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///2013 Abstract Details
2013 Abstract Details2019-08-02T16:57:45-05:00

Cutaneous cerebrospinal fluid leak after a continuous spinal anesthesia for labour

Abstract Number: S 44
Abstract Type: Case Report/Case Series

Genevieve Rivard MD, FRCPC1 ; Sandra Lesage MD, FRCPC2; Louis Crevier MD, FRCPC3; Chantal Crochetiere MD, FRCPC4

Cutaneous cerebrospinal fluid (CSF) leakage after different procedures is rarely reported in the literature. It has been detected after spinal trauma[1], neurosurgery or special circumstances where an intrathecal catheter was left in place for several months before its removal[2], but not much is said about the occurrence of this complication after dural puncture for neuraxial anesthesia. To our knowledge, no case had been reported in an obstetric patient in the past twenty years.

Complications of continuous CSF leakage may be serious if infection develops, and conservative measures including bed rest are not without concern in the obstetric patient at increased risk of thrombosis. For the patient herself, limited access and possibility to take care of her newborn is a major concern as well.

We present a case of a woman in labour for whom epidural anesthesia was not satisfactory in spite of multiple techniques, leading to the decision of voluntarily placing a spinal catheter for continuous anesthesia. The patient refused systemics narcotics. Two days later, we had to face a continuous cerebrospinal fluid leakage through the skin hole. Although some authors have advocated the benefit of liquid skin sealant[3] or biological glue[2] when usual management proves ineffective, we were able to stop the CSF leak with a single tight Nylon skin stitch and sterile compressive dressing for 24 hours. However, 48 hours later, the patient experienced a post-dural puncture headache that necessitated a blood patch, which was done with success.

In the case of this patient, we hypothesize that a previous intrathecal chemotherapy, received 10 years ago, could have been in part responsible for a scarred dural sheath leading to a cutaneous fistula[4] which prohibited natural healing of the tissues. Of course, the many neuraxial procedures the patient had experienced may have contributed to this complication. Fortunately, the patient never developed fever, abnormal white blood cell count or neurologic deficits. The stitch was removed five days later by the neurosurgeon. The patient had no complaint.

1. Rahamimov, N., H. Mulla, and S. Freiman, Cerebrospinal fluid leakage and pneumocephalus secondary to spine stab wounds. J Orthop Traumatol, 2010. 11(1): p. 57-9.

2. Hidou, M., J.P. Caramella, and E. Claude, [Persistent leakage of cerebrospinal fluid after removal of a device implanted for subarachnoid analgesia]. Ann Fr Anesth Reanim, 1992. 11(4): p. 467-9.

3. Rotenberg, B.W., A. Marchie, and M.D. Cusimano, Skin sealants: an effective option for closing cerebrospinal fluid leakage. Can J Surg, 2004. 47(6): p. 466-8.

4. Jawalekar, S.R. and G.F. Marx, Cutaneous cerebrospinal fluid leakage following attempted extradural block. Anesthesiology, 1981. 54(4): p. 348-9.

SOAP 2013