Hussein Kheshaifati

BackgroundCerebrospinal fluid (CSF) leak is a known complication of spine surgery, and an effective protocol for prevention, recognition, and treatment of postoperative CSF leak is essential to avoid a cascade of associated adverse outcomes, such as durocutaneous fistula, wound infection, and intracranial hemorrhage. We aim to identify the incidence of CSF leak post spinal surgeries and to obtain the factors that could predict the risks of having a CSF leak following spine surgeries. MethodsThis study was conducted as a retrospective cohort study on patients who had CSF leaks post spinal surgery in King Abdul-Aziz Medical City, Jeddah, from June 2016 to January 2024. ResultsThe occurrence of cerebrospinal fluid (CSF) leak post-surgery was relatively low (2.6%), and more than 97% of the participants studied had no CSF leak. There is a statistically insignificant relation with age, gender, DM, BMI, hypertension, malignancy, and cardiovascular diseases. Still, there is a statistically significant relation with the attempt to watertight closure, and type of surgery (P value ≤ 0.05). ConclusionPostoperative CSF leak following spinal surgery is associated with morbidity and can lead to re-operation and infection. The incidence of CSF leaks among our study participants was about 2.6%, which is relatively low. Identifying predictors for CSF leaks can assist in counseling patients concerning surgical risk and expected postoperative recovery.

Published articles pertaining to possible ways to increase the accuracy of image-guided frameless surgery are abundant in the literature. Accurate target localization is dependent on many factors, of which noteworthy is the meticulous registration and constant fixation of instruments during the procedure. Frequent changing of instruments’ application or inadvertent destabilization of its fixation during surgery after registration might disrupt the preset navigation measurements, leading to inaccurate targeting. Technical wise, we managed to avoid the drawback of moving the aiming device repeatedly during the procedure, as we will discuss later. This retrospective study aims to evaluate the feasibility and reliability of a simple frameless technique we used in navigation-guided brain biopsy and to show how it refines the accuracy of frameless biopsy procedures. All procedures were performed at our institution in the period from 2018 to 2019 and included 10 patients with different brain lesions. The mean operative time using our technique was noticeably short (18 minutes) and the standard deviation was 2.1. The used technique was easy, undemanding, and reliable in obtaining samples from brain tumors, guaranteeing more precision by applying an all-time fixed and stable navigation reference hardware.