Posttravmatik beyin omurilik sývýsý fistüllerinde kontinü lomber drenajýn etkinliði

AMAÇ: Kliniðimizde yatýrýlarak kontinü lomber drenaj (KLD) uygulanan posttravmatik beyin omurilik sývýsý (BOS) fistülü olan hastalarýn klinik sonuçlarýný araþtýrmak ve bunu non-travmatik nedenlerle KLD uygulanan hastalarla karþýlaþtýrmaktýr.
GEREÇ VE YÖNTEM: Ocak 2018–Aralýk 2019 tarihleri arasýnda beyin ve sinir cerrahisi kliniðine yatýrýlan ve KLD takýlan hastalarýn dosyasý incelendi. Bu hastalarýn tanýsý, demografik özellikleri, BOS sonuçlarý ve klinik sonuçlarý deðerlendirildi. Travma nedeniyle dura defekti ve BOS fistülü olan hastalarýn sonuçlarý diðer sebeplerle BOS fistülü olan ve lomber drenaja alýnan hastalarla karþýlaþtýrýldý.
BULGULAR: Toplam 45 hastaya 51 kez KLD uygulandý. Hastalardaki yaþ ortalamasý 38.84 yýl olup hastalarýn 27’si (%60) erkek idi. Yedi (%15.55) hastaya posttravmatik BOS fistülü nedeniyle, 38 hastaya ise tümör veya malformasyon cerrahisi sonrasý KLD uygulandý. Beþ hastada ateþli silah yaralanmasý (ASY) sonrasý dura defektine baðlý BOS fistülü geliþmiþ iken iki hastada trafik kazasý sonrasý BOS fistülü gözlenmiþtir. Staphylococcus epidermidis posttravmatik BOS fistülü olan bir hastada, Serratia marcescens ise posterior fossa tümörüne sekonder BOS fistülü olan hastada üremiþtir. Posttravmatik KLD uygulan yedi hastadan hiçbirisi takip sürecinde ölmemiþ iken tümörlere baðlý KLD uygulan hastalarda bir tanesi takip sürecinde sepsisden dolayý kaybedilmiþtir.
TARTIÞMA: Posttravmatik BOS fistüllerinde KLD uygulamasý güvenli ve etkili bir tedavi yöntemidir. Özellikle ateþli silah yaralanmalý hastalarda BOS fistülünün tedavisinde revizyon cerrahisi yapýlmadan önce mutlaka KLD uygulanmalýdýr. Daha geniþ travma gruplarýnda daha farklý parametreler ile yapýlacak çalýþmalara ihtiyaç vardýr.

The efficacy of continuous lumbar drainage in post-traumatic cerebrospinal fluid fistulas

BACKGROUND: This study aims to investigate the clinical outcomes of patients who underwent closed continuous lumbar drainage (CLD) for post-traumatic cerebrospinal fluid (CSF) fistula and to compare with those of non-traumatic patients.
METHODS: The data of patients who were treated in the department of neurosurgery between January 2018 and December 2019 and underwent CLD were analyzed. The diagnosis, demographic characteristics, CSF results and clinical outcomes of these patients were evaluated. The outcomes of the patients with dura defect and CSF fistula due to trauma were compared with patients who underwent CLD for other diagnoses.
RESULTS: In this study, 45 patients underwent CLD for 51 times. The mean age was 38.84 years, and 27 (60%) of the patients were male. Seven (15.55%) patients underwent CLD due to post-traumatic CSF fistula and 38 patients after tumor or malformation surgery. While five patients developed CSF fistula due to dura defect after gunshot injury, two patients developed CSF fistula secondary to motor vehicle accident. Staphylococcus Epidermidis was isolated in one patient among post-traumatic CSF fistula patients while Serratia Marcescens was isolated in patients with CSF fistula secondary to posterior fossa tumor surgery. While none of the seven patients died during the follow-up period in post-traumatic group, one of the 38 patients with CLD secondary to tumor surgery was lost due to sepsis in the follow-up period.
CONCLUSION: CLD in post-traumatic CSF fistulas is a safe and effective treatment method. Especially in patients with gunshot wounds, CLD should be performed before revision surgery in the treatment of CSF fistula. Studies with different parameters are needed in larger trauma populations.