Treatment of the subarachnoid–pleural fistula

Abstract

<jats:p>Subarachnoid–pleural fistula is a rare type of cerebrospinal fluid (CSF) fistula, and there are only several cases reported in the literature. The authors describe a 65-year-old male patient in whom a diagnosis of T7–8 disc herniation had been made. He underwent surgery via a right lateral extracavitary approach. Postoperatively he developed progressive respiratory distress and headache. A chest x-ray film revealed a pleural effusion, and computerized tomography (CT) myelography demonstrated a subarachnoidal-pleural fistula at the level at which the herniated disc had been removed. The patient had been managed via a CSF drainage system and a chest tube. He was discharged after relief of symptoms was attained. Subarachnoid–pleural fistulas can be secondary to traumatic injury and surgery, or they can be spontaneous. Patients present with rapidly filling pleural effusion and headache. A diagnosis can be established using CT myelography or myeloscintigraphy. Treatment is conservative, with the placement of a chest tube and insertion of a CSF drainage catheter, and surgical repair should be considered only if the conservative therapy fails.</jats:p>

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

“…Those requiring operative intervention represent an even smaller number. Of all operations performed for compressive discogenic pathologies, the thoracic region comprises only 1.8 % at most [1][2][3][4]. Hott et al suggested a classification of herniations occupying more than 40 % of the spinal canal to be regarded as 'giant' [5].…”

“…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].…”

Intracranial Hypotension Caused by Dural‐Pleural Fistula

“…A dural‐pleural fistula is a rare CSF fistula that typically occurs following trauma. To the author's knowledge, there are only four other reports in the literature of a dural‐pleural fistula following thoracic spinal surgery 3–6 . Of these, there is only one report in which such a fistula leads to development of opthalmoplegia, as occurred in this patient 5 .…”

Percutaneous treatment of subarachnoid-pleural fistula with Onyx

“…Although rare, subarachnoid-pleural fistula has been well described following surgery for either tumor resection, 2,4,9,16 discectomy, 14,15 or vertebral fracture. 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.…”