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Vol. 33. Issue 6.
Pages 293-299 (November - December 2022)
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Vol. 33. Issue 6.
Pages 293-299 (November - December 2022)
Clinical Research
Investigating acetazolamide effectiveness on CSF leak in adult patients after spinal surgery
Investigación de la eficacia de la acetazolamida en la fuga de LCR en pacientes adultos después de una cirugía de columna
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Samuel Berchi Kankama, Elham Aminib, Kamyar Khoshnevisanc, Alireza Khoshnevisana,
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akhoshnevisan@tums.ac.ir

Corresponding author.
a Department of Neurosurgery, School of Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
b Pharmaceutical Care Department, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
c Biosensor Research Center, Endocrinology and Metabolism Molecular-Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
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Abstract
Introduction and objectives

Despite the use of acetazolamide in the management of CSF leak in most patients after CNS surgeries, there is scant evidence in the literature about the efficacy of this established protocol among adult patients in post-spinal surgery observations. We investigated the potential positive effect of acetazolamide in reducing CSF leak after spine surgery.

Materials and methods

We conducted a single-center, double-blind, randomized -controlled trial comparing Oral Acetazolamide plus Corrected body (prone) position (CP+A) versus Corrected body (prone) position alone (CP–A) from January 2014 to September 2015 in the Neurosurgery ward of Shariati Teaching Hospital, Tehran University of Medical Sciences, Tehran, Iran. Seventy-two Patients divided into two groups [CP–A group (n = 36, 50%) and CP+A group (n = 36, 50%)] were randomly assigned to this Clinical Trial study. CP+A group (maintained the 3/4 lateral position + dose of acetazolamide 20 mg/kg/day in 3–4 divided doses for 7 days), and CP–A group (Control group) (maintained the 3/4 lateral position for 7 days with no acetazolamide).

Results

Baseline characteristics between the two groups showed no significant differences: Sex (P < .637), Age (P < .988) and previous CNS operation at other location besides the spine (P < .496). Although we reported post-surgical CSF leak in 2/36 (5.55%) of CP+A group and 4/36 (11.11%) of CP–A (control) group, there was no significant difference observed between the two groups (95%CI, 0.081–2.748; OR = 0.471; P < .402; Adjusted P < .247). Additionally, no significant differences were observed when we examined surgical characteristics, such as the size of the dural opening (P < .489) and type of operation (P < .465).

Conclusion

Acetazolamide has no positive effect in controlling CSF leak after dural opening/dural tear in adult patients who undergo spinal surgery, when we considered alongside the one-week prone position. Therefore, acetazolamide administration may not be essential for postoperative spinal surgery for dural tear. Prospective studies involving a larger sample size may be needed to track long-term acetazolamide complications on patients with CSF leak.

Keywords:
Acetazolamide
CSF leak
Adult spinal surgery
Prone position
Abbreviations:
CSF
CNS
ID
OR
TUMS
AVF
Resumen
Introducción y objetivos

A pesar del uso de acetazolamida en el manejo de la fuga de LCR en la mayoría de los pacientes después de cirugías del SNC, existe escasa evidencia en la literatura sobre la eficacia de este protocolo establecido entre pacientes adultos en observaciones poscirugía de columna. Investigamos el posible efecto positivo de la acetazolamida en la reducción de la fuga de LCR después de la cirugía de columna.

Materiales y métodos

Realizamos un ensayo controlado aleatorio, doble ciego, de un solo centro comparando acetazolamida oral más posición corporal (prona) corregida (CP+A) versus posición corporal (prona) corregida sola (CP–A) desde enero de 2014 hasta septiembre de 2015 en la sala de neurocirugía del Hospital Docente Shariati, Universidad de Ciencias Médicas de Teherán, Teherán, Irán. Setenta y dos pacientes divididos en dos grupos [grupo CP–A (n = 36, 50%) y grupo CP+A (n = 36, 50%)] fueron asignados aleatoriamente a este ensayo clínico. Grupo CP+A (mantuvo la posición lateral 3/4 + dosis de acetazolamida 20 mg/kg/día en 3–4 dosis divididas durante 7 días) y grupo CP–A (grupo Control) (mantuvo la posición lateral 3/4 durante 7 días). 7 días sin acetazolamida).

Resultados

Las características basales entre los dos grupos no mostraron diferencias significativas: sexo (P < ,637), edad (P < ,988) y operación previa del SNC en otra ubicación además de la columna (P < ,496). Aunque informamos fuga de LCR posquirúrgica en 2/36 (5,55%) del grupo CP+A y 4/36 (11,11%) del grupo CP–A (control), no se observaron diferencias significativas entre los dos grupos (95% IC, 0,081–2,748; OR = 0,471; P < ,402; P ajustado <,247). Además, no se observaron diferencias significativas cuando examinamos las características quirúrgicas, como el tamaño de la abertura dural (P < ,489) y el tipo de operación (P < ,465).

Conclusión

La acetazolamida no tiene un efecto positivo en el control de la fuga de LCR después de la apertura de la duramadre/desgarro de la duramadre en pacientes adultos que se someten a cirugía de columna, cuando se considera junto con la posición prona de una semana. Por lo tanto, la administración de acetazolamida puede no ser esencial para la cirugía posoperatoria de la columna para el desgarro de la duramadre. Es posible que se necesiten estudios prospectivos que involucren un tamaño de muestra más grande para rastrear las complicaciones de la acetazolamida a largo plazo en pacientes con pérdida de LCR.

Palabras llave:
Acetazolamida
Fuga de LCR
Cirugía de columna en adultos
Posición prona

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