ABSTRACT
Cerebrospinal fluid (CSF) leaks are an inevitability in spine surgery. An attempt should be made to repair any dural tear when noticed intraoperatively. A smooth emergence from general anesthesia can mean the difference between a successful and unsuccessful surgery. An old neurosurgical adage is that a wound leaking CSF is due to infection or hydrocephalus until proven otherwise. An asymptomatic pseudomeningocoele may be considered one that is unaccompanied by a postural headache or wound swelling that is cosmetically distressing to the patient. Common choices include local lumbodorsal of trapezius fascia, as well as fascia lata, and perhaps even pericranium for posterior cervical defects. Inserting a lumbar drain at the completion of the operation can be challenging, when the CSF has been drained and the turgor of the thecal sac diminished. The authors have found that placing the lumbar drain first, before opening the wound and draining the pseudomeningocoele, provides the best opportunity to easily and successfully insert the lumbar drain.
