Management of cerebrospinal fluid leak from cervical gunshot
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A 39-year-old male presented with a gunshot wound through the right neck. The patient suffered a comminuted C6, C7, and T1 fractures with suspected right vertebral artery injury. The patient was taken emergently to the operating room by the trauma surgery team for emergent neck exploration, right external jugular vein ligation, and partial wound closure. The patient was noted to have a C4 ASIA A spinal cord injury. On hospital day 2, the patient underwent a digital subtraction angiogram and embolization of a right vertebral arteriovenous fistula. On hospital day 3, the patient was noted to have a CSF leak. Despite additional attempts to achieve wound closure and several days of conservative management, the CSF leak persisted. surgeons decided to place an EVD because the spinal canal at c6/7 appeared completely obliterated.

An EVD was placed in the intensive care unit after informed consent was obtained. The EVD was placed under sterile conditions using local anesthesia consisting of lidocaine with 1% epinephrine and mild conscious sedation consisting of 5 mg of diazepam, and 2 mg of morphine. Ten milliliters of CSF was drained every hour for a total of 7 days. The EVD was removed after a successful 48 h clamp trial. There were no complications as a result of the CSF diversion. The patient underwent a delayed C3-T3 posterior cervicothoracic fusion once the CSF fistula resolved. Their patient remained free of CSF leak at 6-month follow-up and regained limited use of his left upper extremity.