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Martin A, Zahir J, Smith N, Raji O, Nelles D, Kondrashov D. High incidence of dural tears with 3-column osteotomies: a systematic review of adult spinal deformity surgery literature for the past decade. Spine Deform 2024; 12:1253-1260. [PMID: 38914908 DOI: 10.1007/s43390-024-00916-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 06/03/2024] [Indexed: 06/26/2024]
Abstract
PURPOSE Dural tear (DT) is a well-known complication of spinal surgery. We aimed to systematically review the literature from the past decade and determine the incidence and risk factors for DT in the adult spinal deformity (ASD) population to improve both the surgical strategy and counseling of patients undergoing ASD correction. METHODS A systematic review from 2013 to 2023 utilizing PRISMA guidelines was performed. The MEDLINE database was used to collect primary English language articles. The inclusion criterion for patients was degenerative ASD. Pediatric studies, animal studies, review articles, case reports, studies investigating minimally invasive surgery (MIS), studies lacking data on DT incidence, and articles pertaining to infectious, metastatic or neoplastic, traumatic, or posttraumatic etiologies of ASD were excluded. RESULTS Our results demonstrate that the incidence of DT in ASD surgery ranges from 2.0% to 35.7%, which is a much broader range than the reported incidence for non deformity surgery. Moreover, the average rate of DT during ASD surgery stratified by surgical technique was greater for osteotomy overall (19.5% +/- 7.9%), especially for 3-column osteotomy (3CO), and lower for interbody fusion (14.3% +/- 9.9%). Risk factors for DT in the ASD surgery cohort included older age, revision surgery, chronic severe compression, higher-grade osteotomy, complexity of surgery, rheumatoid arthritis (RA), and higher Anesthesiology Society of America (ASA) grade. CONCLUSION To our knowledge, this is the first systematic review discussing the incidence of and risk factors for DT in the ASD population. We found that the risk factors for DT in ASD patients were older age, revision surgery, chronic severe compression, a greater degree of osteotomy, complexity of surgery, RA, and a higher ASA grade. These findings will help guide spine surgeons in patient counseling as well as surgical planning.
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Affiliation(s)
- Anna Martin
- Department of Orthopaedic Surgery, San Francisco Orthopaedic Residency Program, St. Mary's Spine Center, 450 Stanyan St, San Francisco, CA, 94117, USA
- The Taylor Collaboration Orthopaedic Biomechanics Laboratory, San Francisco, CA, USA
| | - Jamal Zahir
- The Taylor Collaboration Orthopaedic Biomechanics Laboratory, San Francisco, CA, USA
| | - Nathan Smith
- Penn State College of Medicine, Hershey, PA, USA
| | - Oluwatodimu Raji
- Department of Orthopaedic Surgery, San Francisco Orthopaedic Residency Program, St. Mary's Spine Center, 450 Stanyan St, San Francisco, CA, 94117, USA
- The Taylor Collaboration Orthopaedic Biomechanics Laboratory, San Francisco, CA, USA
| | - David Nelles
- Department of Orthopaedic Surgery, San Francisco Orthopaedic Residency Program, St. Mary's Spine Center, 450 Stanyan St, San Francisco, CA, 94117, USA
- The Taylor Collaboration Orthopaedic Biomechanics Laboratory, San Francisco, CA, USA
| | - Dimitriy Kondrashov
- Department of Orthopaedic Surgery, San Francisco Orthopaedic Residency Program, St. Mary's Spine Center, 450 Stanyan St, San Francisco, CA, 94117, USA.
- The Taylor Collaboration Orthopaedic Biomechanics Laboratory, San Francisco, CA, USA.
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Rodrigues A, Antunes D, Pereira DJ, Jesus-Ribeiro J. Giant lumbar postoperative pseudomeningocele inducing positional syncope. BMJ Case Rep 2024; 17:e259235. [PMID: 38290984 PMCID: PMC10828859 DOI: 10.1136/bcr-2023-259235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2024] [Indexed: 02/01/2024] Open
Affiliation(s)
- Ana Rodrigues
- Internal Medicine, Centro Hospitalar Leiria EPE, Leiria, Portugal
| | - Daniela Antunes
- Internal Medicine, Centro Hospitalar Leiria EPE, Leiria, Portugal
| | - Daniela Jardim Pereira
- Neuroradiology Functional Unit, Medical Imaging Service, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
- Diaton MRI Unit, Centro Hospitalar Leiria EPE, Leiria, Portugal
| | - Joana Jesus-Ribeiro
- Neurology, Centro Hospitalar Leiria EPE, Leiria, Portugal
- Coimbra Institute for Clinical and Biomedical Research (iCBR) and Center of Investigation in Environment, Genetics and Oncobiology (CIMAGO), University of Coimbra Faculty of Medicine, Coimbra, Portugal
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Vazquez S, Houten JK, Stadlan ZT, Greisman JD, Vaserman G, Spirollari E, Sursal T, Dominguez JF, Kinon MD. Thecal sac ligation in the setting of thoracic spondyloptosis with complete cord transection. Surg Neurol Int 2023; 14:304. [PMID: 37810299 PMCID: PMC10559368 DOI: 10.25259/sni_360_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 07/24/2023] [Indexed: 10/10/2023] Open
Abstract
Background Traumatic spondyloptosis (TS) with complete spinal cord transection and unrepairable durotomy is particularly rare and can lead to a difficult-to-manage cerebrospinal fluid (CSF) leak. Methods We performed a systematic review of the literature on TS and discuss the management strategies and outcomes of TS with cord transection and significant dural tear. We also report a novel case of a 26-year-old female who presented with thoracic TS with complete spinal cord transection and unrepairable durotomy with high-flow CSF leak. Results Of 93 articles that resulted in the search query, 13 described cases of TS with complete cord transection. The approach to dural repair was only described in 8 (n = 20) of the 13 articles. The dura was not repaired in two (20%) of the cases. Ligation of the proximal end of the dural defect was done in 15 (75%) of the cases, all at the same institution. One (5%) case report describes ligation of the distal end; one (5%) case describes the repair of the dura with duraplasty; and another (5%) case describes repair using muscle graft to partially reconstruct the defect. Conclusion Suture ligation of the thecal sac in the setting of traumatic complete spinal cord transection with significant dural disruption has been described in the international literature and is a safe and successful technique to prevent complications associated with persisting high-flow CSF leakage. To the best of our knowledge, this is the first report of thecal sac ligation of the proximal end of the defect from the United States.
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Affiliation(s)
- Sima Vazquez
- Department of Neurosurgery, School of Medicine, New York Medical College, Valhalla, United States
| | - John K Houten
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York City, New York, United States
| | - Zehavya T Stadlan
- Department of Neurosurgery, School of Medicine, New York Medical College, Valhalla, United States
| | - Jacob D Greisman
- Department of Neurosurgery, School of Medicine, New York Medical College, Valhalla, United States
| | - Grigori Vaserman
- Department of Neurosurgery, School of Medicine, New York Medical College, Valhalla, United States
| | - Eris Spirollari
- Department of Neurosurgery, School of Medicine, New York Medical College, Valhalla, United States
| | - Tolga Sursal
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, United States
| | - Jose F Dominguez
- Department of Neurosurgery, Westchester Medical Center, Valhalla, New York, United States
| | - Merritt D Kinon
- Department of Neurosurgery, Westchester Medical Center, Valhalla, New York, United States
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Liang S, Wang Z, Wu P, Chen Z, Yang X, Li Y, Ren X, Zhang D, Ge Z. Risk Factors and Outcomes of Central Nervous System Infection After Spinal Surgery: A Retrospective Cohort Study. World Neurosurg 2023; 170:e170-e179. [PMID: 36328166 DOI: 10.1016/j.wneu.2022.10.098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 10/24/2022] [Accepted: 10/25/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To investigate the risk factor associated with central nervous system infection, a rare and dire complication after spinal surgery. METHODS Univariate and multivariate logistic regression analyses were performed to screen for the independent risk factors. According to the different administration methods of antibiotics, patients were divided into intravenous and intrathecal groups. The differences in time needed for body temperature, white blood cells (WBC), and C-reactive protein (CRP) to return to normal and the time of antibiotic application were compared between the 2 groups. In addition, the differences in WBC, neutrophil ratio, CRP, procalcitonin in blood, and WBC in cerebrospinal fluid were compared before intrathecal injection, after the first one, and the last one. The incidence of complications in the 2 groups was observed. RESULTS Dural tears, laminectomy, and operation time >3 hours were identified as independent risk factors. The time needed for body temperature, WBC, and CRP to return to normal and the antibiotic application time were significantly different between the 2 groups (all P < 0.05). Before and after the first intrathecal injection and after the last intrathecal injection, the differences in WBCs, neutrophil ratios, CRP, procalcitonin in blood, and cerebrospinal fluid-WBC were statistically significant in overall and pairwise comparisons (P < 0.05). Complications occurred in 2 and 14 cases, respectively. CONCLUSIONS The independent risk factors for central nervous system infection after spinal surgery were a dural tear, laminectomy, and operation time > 3 hours. Combined intravenous and intrathecal injections of antibiotics led to a better effect than intravenous injection alone; however, this approach was associated with more complications.
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Affiliation(s)
- Simin Liang
- Department of Orthopaedics, General Hospital of Ningxia Medical University, Yinchuan City of Ningxia, China
| | - Zhiqiang Wang
- Department of Orthopaedics, General Hospital of Ningxia Medical University, Yinchuan City of Ningxia, China
| | - Peng Wu
- Department of Orthopaedics, General Hospital of Ningxia Medical University, Yinchuan City of Ningxia, China
| | - Zhen Chen
- Department of Orthopaedics, General Hospital of Ningxia Medical University, Yinchuan City of Ningxia, China
| | - Xiaoyan Yang
- Medical Laboratory Center, General Hospital of Ningxia Medical University, Yinchuan City of Ningxia, China
| | - Ying Li
- Medical Record Room, General Hospital of Ningxia Medical University, Yinchuan City of Ningxia, China
| | - Xiaolu Ren
- Department of Radiology, General Hospital of Ningxia Medical University, Yinchuan City of Ningxia, China
| | - Danmei Zhang
- Department of Nosocomial Infection, General Hospital of Ningxia Medical University, Yinchuan City of Ningxia, China
| | - Zhaohui Ge
- Department of Orthopaedics, General Hospital of Ningxia Medical University, Yinchuan City of Ningxia, China.
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Palackdkharry CS, Wottrich S, Dienes E, Bydon M, Steinmetz MP, Traynelis VC. The leptomeninges as a critical organ for normal CNS development and function: First patient and public involved systematic review of arachnoiditis (chronic meningitis). PLoS One 2022; 17:e0274634. [PMID: 36178925 PMCID: PMC9524710 DOI: 10.1371/journal.pone.0274634] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 08/31/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND & IMPORTANCE This patient and public-involved systematic review originally focused on arachnoiditis, a supposedly rare "iatrogenic chronic meningitis" causing permanent neurologic damage and intractable pain. We sought to prove disease existence, causation, symptoms, and inform future directions. After 63 terms for the same pathology were found, the study was renamed Diseases of the Leptomeninges (DLMs). We present results that nullify traditional clinical thinking about DLMs, answer study questions, and create a unified path forward. METHODS The prospective PRISMA protocol is published at Arcsology.org. We used four platforms, 10 sources, extraction software, and critical review with ≥2 researchers at each phase. All human sources to 12/6/2020 were eligible for qualitative synthesis utilizing R. Weekly updates since cutoff strengthen conclusions. RESULTS Included were 887/14286 sources containing 12721 DLMs patients. Pathology involves the subarachnoid space (SAS) and pia. DLMs occurred in all countries as a contributor to the top 10 causes of disability-adjusted life years lost, with communicable diseases (CDs) predominating. In the USA, the ratio of CDs to iatrogenic causes is 2.4:1, contradicting arachnoiditis literature. Spinal fusion surgery comprised 54.7% of the iatrogenic category, with rhBMP-2 resulting in 2.4x more DLMs than no use (p<0.0001). Spinal injections and neuraxial anesthesia procedures cause 1.1%, and 0.2% permanent DLMs, respectively. Syringomyelia, hydrocephalus, and arachnoid cysts are complications caused by blocked CSF flow. CNS neuron death occurs due to insufficient arterial supply from compromised vasculature and nerves traversing the SAS. Contrast MRI is currently the diagnostic test of choice. Lack of radiologist recognition is problematic. DISCUSSION & CONCLUSION DLMs are common. The LM clinically functions as an organ with critical CNS-sustaining roles involving the SAS-pia structure, enclosed cells, lymphatics, and biologic pathways. Cases involve all specialties. Causes are numerous, symptoms predictable, and outcomes dependent on time to treatment and extent of residual SAS damage. An international disease classification and possible treatment trials are proposed.
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Affiliation(s)
| | - Stephanie Wottrich
- Case Western Reserve School of Medicine, Cleveland, Ohio, United States of America
| | - Erin Dienes
- Arcsology®, Mead, Colorado, United States of America
| | - Mohamad Bydon
- Department of Neurologic Surgery, Orthopedic Surgery, and Health Services Research, Mayo Clinic School of Medicine, Rochester, Minnesota, United States of America
| | - Michael P. Steinmetz
- Department of Neurological Surgery, Cleveland Clinic Lerner College of Medicine Neurologic Institute, Cleveland, Ohio, United States of America
| | - Vincent C. Traynelis
- Department of Neurosurgery, Rush University School of Medicine, Chicago, Illinois, United States of America
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6
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Takeoka Y, Kakutani K, Miyamoto H, Suzuki T, Yurube T, Komoto I, Ryu M, Satsuma S, Uno K. Complications of Posterior Fusion for Atlantoaxial Instability in Children With Down Syndrome. Neurospine 2022; 18:778-785. [PMID: 35000332 PMCID: PMC8752718 DOI: 10.14245/ns.2142720.360] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 10/20/2021] [Indexed: 11/30/2022] Open
Abstract
Objective To clarify the complications of posterior fusion for atlantoaxial instability (AAI) in children with Down syndrome and to discuss the significance of surgical intervention. Methods Twenty pediatric patients with Down syndrome underwent posterior fusion for AAI between February 2000 and September 2018 (age, 6.1±1.9 years). C1–2 or C1–3 fusion and occipitocervical fusion were performed in 14 and 6 patients, respectively. The past medical history, operation time, estimated blood loss (EBL), duration of Halo vest immobilization, postoperative follow-up period, and intra- and perioperative complications were examined.
Results The operation time was 257.9±55.6 minutes, and the EBL was 101.6±77.9 mL. Complications related to the operation occurred in 6 patients (30.0%). They included 1 major complication (5.0%): hydrocephalus at 3 months postoperatively, possibly related to an intraoperative dural tear. Other surgery-related complications included 3 cases of superficial infections, 1 case of bone graft donor site deep infection, 1 case of C2 pedicle fracture, 1 case of Halo ring dislocation, 1 case of pseudoarthrosis that required revision surgery, and 1 case of temporary neurological deficit after Halo removal at 2 months postoperatively. Complications unrelated to the operation included 2 cases of respiratory infections and 1 case of implant loosening due to a fall at 9 months postoperatively.
Conclusion The complication rate of upper cervical fusion in patients with Down syndrome remained high; however, major complications decreased substantially. Improved intra- and perioperative management facilitates successful surgical intervention for upper cervical instability in pediatric patients with Down syndrome.
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Affiliation(s)
- Yoshiki Takeoka
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.,Department of Orthopaedic Surgery, National Hospital Organization Kobe Medical Center, Kobe, Japan
| | - Kenichiro Kakutani
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hiroshi Miyamoto
- Department of Orthopaedic Surgery, National Hospital Organization Kobe Medical Center, Kobe, Japan.,Department of Orthopaedic Surgery, Kindai University Hospital, Osaka-Sayama, Japan
| | - Teppei Suzuki
- Department of Orthopaedic Surgery, National Hospital Organization Kobe Medical Center, Kobe, Japan
| | - Takashi Yurube
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Izumi Komoto
- Department of Orthopaedic Surgery, Kobe Children's Hospital, Kobe, Japan
| | - Masao Ryu
- Department of Orthopaedic Surgery, National Hospital Organization Kobe Medical Center, Kobe, Japan
| | - Shinichi Satsuma
- Department of Orthopaedic Surgery, Kobe Children's Hospital, Kobe, Japan
| | - Koki Uno
- Department of Orthopaedic Surgery, National Hospital Organization Kobe Medical Center, Kobe, Japan
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7
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Huang HH, Cheng ZH, Ding BZ, Zhao J, Zhao CQ. Subdural fluid collection rather than meningitis contributes to hydrocephalus after cervical laminoplasty: A case report. World J Clin Cases 2021; 9:6485-6492. [PMID: 34435016 PMCID: PMC8362574 DOI: 10.12998/wjcc.v9.i22.6485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 05/09/2021] [Accepted: 05/27/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hydrocephalus following dural tear after spinal surgery is rare. Although a few cases of obstructive hydrocephalus caused by subdural fluid collection and communicating hydrocephalus associated with meningitis have been reported, the mechanism remains uncertain. Herein we describe a patient complicated with hydrocephalus after cervical laminoplasty in whom subdural fluid collection in the cervical spine and posterior cranial fossa rather than chronic meningitis was the main mechanism.
CASE SUMMARY A 45-year-old man underwent cervical laminoplasty for cervical spondylotic myelopathy at a local hospital. Ten days postoperatively, a high fever occurred and magnetic resonance imaging (MRI) showed cerebrospinal fluid (CSF) leakage. Pseudomeningocele liquid test showed high levels of protein and white blood cell (WBC) count with negative bacterial culture. The patient was treated with short-term intravenous antibiotic and discharged with normal body temperature. The patient was uneventful during the first 8 mo follow-up although repeated MRI showed persistent pseudomeningocele. At the 9th mo postoperatively, the patient gradually presented with dizziness and headache accompanied by recurrent weakness of his left arm. Imaging examinations demonstrated hydrocephalus and a cystic lesion around the cervical spinal cord. CSF test from lumbar puncture indicated chronic meningitis. MRI on 1 d after pseudomeningocele drainage showed a significant decrease in the cystic volume, suggesting that the cystic lesion would be subdural fluid collection rather than adhesive arachnoiditis. After dural defect repair, the patient’s symptoms completely resolved and hydrocephalus gradually disappeared. CSF analysis at the 21-mo follow-up revealed significantly decreased protein level and WBC count.
CONCLUSION Subdural fluid collection rather than meningitis contributes to the hydrocephalus formation after cervical laminoplasty.
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Affiliation(s)
- Hao-Han Huang
- Department of Orthopaedics, Shanghai Key Laboratory of Orthopaedic Implants, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Zhi-Hua Cheng
- Department of Neurosurgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Bao-Zhi Ding
- Department of Orthopaedics, Shanghai Key Laboratory of Orthopaedic Implants, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Jie Zhao
- Department of Orthopaedics, Shanghai Key Laboratory of Orthopaedic Implants, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Chang-Qing Zhao
- Department of Orthopaedics, Shanghai Key Laboratory of Orthopaedic Implants, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
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Sanabria Sanchinel AA, Lin Y, Rodríguez Rubio D. Pseudomeningocele: headache, apnoea, and syncope. NEUROLOGÍA (ENGLISH EDITION) 2021; 36:654-656. [PMID: 34266800 DOI: 10.1016/j.nrleng.2020.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 11/19/2020] [Indexed: 11/25/2022] Open
Affiliation(s)
| | - Y Lin
- Servicio de Neurofisiología, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
| | - D Rodríguez Rubio
- Servicio de Neurocirugía, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
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9
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Sanabria Sanchinel AA, Lin Y, Rodríguez Rubio D. Pseudomeningocele: Headache, apnea and syncope. Neurologia 2020; 36:S0213-4853(20)30435-7. [PMID: 33371979 DOI: 10.1016/j.nrl.2020.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 11/08/2020] [Accepted: 11/19/2020] [Indexed: 11/26/2022] Open
Affiliation(s)
| | - Y Lin
- Servicio de Neurofisiología, Hospital del Mar, Parc de Salut Mar, Barcelona, España
| | - D Rodríguez Rubio
- Servicio de Neurocirugía, Hospital del Mar, Parc de Salut Mar, Barcelona, España
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Rudrappa S, Govindasamy R, Sekar A, Tukkapuram R, Vikrama A. Hydrocephalic Attack-An Uncommon Complication of Spine Surgery: A Case Series and Review of Literature. World Neurosurg 2019; 126:101-106. [PMID: 30857997 DOI: 10.1016/j.wneu.2019.02.155] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 02/14/2019] [Accepted: 02/15/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Spinal pseudomeningocele refers to an abnormal accumulation of cerebrospinal fluid (CSF) in a fibrous sac without arachnoid lining that occurs mostly as a result of an accidental dural opening. When accidental dural openings are found intraoperatively, they should be repaired to prevent further complications. Sometimes inadequately dealt dural openings, unnoticed, or postoperative dural openings may produce complications. CASE DESCRIPTION Three patients had complications as a result of spine surgery and presented several days after the surgery with episodic symptoms of raised intracranial pressure, including headache, opisthotonos, altered breathing patterns, and altered sensorium. These symptoms increased whenever pressure was applied on the operated area suggesting hydrocephalic attacks. All 3 patients had a giant pseudomeningocele at the operated area, a complication that resulted from the spine surgery. Magnetic resonance imaging CSF flow study revealed hyperdynamic flow and increase in absolute stroke volume across the cerebral aqueduct when constant pressure was applied on the pseudomeningocele sac. CONCLUSIONS Usually pseudomeningoceles are asymptomatic, and if symptomatic, the common presentations are local swelling, back pain, radiculopathy, and orthostatic headache. To our knowledge, this is the first article in the literature reporting the uncommon presentation of hydrocephalic attacks in 3 cases subsequent to CSF backflow from the sac, confirmed with MRI CSF flow study. This case series emphasizes rare presentations can result from transiently increased intracranial pressure related to postoperative pseudomeningocele in spine surgeries.
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Affiliation(s)
- Satish Rudrappa
- Department of Neurosurgery, Sakra World Hospital, Bangalore, India
| | | | - Arunkumar Sekar
- Department of Neurosurgery, Sakra World Hospital, Bangalore, India
| | | | - Amita Vikrama
- Department of Radiology, Sakra World Hospital, Bangalore, India
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11
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Rudrappa S, Govindasamy R, Tukkapuram VR, Gopal S. Lumbar pseudomeningocele presenting as decerebrate rigidity-A rare case entity. Int J Surg Case Rep 2018; 47:41-44. [PMID: 29709844 PMCID: PMC5994805 DOI: 10.1016/j.ijscr.2018.04.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 03/14/2018] [Accepted: 04/15/2018] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Spinal pseudomeningoceles are extradural collections of cerebrospinal fluid that result following a breach in the dural-arachnoid layer and is reported as one of the complications of lumbar disc surgery. Although they are often self subsiding and asymptomatic, they may occasionally cause low-back pain, headaches, and even nerve root entrapment. The purpose of this case report is to present an unreported presentation of pseudomeningocele PRESENTATION OF CASE: A 34 year obese male presented one month post lumbar discectomy with symptoms suggestive of raised intra cranial pressure presenting as repetitive decerebrate rigidity and altered sensorium lasting for few minutes when there is pressure on the pseudomeningocele sac and subsiding with change in position of the patient. He underwent surgical repair of the dural tear and was improved symptomatically with no recurrence of symptoms at five years follow up. DISCUSSION Radiological investigation helped in ruling out the other causes of decerebrate rigidity and the possible mechanism of development of such symptom in pseudomeningocele is discussed. CONCLUSION To the best of our knowledge, this is the first reported case of pseudomeningooele presenting as decerebrate rigidity. Spinal pseudomeningocele can present in varied ways and earliest detection is the key to avoid such complications.
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Affiliation(s)
- Satish Rudrappa
- Department of Neurological Sciences, Sakra World Hospital, Bangalore, India.
| | | | | | - Swaroop Gopal
- Department of Neurological Sciences, Sakra World Hospital, Bangalore, India.
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12
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Matsushima K, Hashimoto R, Gondo M, Fukuhara H, Kohno M, Jimbo H. Perifascial Areolar Tissue Graft for Spinal Dural Repair with Cerebrospinal Fluid Leakage: Case Report of Novel Graft Material, Radiological Assessment Technique, and Rare Postoperative Hydrocephalus. World Neurosurg 2016; 95:619.e5-619.e10. [PMID: 27554306 DOI: 10.1016/j.wneu.2016.08.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 08/05/2016] [Accepted: 08/06/2016] [Indexed: 01/29/2023]
Abstract
BACKGROUND Incidental durotomy is a relatively common complication in spinal surgeries, and treatment of persistent cerebrospinal fluid (CSF) leakage is still challenging, especially in cases for which "watertight" suturing is inapplicable. The usefulness of a nonvascularized perifascial areolar tissue (PAT) graft recently was emphasized for plastic and skull base surgeries. Its hypervascularity allows for early engraftment and long-term survival, and its flexibility is advantageous in fixing defects of complex shapes in limited surgical spaces. CASE DESCRIPTION The authors report a case of persistent CSF leakage after cervical spine surgery in which a PAT graft was used successfully for direct closure of the dural defect. The noninvasive, spin-labeled magnetic resonance imaging technique was used for postoperative assessment of CSF dynamics, not for CSF accumulation but for CSF leakage itself. In addition, some potential causes for the rare development of communicating hydrocephalus after cervical laminoplasty, as seen in this case, are discussed. CONCLUSIONS PAT was used successfully as an alternative free graft material for direct spinal dural closure, and its hypervascularity seemed to assist with rapid resolution of CSF leakage in our case. Spin-labeled magnetic resonance imaging may enable assessment of spinal CSF dynamics without invasion.
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Affiliation(s)
- Ken Matsushima
- Department of Neurosurgery, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan; Department of Neurosurgery, Tokyo Medical University, Tokyo, Japan
| | - Ryo Hashimoto
- Department of Neurosurgery, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Masahide Gondo
- Department of Plastic and Reconstructive Surgery, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Hirokazu Fukuhara
- Department of Neurosurgery, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Michihiro Kohno
- Department of Neurosurgery, Tokyo Medical University, Tokyo, Japan
| | - Hiroyuki Jimbo
- Department of Neurosurgery, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan.
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