Cerebrospinal fluid fistula
There is a incomplete sealing of the dura mater and is a major complication of intradural procedures.
Dural closure‘s reinforcement using different new dural sealants plays an important role in prevention. Moreover, the use of neuronavigation systems in skull base and posterior fossa surgery can help to minimize the size of approach and reduce the incidence of CSF leak. New minimally invasive spinal approaches, such as minimally invasive decompression for spinal degenerative disorders or performing selective laminotomy over laminectomy for intradural spinal pathology are very useful techniques to prevent CSF leak in this kind of surgery. In conclusion, although CSF leak remains a risky complication in neurosurgery, its prevention and treatment significantly benefited from advances in biomaterials and surgical technique 1).
Ramos-Rincon et al. aimed to analyze research activity on cerebrospinal fluid (CSF) leaks in general and CSF cerebrospinal fluid rhinorrhea and cerebrospinal fluid otorrhea in particular and to identify the main topic clusters in these areas.
They identified all relevant documents, using the medical subject headings (MeSH) term “Cerebrospinal Fluid Leak”, that are indexed in the MEDLINE database between 1945 and 2018. They performed a descriptive bibliometric analysis and analyses of networks and research clusters in order to identify the main topic areas of research.
From 1945 to 2018, a total of 4,130 records were published with the term CSF leak, including 2,821 documents (68.1%) with the term CSF rhinorrhea and 1,040 documents (25.8%) with CSF otorrhea. The number of documents published increased from 10 in 1945-49 to 642 in 2010-14. Articles represented the dominant document type (86.8% of the documents analyzed), while case reports were the main type of study (37.4%). In terms of geographical distribution, researchers from the USA led in the number of signatures (39.1%), followed by those from the UK (7.5%). The most active areas of research in the field were “Postoperative Complications,” “Tomography, X-Ray Computed,” and “Magnetic Resonance Imaging.” The terms “Adults,” “Young Adult,” and “Middle-Aged” were most common in CSF rhinorrhea research; and the terms “Infant,” “Child, Preschool,” “Child,” and “Adolescent” were more common in CSF otorrhea.
Based on these findings, articles and case reports related to “Surgery” and “postoperative complications” associated with the cerebrospinal fluid fistula diagnosis are the main topics of study, highlighting the importance of this document type in advancing knowledge in the field 2).