Burr Hole Drainage : Could Be Another Treatment Option for Cerebrospinal Fluid Leakage after Unidentified Dural Tear during Spinal Surgery?

Abstract

Authors report a rare case of acute intracranial subdural and intraventricular hemorrhage that were caused by intracranial hypotension resulted from cerebrospinal fluid leakage through an unidentified dural tear site during spinal surgery. The initial brain computed tomography image showed acute hemorrhages combined with preexisting asymptomatic chronic subdural hemorrhage. One burr hole was made over the right parietal skull to drain intracranial hemorrhages and subsequent drainage of cerebrospinal fluid induced by closure of the durotomy site. Among various methods to treat cerebrospinal fluid leakage through unidentified dural injury site, primary repair and spinal subarachnoid drainage are well known treatment options. The brain imaging study to diagnose intracranial hemorrhage should be taken before selecting the treatment method, especially for spinal subarachnoid drainage. Similar mechanism to its spinal counterpart, cranial cerebrospinal fluid drainage has not been mentioned in previous article and could be another treatment option to seal off an unidentified dural tear in particular case of drainage of intracranial hemorrhage is needed.

Clinical case-series report of traumatic cauda equina herniation

“…The dura was sutured or reconstructed with autologus patch. [ 14 , 15 ] As compared to posterior lacerations, anterior dural tears are more difficult to be repaired due to the smaller and deeper operative field at the site of decompression. Furthermore, the dural laceration may be linked with the pleural space if the injury occurs at L1 or above, which increases the risk of postoperative CSF leakage.…”

Subarachnoid Hemorrhage Presenting with Seizure due to Cerebrospinal Fluid Leakage after Spinal Surgery

“…In addition to the pathophysiology of pseudo-subarachnoid hemorrhage, these suggestions could also help to explain the mechaniam of action. Otherwise, it is accepted that older people constitute the majority of patients who undergo spinal surgery and are much more vulnerable to the occurrence of intracranial hemorrhage after CSF leakage in association with a history of underlying chronic hypertension and age–related brain atrophy 11) .…”

Biodegradable Mineralized Collagen Plug for the Reconstruction of Craniotomy Burr-Holes: A Report of Three Cases

“…There are increasing clinical safety requirements for sealing the cranial bone defects and protecting organs and tissues inside the skull in order to reduce the risks of complications due to the holes, such as cerebrospinal fluid leakage and infection [3] . Cerebrospinal fluid leakage is a potential complication that can result from dural wounds during neurosurgical surgeries [19] . Cerebrospinal fluid leakage could result in intracranial hypotension, which is considered to be the main pathogenic mechanism underlying intracranial hemorrhage [20] .…”