Post-op lumbar subdural hygroma: a case report

Asymptomatic spinal subdural epiarachnoid hygroma after lumbar laminectomy for lumbar spinal canal stenosis: illustrative case

“…Several cases of SSEHs with cauda equina syndrome after lumbar surgery have been reported. [3][4][5][6] However, to the best of our knowledge, this study is the first to report an asymptomatic SSEH with improved imaging (Table 1). MRI is suitable for the diagnosis of SSEH.…”

“…In previous reports of SSEH with and without intraoperative durotomy, researchers proposed that the mechanism of CSF collection within the subdural space may be caused by the destruction of the arachnoid layer, resulting in a oneway valve that allows CSF to enter the subdural space. [1][2][3][4][5][6] In this case, durotomy or CSF leakage was not noted intraoperatively; however, arachnoid injury may have occurred due to physical stimulation by the procedure. A possible reason for the unilateral passage of CSF from the subarachnoid space to the subdural space is the effect of pressure changes in the meningeal compartments.…”

“…If progressive cauda equina syndrome is observed due to SSEH postoperatively, treatments to decompress SSEH tension by laminectomy and standard durotomy and repair the arachnoid should be performed immediately. [3][4][5][6] However, for asymptomatic SSEHs, as in the current case, conservative treatment can be selected.…”

“…Some cases of SSEHs associated with intraoperative durotomy in cranial and spinal surgery have been reported in the literature. [1][2][3] Although there have been few reports of symptomatic SSEH after spinal fusion without intraoperative durotomy, [4][5][6] to the best of our knowledge, a case of asymptomatic SSEH with spontaneous resolution captured through imaging has not been recognized. We herein report a case of postoperative asymptomatic SSEH caused by an uneventful LPD without intraoperative durotomy that spontaneously resolved as observed on magnetic resonance imaging (MRI).…”

Subdural Extra-arachnoid Hygroma Because of Occult Distal Durotomy After Minimally Invasive Decompression

“…Although authors of previous case reports stress targeting the surgical approach to the site of previous surgery, our experience highlights the potential necessity to explore proximal and distal to the site of the index surgery to identify the offending durotomy 4,11 . This is particularly relevant after MIS approaches with considerable thecal sac manipulation, given greater risks of occult dural injury.…”