Video-Assisted Thorascopic Repair of a Subarachnoid-Pleural Fistula in a Child After Thoracic Tumor Resection

Kitagawa, Ryan S.; Satyan, Krishna B; Relyea, Katherine; Dauser, Robert C.; Nuchtern, Jed G.; Minifee, Paul K.; Whitehead, William E.; Curry, Daniel J.; Luerssen, Thomas G.; Jea, Andrew

doi:10.1097/brs.0b013e3181d83538

Cited by 9 publications

(9 citation statements)

References 16 publications

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“…β2‐transferrin could not be measured in the present patient. The diagnosis of a CSF fistula was confirmed with MRI and CT. CT myelography, MR cisternography and MR myelography can be used for identifying anatomical detail 1,5 . In the present case, fistula localization was determined by MRI and CT myelography.…”

Section: Discussionmentioning

confidence: 74%

“…Intervention is almost always required because subarachnoid‐pleural fistulas do not resolve with conservative therapies 1 . Previously reported conservative therapies consist of lumbar/cervical spinal catheter or passive CSF drainage by the chest tube, positive pressured non‐invasive ventilation, serial thoracentesis, epidural blood patch or fibrin glue insertion and bed rest 6 .…”

Section: Discussionmentioning

confidence: 99%

“…Cerebrospinal fluid (CSF) hydrothorax caused by subarachnoid‐pleural fistula is a rare condition. A subarachnoid‐pleural fistula may occur iatrogenically after thoracotomy or after trauma to the thoracic or thoracolumbar spinal column 1 . Such fistulas usually do not respond to conservative methods and direct operative repair is often necessary for permanent definitive treatment of the established subarachnoid‐pleural fistula in pediatric patients 2 .…”

mentioning

confidence: 99%

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Subarachnoid‐pleural fistula in a child: The cause and treatment

Karabayır

Demirkol

et al. 2012

Pediatrics International

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Hydrothorax of the cerebrospinal fluid after a subarachnoid-pleural fistula is a rare condition. Subarachnoid-pleural fistula may appear after a trauma at the thoracolumbar vertebral column or iatrogenically after thoracotomy. A two years and four months old boy who was operated because of ganglioneuroblastoma was admitted to hospital due to respiratory distress. The chest roentgenogram obtained two months after thoracotomy, showed a pleural effusion at the left side and a chest tube was inserted. The craniospinal magnetic resonance imagining revealed subarachnoid-pleural fistula and lumbar external cerebrospinal fluid drainage was performed. The chest tube was removed by application of tetracycline between pleural layers. After the patient was discharged, respiratory distress reoccurred after 3 weeks and a chest tube was reinserted due to fluid at the left hemithorax. An external lumbar drainage was reapplied. The location of the fistula was determined by craniospinal magnetic resonance imagining and myelography. The fistula was surgically restored by a posterior approach and laminectomy. The cerebrospinal fluid drainage and chest tube was removed three days and seven days after the operation respectively. The patient was discharged at the 13 days after the operation. During periodical outpatient follow up the patient has no symptoms and is neurologically intact. Subarachnoid-pleural fistulas, usually do not regress spontaneously or respond to conservative methods. Invasive approaches including surgery may be needed to treat patients with subarachnoid-pleural fistulae.

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Section: Discussionmentioning

confidence: 74%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Subarachnoid‐pleural fistula in a child: The cause and treatment

Karabayır

Demirkol

et al. 2012

Pediatrics International

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“…24 There are few reports of SPF in the pediatric neurosurgical literature, with sporadic single cases that mainly occur after thoracic tumor resection and trauma. 9,10,18,24 Common to these cases were requirements for open surgery and repair of the dural defect. Postoperatively, patients in these cases remained in the hospital for 7-14 days for observation and chest tube management.…”

Section: Discussionmentioning

confidence: 99%

“…20 Surgical intervention is often required to eliminate this pressure differential and entails direct repair of pleural and dural defects, either with open surgery or in a minimally invasive fashion. 10,20 This surgical intervention most commonly requires the use of a dural substitute or sealant (Tisseel, DuraSeal) and can be augmented with a vascularized graft. 7,8,19 Other authors have reported success with secondary occlusion of fistulas by using an epidural blood patch (EBP) 1 or synthetic material such as DuraSeal, Tisseel, and even Onyx; 4,6,11 however, all of these successes occurred in adult patients.…”

Section: Discussionmentioning

confidence: 99%

Repair of a traumatic subarachnoid-pleural fistula with the percutaneous injection of fibrin glue in a 2-year-old

Chu¹,

Miller²,

Bazylewicz

et al. 2016

PED

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Subarachnoid-pleural fistulas (SPFs) are rare clinical entities that occur after severe thoracic trauma or iatrogenic injury during anterolateral approaches to the spine. Treatment of these fistulas often entails open repair of the dural defect. The authors present the case of an SPF in a 2-year-old female after a penetrating injury to the chest. The diagnosis of an SPF was suspected given the high chest tube output and was confirmed with a positive β2-transferrin test of the chest tube fluid, as well as visualization of dural defects on MRI. The dural defects were successfully repaired with CT-guided percutaneous epidural injection of fibrin glue alone. This case represents the youngest pediatric patient with a traumatic SPF to be treated percutaneously. This technique can be safely used in pediatric patients, offers several advantages over open surgical repair, and could be considered as an alternative first-line therapy for the obliteration of SPFs.

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