Ohlopkov V.A., Potapov A.A., Kravchuk A.D., Lihterman L.B., Kapitanov D.N.
Burdenko Research Institute of Neurosurgery, Moscow, Russia
The study goal has been to compare results of surgical treatment of prolonged basal liquorrhea (PBL) and their dependence on an intervention type.
Material and Methods. There were 237 cases, aged 3-70 (27.9 years on the average), who were operated for PBL in 1988-2009. Operations were performed in acute, intermediate and delayed periods of craniocerebral trauma in 11.3%, 13.4% and 75.3% of cases, respectively. Liquorrhea was complicated by meningitis in 111 patients (46.8%). Its duration varied from one month up to 25 years (2.7 years on the average). Only autotissue was used for plasty of liquor fistulas. A fibrin-thrombin glue was used in 129 cases.
Results. Intracranial intervention, combined with postoperative repeated lumbar punctures, was performed in 46 cases; liquorrhea relapse was watched in 10 of them (21.7%). Intra- and postoperative external drainage of lumbar liquor (up to 17 days; 8 days on the average) was used in 131 cases: there was liquorrhea relapse in 15 patients (11.5%). Simple percutaneous external drainage was applied in the first 17 cases. However, a high rate (23.5%) of meningitis in this series necessitated development of a ”long tunnel” method of liquor drainage. This method was used in 114 cases and only 6 of them (5.3%) developed meningitis. Endoscopic endonasal closure of fistulas was performed in 45 cases; liquor recurrence was observed in 6 of them (13.3%). Only shunting operations were made in 15 patients (lumboperiotoneostomy – 14, venrticuloperitoneostomy – 1); there were 3 cases with liquorrhea relapse.
Conclusion. The best results of surgical treatment of PBL with verified fistula are achieved in combination of intracranial intervention with intra- and postoperative drainage of liquor.