液外引流，定期取引流脑脊液进行常规和生化检查；抗生素组采用静脉抗生素治疗。对两组颅内感染情况进行对比分析。 结果 外引流组经持续腰池置管脑脊液外引流治疗后，颅内感染临床症状明显缓解，脑脊液有核细胞数和脑脊液微量蛋白含量显著降低、脑脊液葡萄糖和氯化物浓度升高（Plt;0.05）。治疗10 d后，外引流组体温、脑脊液有核细胞数、脑脊液微量蛋白含量、脑脊液葡萄糖和氯化物浓度的改善程度明显优于抗生素组（Plt;0.05）。 结论 持续腰池置管脑脊液外引流治疗颅内感染具有安全性高、操作简便、观察颅内感染情况方便的优点，可作为颅内感染可靠治疗手段。【Abstract】 Objective To observe the efficacy of continuous lumbar drainage of cerebrospinal fluid via a lumbar catheter in treating intracranial infection. Methods From September 2008 to November 2009, 20 patients with intracranial infection after head trauma were enrolled in this study. Ten of them, classified as the external drainage group, sustained continuous external lumbar drainage of cerebrospinal fluid. The cerebrospinal fluid was obtained regularly for routine and biochemical examination. The other 10 patients were categorized as the antibiotics group. They only accepted intravenous antibiotic therapy. Results For the patients in the external drainage goup, after continuous external lumbar drainage of cerebrospinal fluid, their clinical symptoms of intracranial infection were significantly alleviated and the number of nucleated cells and protein content in the cerebrospinal fluid decreased significantly, while the glucose and chloride concentrations increased significantly (Plt;0.05). After 10 days of treatment, the patients in the external drainage group were superior to those in the antibiotics group in improvement of the body temperature, the number of nucleated cells and protein content, glucose and chloride concentrations in the cerebrospinal fluid (Plt;0.05). Conclusion Continuous lumbar drainage of cerebrospinal fluid is simple and safe. It provides an easy way of monitoring the intracranial infection and can be a reliable treatment.
【Abstract】 Objective To investigate the surgical management of dural injuries and postoperative cerebrospinal fluid(CSF) fistulas in spinal surgeries and to observe cl inical outcomes, since intraoperative injury of dura mater and postoperative CSF fistulas are common compl ications of spinal surgeries. Methods A retrospective research was designed and 405 patients with complete data who underwent spinal surgeries between June 2002 and March 2006 were acquired, including 298 cases of male and 107 cases of female, with the mean age of 46.2 years (ranging from 11 years to 78 years). The course of disease lasted from 3 months to 5 years. A total of 28 cases of intraoperative dural injuries and durotomies (28/405, 6.91%) were recorded, including 3 cases of cervical spinal surgery (3/152, 1.97%), 19 cases of thoracic and lumbar spinal surgery (19/239, 7.95%) and 6 cases of sacral surgery (6/14, 42.86%). CSF fistulas occurred in 6 cases of 28 patients. There were 2 cases in which no intraoperative dural injury was detected but CSF fistulas occurred after operation. The incidence of postoperative CSF fistula was 1.98% (8/405). Surgical management included closure of breach in the dura mater, oversewing every layer of the wound, bed rest and compression dressing and so on. Cl inical outcomes of surgical management were recorded. Results The average followup lasted for 1 year and 5 months (ranging from 3 months to 4 years). Preoperative symptoms remitted to different extents There were 8 cases of postoperative CSF fistula which were cured ultimately. A total of 6 cases of CSF fistulas from dorsal injuries of dura mater were treated mainly by bed rest, compression dressing and reoperations, while 2 cases of fistulas from ventral and lateral injuries of dura mater were treated by additional continuous cerebrospinal fluid drainage using a lumbar subarachnoid catheter. One case of central nervous system infection occurred and was treated successfully by multi-discipl inary disposal. Conclusion Timely and correct surgical intervention and postoperative management can help to heal dural injuries in spinal surgeries and can prevent occurrence of postoperative CSF fistulas.
Objective To evaluate the relation of human immunodeficiency virus (HIV)-1 ribonucleic acid (RNA) loads in cerebrospinal fluid with central neurological diseases. Methods The inpatients with HIV-1 infection diagnosed by Public Health Clinical Center of Chengdu between January 1st, 2015 and March 1st, 2018 were retrospectively included. The included patients were divided into central neurological disease group and non-central neurological disease group, and high viral load group and low viral load group. The demographic data, CD4+ T lymphocyte count, routine detection of cerebrospinal fluid, HIV RNA load in cerebrospinal fluid and plasma of patients with and without central neurological diseases were observed and compared.Multiple logistic regression analysis was used to identify risk factors for central neurological diseases. Results A total of 367 patients were included. In the central neurological disease group, 210 cases (57.22%) were complicated with central neurological diseases, and cryptococcus infection was the most. Compared with the non-central neurological disease group, the increase rate of cerebrospinal fluid cell counts, cerebrospinal fluid cell counts, cerebrospinal fluid HIV RNA positivity and cerebrospinal fluid HIV RNA load were higher in the central neurological disease group (P<0.05). Logistic regression analysis showed that HIV RNA load in cerebrospinal fluid≥100 000 copies/mL and CD4+ T lymphocyte count<200 cells/mm3 were risk factors for central neurological diseases. Conclusion Cerebrospinal fluid HIV RNA load≥100 000 copies/mL is an independent risk factor for HIV/AIDS patients with central neurological diseases and clinical treatment should take this factor into consideration to reasonably optimize the selection of antiretroviral therapy.