Bilateral Subdural Hematoma due to an Unnoticed Dural Tear during Spine Surgery

Jung, Youn Young; Ju, Chng Il; Kim, Seok Won

doi:10.3340/jkns.2010.47.4.316

Cited by 17 publications

(18 citation statements)

References 6 publications

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“…A review of the literature reveals 44 described cases of massive pleura-dural fistula. It can be observed that 77 % of these cases were caused by trauma of varying aetiologies and only two (4.5 %) of the cases were described as subsequent to post-operative thoracic disc resection [2,9,[14][15][16][17]. Recently, two cases of spontaneous thoracic CSF leakage in the presence of thoracic disc hernias were described [18].…”

Section: Epidemiology Pathology and Rationale For Treatmentmentioning

confidence: 99%

“…This results in tension and occlusion of the superior cerebellar bridging veins, which is thought to result in venous infarction and haemorrhage [21,22]. A review of the literature reveals only five cases of confirmed remote subdural haemorrhage subsequent to spinal surgery [16]. Two of these were subsequent to thoracic spinal surgery, while the remainder were associated with lumbar surgery.…”

Section: Epidemiology Pathology and Rationale For Treatmentmentioning

confidence: 99%

“…At re-exploration, the options for repair depend largely on the morphology of the dural injury involved. To achieve a direct repair, the described technique involves the use of synthetic collagen patches, which combined with layered fibrin glue, have been used to create a watertight seal [16]. These may be applied directly to the dura to achieve a repair of the defect.…”

Section: Epidemiology Pathology and Rationale For Treatmentmentioning

confidence: 99%

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Intracranial hypotension with a sixth cranial nerve palsy subsequent to massive thoracic CSF hygroma: a rare complication of thoracic disc excision

et al. 2013

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Background Thoracic cerebrospinal fluid (CSF) hygroma is a rare and potentially devastating complication of the anterior thoracic approach to the spine. We present two cases in which this complication resulted in acute cranial nerve palsy and discuss the pathoanatomy and management options in this scenario. Case reports Two male patients presented to our department with neurological deterioration due to a giant herniated thoracic disc. The extruded disc fragment was noted preoperatively to be calcified in both patients. A durotomy was performed at primary disc prolapse resection in the first patient, whereas an incidental durotomy during the

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Section: Epidemiology Pathology and Rationale For Treatmentmentioning

confidence: 99%

Section: Epidemiology Pathology and Rationale For Treatmentmentioning

confidence: 99%

Section: Epidemiology Pathology and Rationale For Treatmentmentioning

confidence: 99%

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Intracranial hypotension with a sixth cranial nerve palsy subsequent to massive thoracic CSF hygroma: a rare complication of thoracic disc excision

et al. 2013

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“…CSF leakage after a dural tear during spinal surgery may cause intracranial hemorrhage, such as SDH, [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] subarachnoid hemorrhage, 24 ,26 or epidural hemorrhage 11 , 12 , 27 alone or concurrently, but only 17 cases of SDH including the present cases have been reported [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] ( Table 1 ). In most cases, a prolonged headache and nausea were the main symptoms, whereas acute disturbance of consciousness beginning within several hours after spinal surgery only occurred in 2 cases.…”

Section: Discussionmentioning

confidence: 82%

Supratentorial Subdural Hemorrhage of a Previous Head Injury and Cerebellar Hemorrhage After Cervical Spinal Surgery

Morimoto

Shiraki

Otani³

et al. 2014

Spine

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“…Many authors propose that CSF hypotension associated with excessive CSF drainage, results in strain on bridging vessels. The result is a SSDH due to intracranial hemorrhage and migration of blood into the spinal subdural space, facilitated by CSF hypovolemia and gravity [20][21][22][23][24][25][26][27][28][29][30][31][32]. This pathophysiology is also cited for SSDH, after incidental durotomy associated with CSF leak [33][34][35].…”

Section: Discussionmentioning

confidence: 99%

Acute Spinal Subdural Hematoma Subsequent To Posterior Lumbar Fusion

Ali

Barkley²,

Malhotra³

2013

J Osteopor Phys Act

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of arthrodesis is exceedingly rare [6][7][8][9]. We present a case of acute SSDH, presenting with cauda equina after surgical decompression and reconstruction, as well as summarize the current literature on SSDH. Case ReportA 72 year old man presented with lower back pain extending down the left anterior thigh, one year after an uncomplicated L2-5 laminectomy for lumbar spinal stenosis. AbstractObjective: To report a rare case of post-operative cauda equina syndrome subsequent to lumbar decompression and reconstruction, and review the relevant anatomical causes of spinal subdural hematoma. We present a case report of an acute spinal subdural hematoma, following surgical decompression and fusion. The etiology of spinal subdural hematoma after spinal surgery is controversial. We propose that violation of the dural-arachnoid interface is a likely mechanism of this complication. Summary of background data:Spinal subdural hematoma (SSDH) is a very rare postoperative complication of surgical decompression. We report the presentation of acute SSDH presenting with acute cauda equine, following lumbar decompression and reconstruction in a patient lacking risk factors for this rare complication. Methods:A 72 year old man with a history of prior L2-5 laminectomy presented with persistent lower back and left lower extremity radicular pain, due to lumbar spondylosis with foraminal stenosis due to synovial cyst, and lumbar disc herniation. He underwent a revision L2-5 laminectomy with foramintomies, L3-4 synovial cyst resection, and L3-4 posterolateral instrumented fusion. Small incidental duratomy without arachnoid fenestration and without cerebrospinal fluid extravasation, was noted and repaired intraoperatively. On post-operative day four, the patient presented with acute cauda equina syndrome, found to be associated with an acute dorsal lumbar subdural hematoma.Results: After emergent evacuation of the hematoma, patient had immediate resolution of symptoms, and continued to demonstrate dramatic improvement after 1-year follow-up. Conclusions:Despite its low incidence, SSDH should be considered in the setting of acute cauda equina syndrome, following surgical decompression. Prompt evacuation of hematoma is associated with good prognosis. The etiology of SSDH post spinal surgery is controversial. Violation of the dural-arachnoid interface and destruction of local neurothelial cells is the suspected etiology of this very rare complication. Key Points* SSDH is a very rare complication of surgical decompression, with coagulopathy conferring an increased risk.* Although rare, acute SSDH should be considered in the setting of acute cauda equina syndrome, following lumbar decompression associated with intraoperative durotomy, without spinal fluid leak.* Emergent evacuation of SSDH provides greatest chance of good prognosis and reversal of symptoms.* Our case demonstrates that violation of the dural-arachnoid interface is a plausible etiology for postoperative SSDH.

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Bilateral Subdural Hematoma due to an Unnoticed Dural Tear during Spine Surgery

Cited by 17 publications

References 6 publications

Intracranial hypotension with a sixth cranial nerve palsy subsequent to massive thoracic CSF hygroma: a rare complication of thoracic disc excision

Intracranial hypotension with a sixth cranial nerve palsy subsequent to massive thoracic CSF hygroma: a rare complication of thoracic disc excision

Supratentorial Subdural Hemorrhage of a Previous Head Injury and Cerebellar Hemorrhage After Cervical Spinal Surgery

Acute Spinal Subdural Hematoma Subsequent To Posterior Lumbar Fusion

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