Chen PH, Li CR, Gan CW, Yang TH, Chang CS, Chan FH. Rare combination of traumatic subarachnoid-pleural fistula and intracranial subdural hygromas: A case report. World J Clin Cases 2023; 11(21): 5173-5178 [PMID: 37583858 DOI: 10.12998/wjcc.v11.i21.5173]
Corresponding Author of This Article
Fook-How Chan, Doctor, MD, Attending Doctor, Department of Neurosurgery, School of Medicine, Chung Shan Medical University Hospital, No. 110, Section 1, Jianguo North Road, Taichung 40201, Taiwan. fhchantw@gmail.com
Research Domain of This Article
Neurosciences
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Po-Han Chen, Cheat-Wei Gan, Tsung-Hsi Yang, Cheng-Siu Chang, Fook-How Chan, Department of Neurosurgery, School of Medicine, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
Chi-Ruei Li, Department of Neurosurgery, Neurological Institute, Taichung Veterans General Hospital, Taichung 40201, Taiwan
Author contributions: Chen PH wrote the paper; Li CR collect the review articles and participate wrote the paper; Gan CW collect the review articles; Yang TH collect the review articles; Chang CS comment and modify the paper; Chan FH comment and modify the paper.
Informed consent statement: Informed written consent was obtained from the patient and her parents for the publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Fook-How Chan, Doctor, MD, Attending Doctor, Department of Neurosurgery, School of Medicine, Chung Shan Medical University Hospital, No. 110, Section 1, Jianguo North Road, Taichung 40201, Taiwan. fhchantw@gmail.com
Received: May 19, 2023 Peer-review started: May 19, 2023 First decision: June 13, 2023 Revised: June 21, 2023 Accepted: July 4, 2023 Article in press: July 4, 2023 Published online: July 26, 2023
Abstract
BACKGROUND
Subarachnoid-pleural fistula (SPF) is a complex and rare condition characterized by a pathological shunt between the subarachnoid and pleural spaces. It can lead to the accumulation of cerebrospinal fluid (CSF) in the pleural space, pneumocephalus, and the development of central nervous system infection. Trauma or thoracic spinal surgery are common causes of SPF, with symptoms including postural headache, consciousness status changes, and dyspnea. The combination of SPF and subdural hygroma is a severe and rare condition, with little existing literature on its clinical correlation.
CASE SUMMARY
We report a case of an 83-year-old male patient with traumatic SPF and bilateral frontal subdural hygroma following a fall from height. The patient initially presented with severe lower back and buttock pain. During admission, the patient developed worsening lower limb weakness and pleural effusion. Further investigation revealed the presence of subdural hygromas with mass effect, requiring emergency bilateral subdural drainage. A multidisciplinary approach was undertaken to manage this complex condition, including intervention for hypovolemic CSF status and subdural hygroma management. The pleural effusion eventually resolved and the patient attained a higher level of consciousness after bilateral hygroma drainage surgery. We also reviewed the present literature relating to this rare combination of medical conditions.
CONCLUSION
Traumatic SPF with subsequent subdural hygroma is a rare but serious combination. Although the optimal treatment strategy for this complex condition remains uncertain, our literature review suggested that a multidisciplinary approach, including intervention for hypovolemic CSF and management of the subdural hygroma, is the most beneficial.
Core Tip: We present here a case of traumatic subarachnoid-pleural fistula in combination with bilateral frontal subdural hygroma. We also searched the existing literature to provide an evidence-based discussion of the correlation between these two clinical events.
