Cerebrospinal fluid fistula after foramen magnum meningioma surgery [Neurosurgery Wiki]

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====== Cerebrospinal fluid fistula after foramen magnum meningioma surgery ======

[[https://operativeneurosurgery.com/doku.php?id=foramen_magnum_meningioma#foramen_magnum_meningioma_general_university_hospital_of_alicante_cases|Cerebrospinal fluid fistula after foramen magnum meningioma surgery General University Hospital of Alicante Cases]]



In the series of Magill et al. there were 38 complications in 12 patients (43%), and 6 patients (21%) had complications requiring additional surgery. Complications included [[cerebrospinal fluid leak]]/[[hydrocephalus]] ( n = 7, 25%), weakness ( n = 4, 14%), numbness ( n = 4, 14%), and cranial nerve deficits: IX, X ( n = 4, 14%), XI ( n = 2, 7%), XII ( n = 5, 18%). Medical complications included pneumonia ( n = 1, 4%) and meningitis ( n = 1, 4%). Tumor volume greater than 14 cm 3 (odds ratio [OR] = 21.7, p = 0.0010), any vertebral artery encasement (OR 6.1, p = 0.0386), and subtotal resection (OR 6.4, p = 0.0398) were significantly associated with complications
((Magill ST, Shahin MN, Lucas CG, Yen AJ, Lee DS, Raleigh DR, Aghi MK, Theodosopoulos PV, McDermott MW. Surgical Outcomes, Complications, and Management Strategies for Foramen Magnum Meningiomas. J Neurol Surg B Skull Base. 2019 Feb;80(1):1-9. doi: 10.1055/s-0038-1654702. Epub 2018 May 28. PMID: 30733894; PMCID: PMC6365236.)).
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In the Altaf et al. of Posterior Cranial Fossa Surgery, there were 25 (17%) cases of CSF leakage, including 24 incisional CSF leaks and one case of CSF otorrhea. In eight patients with incisional CSF leakage treated initially with conservative measures including re-suturing of the wound, CSF leakage stopped in only two cases. CSF lumbar drainage instituted later on in six cases with persistent leakage stopped the CSF leakage. In fourteen patients managed initially with re-suturing of the wound and concomitant CSF lumbar drainage, CSF leakage settled in all the cases. Two patients with gross hydrocephalus on post operative CT were managed successfully with VP shunt. Re-suturing of the wound with concomitant CSF lumbar drainage was found to be significantly associated (p=0.003) with the stoppage of CSF leakage, and the settlement of meningitis (p= 0.014)
((Altaf I, Vohra AH, Shams S. Management of Cerebrospinal Fluid Leak following Posterior Cranial Fossa Surgery. Pak J Med Sci. 2016 Nov-Dec;32(6):1439-1443. doi: 10.12669/pjms.326.9956. PMID: 28083041; PMCID: PMC5216297.)).