A retrospective review was conducted to assess the effectiveness and
safety of a temporary subarachnoid shunt to treat patients who have a leak
of cerebrospinal fluid after a spinal operation. The shunt is
percutaneously inserted in the lumbar spine and is removed after four days.
This technique was used in nineteen patients over a ten-year period. Of the
seventeen patients who had the shunt in place for the full four days,
fourteen had resolution of the drainage of cerebrospinal fluid from the
wound. One of two patients whose shunt was removed early also had a
successful result. Eleven of the fifteen patients who were successfully
treated were available for follow-up, and none had any adverse effects
related to the original cerebrospinal-fluid leak or its treatment. The four
patients who had a persistent leak were successfully treated with
reoperation and direct repair of the dura. Eleven (58 per cent) of the
nineteen patients had transient complaints of nausea and vomiting while
being treated with subarachnoid drainage. Two of the nineteen patients had
evidence of an intradural infection after placement of the catheter; the
infection resolved in both patients after removal of the catheter and
treatment with appropriate antibiotics. Closed subarachnoid drainage, when
properly performed and monitored, is a reasonably effective and safe method
for treating dural-cutaneous cerebrospinal-fluid leaks after a spinal
operation. It may be considered as a non-operative alternative to the
standard procedure of reoperation and direct repair of the dura. A good
result is still possible in patients in whom this technique fails and who
eventually need surgical management.