Clinical characteristics and treatment of symptoms of intracranial hypotension secondary to cerebrospinal fluid leakage after thoracic spinal stenosis surgery

English Keywords:Thoracic spinal stenosis  Cerebrospinal fluid leakage  Post-operative complication  Symptoms of intracranial hypotension  Treatment

English Abstract:

  【Abstract】 Objectives: To investigate the clinical characteristics and treatment plan of symptoms of intracranial hypotension (SIH) secondary to cerebrospinal fluid leakage(CSFL) after symptomatic thoracic spinal stenosis surgery. Methods: A retrospective cohort study was conducted to analyze the data of 38 patients with thoracic spinal stenosis complicated with postoperative CSFL who underwent thoracic posterior approach surgery in Peking University Third Hospital from August 2021 to March 2022. There were 7 males and 31 females, aged 56.6±11.1(30-78) years old. According to whether occurred postoperative symptoms of intracranial hypotension, the patients were divided into SIH group of 15 patients including 1 male and 14 females, aged 58.9±11.0(43-78) years, and non-SIH group of 23 patients including 6 males and 17 females, aged 55.1±11.2(30-72) years old. The operation time, intra-operative blood loss, post-operative fluid infusion, and drainage volume were compared between the two groups. Risk factors for SIH were analyzed by binary logistic analysis. Headache was assessed by visual analogue scale (VAS), nausea and vomiting were graded according to WHO standards, and dizziness was classified as mild, moderate and severe according to patients′ subjective feelings. The clinical manifestations, severity, occurrence time and duration of SIH were summarized; the efficacy of fluid infusion, postural adjustment, and drainage mode changes in the treatment of SIH was evaluated. Results: 15 patients developed SIH, among which, 11 cases (73.3%) had headache, 9 cases (60.0%) had nausea and vomiting, and 5 cases (33.3%) had dizziness. Of these 15 cases, 7 cases (46.7%) had single symptom, 6 cases (40.0%) had two symptoms, and 2 cases(13.3%) had three symptoms. The VAS score of headache ranged from 2 to 6, with an average of 4.0±1.0. The severity of nausea and vomiting fell in grade Ⅱ(1 case), Grade Ⅲ(7 cases), and grade Ⅳ(1 case). The degree of dizziness was all mild. Postoperative SIH lasted from 24 hours to 96 hours, with an average of 41.3±25.5h. The duration of SIH averaged 2.2±0.9(1-4) days. SIH were treated with fluid infusion, postural adjustment and drainage regulation. The duration of epidural drainage was between 3-5 days, with an average of 3.9 days. After conservative treatment, the SIH in 15 patients were all completely relieved. There were 3 complications secondary to CSFL, including 1 case of intracranial hemorrhage and 1 case of subarachnoid-pleural fistula in non-SIH group and 1 case of wound dehiscence in SIH group. The proportion of SIH in CSFL patients after thoracic spinal stenosis surgery was 39.5%(15/38). And there was no statistical significance in operation time, intra-operative blood loss, post-operative fluid infusion and drainage volume between the two groups(P>0.05). Logistic regression analysis showed that age, gender, weight, height, BMI, operation time, operation segment, total intraoperative input, total intraoperative output, intraoperative blood loss, serum sodium on the first day after operation, average daily drainage volume, average daily drainage volume/body weight, average daily fluid infusion volume, and average daily fluid infusion volume/body weight were not significantly associated with symptoms of hypotension(P>0.05). Conclusions: Patients with CSFL after thoracic spinal stenosis surgery had a relative high proportion of SIH. The main clinical manifestations of SIH were headache, nausea and vomiting, dizziness, and almost half cases might have two symptoms or above. The comprehensive treatment including fluid infusion, body position adjustment and drainage regulation could effectively relieve the SIH or shorten its duration.