Management of cerebrospinal fluid leakage complicating anterior procedures through thoracotomy: report of three cases

Postoperative cerebrospinal fluid (CSF) leakage is a serious complication accompanying an anterior procedure through thoracotomy, and it is difficult to cure. In this report, we present three patients with CSF leakage in the thoracic spine complicating anterior decompression and fusion for ossification of posterior longitudinal ligament who were treated by surgical or nonsurgical methods. As a surgical method, direct closure by fixing substitute dura mater with fibrin adhesive sealant or cyanoacrylate adhesive was performed in two patients. This technique was effective but required another thoracotomy. As a nonsurgical method, intrapleural administration of OK-432 through chest drainage tubes was also effective to reduce intrapleural effusions in one patient, but with this method, care must be taken for neurotoxic reactions. Both techniques seem to be useful and effective for postoperative intrapleural CSF leakages complicating anterior procedures through thoracotomy.