Quratulain Fatima Masood, Connie Chung, Antonio Forte, Reza Momeni and Deepak Narayan
Accepted Abstracts: Surgery Curr Res
Objective: A critical element in the prevention of wound and cerebrospinal fluid (CSF) infections aftercraniotomies is the prevention of post-procedural CSF leaks. The salvage of infected prosthetic duralmaterial in this milieu is not adequately addressed in the literature and is the subject of this study. Methods: A seven-year retrospective review of the records of Yale-New Haven Hospital toidentify successful salvage strategies in patients with CSF leaks refractory to non-invasive measures.Twenty data points were collected including original diagnosis, nature of the procedure, presence of duralgraft, definitive treatment of the leak, culture results, pre- and post-operative antibiotics. Results: Thirteen patients experienced post-craniotomy CSF leak that required surgical intervention forcontrol. The most common cause of original craniotomy (54% of patients) was for oncologic etiology, followed by ruptured aneurysms or hemorrhage in 31%. 76% of patients' leaks involved the posterior skullbase and a trapezius muscle flap was used in 38% of cases. In all patients with bovine pericardial graft(10/13), this non-autologous graft was left in place and was not removed. CSF drainage procedures wereemployed in most patients (10/13) around the time of definitive repair. Positive bacterial growth of Grampositiveorganisms on cultures was found in 76% of cases. The most frequent offenders were S. aureus(5/13), coagulasenegative Staphyloccocal species (2/13), and methicillin-resistant S. aureus (2/13).Vancomycin was administered in all cases pre-operatively. All 13 patients who underwent open surgery for CSF leak had complete resolution of the leak without need for additional reconstructive surgical intervention. Conclusion: The success of our treatment strategy suggests that this comprehensive method of treating CSF leaks in conjunction with the salvage of bovine pericardial dural grafts may be a viable clinical option.
