Subarachnoid-pleural fistula after resection of a pancoast tumor with hyponatremia

Boyev, Paul; Krasna, Mark J.; White, Charles S.; McLaughlin, Joseph S.

doi:10.1016/0003-4975(95)00039-n

Cited by 11 publications

(8 citation statements)

References 4 publications

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“…Only 13 cases of SAPF following surgery have been reported in the literature135681112131416171819) (Table 1). Postoperative pneumocephalus could result from combination of a dural tear and a pneumorrhachis.…”

Section: Discussionmentioning

confidence: 99%

“…Postoperative pneumocephalus could result from combination of a dural tear and a pneumorrhachis. An SAPF may remain asymptomatic when small, or may cause pleural effusion and subsequent dyspnea and pleuritic chest pain, in addition to postural headaches4579), nausea, and vomiting secondary to intracranial hypotension1). An SAPF once developed causes a pressure gradient, which allows cerebrospinal fluid (CSF) to flow from the positive-pressure spinal subarachnoid space to the negative-pressure pleural space.…”

Section: Discussionmentioning

confidence: 99%

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Pneumocephalus and Pneumorrhachis due to a Subarachnoid Pleural Fistula That Developed after Thoracic Spine Surgery

Lee

Kim

et al. 2016

Korean J Spine

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Development of a communication between the spinal subarachnoid space and the pleural space after thoracic spine surgery is uncommon. Subarachnoid pleural fistula (SAPF), a distressing condition, involves cerebrospinal fluid leakage. Here we report an unusual case of SAPF, occurring after thoracic spine surgery, that was further complicated by pneumocephalus and pneumorrhachis postthoracentesis, which was performed for unilateral pleural effusion.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Pneumocephalus and Pneumorrhachis due to a Subarachnoid Pleural Fistula That Developed after Thoracic Spine Surgery

Lee

Kim

et al. 2016

Korean J Spine

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“…11,18 Clinical presentation typically includes respiratory signs due to pleural effusion, signs of intracranial hypotension such as orthostatic headache and oculomotor paralysis, and signs of pneumocephalus. 2 The fistula can be demonstrated on CT myelography, 6 MRI, or myeloscintigraphy. 7 Management of subarachnoid-pleural fistula is challenging, as the negative intrapleural pressure occurring at each inspiration constantly draws CSF into the pleural cavity, thereby promoting persistence of the fistula.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous treatment of subarachnoid-pleural fistula with Onyx

Knafo

Parker²,

Herbrecht³

et al. 2013

SPI

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Subarachnoid-pleural fistula is a well-described complication after anterior surgery for thoracic disc herniation, but is difficult to treat by means of traditional chest and lumbar drains due to interference by positive ventilation pressures that may keep the fistula open and prevent proper closure. Current treatment strategies include surgical repair, which is technically challenging, and noninvasive positive pressure ventilation, which can take several weeks to be effective. In this report, the authors describe a novel treatment for subarachnoid-pleural fistula using percutaneous obliteration with Onyx. Surgery for removal of a T7-8 disc herniation associated with ossification of the posterior longitudinal ligament was performed in a 56-year-old woman via an anterior transthoracic transpleural approach. Ten days after surgery, she presented with diplopia due to a subarachnoid-pleural fistula that was confirmed by CT myelography. Percutaneous injection of Onyx was performed under local anesthesia. Postprocedure CT showed complete obliteration of the fistula with no adverse events. A CT scan obtained 1 month later showed complete resolution of the pleural effusion. Neurological examination at 3 months postsurgery was normal. Clinical and radiological follow-up at 1 year showed complete recovery and no sign of fistula recurrence. Percutaneous treatment for subarachnoid-pleural fistula is an easy, safe, and effective strategy and can therefore be proposed as a first-line option for this challenging complication.

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“…Reportedly it usually occurs after trauma, either blunt 5,14,22,26 or penetrating. 12,17,18 Reports of cases of SPF following surgery are almost always limited to single-patient case reports in the literature, 4,8,9,16,27 with the largest single series containing only three patients. 3 Subarachnoid-pleural fistulas can be difficult to diagnose and may not be suspected clinically at initial presentation.…”

mentioning

confidence: 97%

Subarachnoid—pleural fistula after resection of thoracic tumors

Hentschel¹,

Rhines²,

Wong

et al. 2004

Journal of Neurosurgery: Spine

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Object. Little has been written about the appropriate diagnosis, investigation, and management of subarachnoid—pleural fistula (SPF). The authors report a series of patients with SPF that developed after resection of spinal tumor and discuss the diagnosis and treatment of this entity. Methods. Between 1993 and 2002, nine patients with SPF observed after spinal surgery at the M. D. Anderson Cancer Center were prospectively followed. In all patients the tumors were located in the thoracic region, and the most common entity was vertebral body metastasis (six cases), with renal cell carcinoma being the most common form of the disease (three cases). All but one patient underwent surgery via a transthoracic approach; in only one patient an intradural approach was performed. The most common presentation was overt cerebrospinal fluid (CSF) leakage, manifesting as chest tube drainage (four cases) or as leakage through the wound (one case). A definitive diagnosis of SPF was established in four patients, with evidence of extraspinal leakage on an 111In-radionuclide CSF study. Although all patients initially underwent a trial of lumbar CSF drainage, all but one required open repair, including creation of intercostal muscle (three cases) and omental (one case) flaps. Conclusions. After spinal surgery in which the thorax is entered, a diagnosis of SPF should be considered in any patient with abnormal chest tube output, persistent pleural effusion, or clinical evidence of intracranial hypotension. The diagnosis should be confirmed by performing a radionuclide-labeled CSF study. Definitive open repair is required in most cases and preferentially consists of a vascularized tissue graft, which is most easily obtained from an intercostal muscle flap.

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Subarachnoid-pleural fistula after resection of a pancoast tumor with hyponatremia

Cited by 11 publications

References 4 publications

Pneumocephalus and Pneumorrhachis due to a Subarachnoid Pleural Fistula That Developed after Thoracic Spine Surgery

Pneumocephalus and Pneumorrhachis due to a Subarachnoid Pleural Fistula That Developed after Thoracic Spine Surgery

Percutaneous treatment of subarachnoid-pleural fistula with Onyx

Subarachnoid—pleural fistula after resection of thoracic tumors

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