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Kim JY, Oh BH, Kim IS, Hong JT, Sung JH, Lee HJ. The safety and effectiveness of lumbar drainage for cerebrospinal fluid leakage after spinal surgery. Neurochirurgie 2023; 69:101501. [PMID: 37741364 DOI: 10.1016/j.neuchi.2023.101501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 09/03/2023] [Accepted: 09/12/2023] [Indexed: 09/25/2023]
Abstract
PURPOSE Cerebrospinal fluid (CSF) leakage is a frequent complication after spinal surgery. The lumbar drainage procedure (LDP) is the preferred method for early closure of a dural tear. This study was conducted to assess the safety and effectiveness of LDP after spinal surgery. MATERIALS AND METHODS We retrospectively reviewed 122 patients (55 male and 67 female) who underwent LDP after spinal surgery between January 2010 and June 2021. LDP was performed on patients with suspected CSF leakage due to a dural tear during spinal surgery or in whom mixed-color CSF was observed in the hemo-drain after surgery. LDP was performed aseptically by a resident according to our institution's protocol, and the amount drained was from 200cc to 300cc per day. Absolute bed rest was maintained during the lumbar drainage period. The hemo-drain was opened to confirm that CSF was no longer mixed or oozing, at which time the lumbar drain was removed. Culture was performed at the drain tip when the lumbar drain was removed. RESULTS The spinal surgery level was cervical in 23 patients, thoracic in 27 patients, and lumbar in 72 patients. The mean duration of the indwelling lumbar drain was 7.2 days (2 days-18 days), and the mean amount of drainage was 1198.2cc (100cc-2542cc). Among the 122 patients, the CSF leakage in 101 patients was resolved with the initial procedure, but 21 patients required re-insertion. Of those 21 patients, improper insertion due to a technical problem occurred in 15 patients, poor line fixation occurred in 2 patients, and CSF leakage was again observed after removal of the lumbar drain in 4 patients. In only 1 case was open surgery done after LDP because follow-up magnetic resonance imaging showed a suspected infection. During lumbar drainage, 76 patients used antibiotics, and 46 patients did not. Four patients showed bacterial growth in the tip culture, and 3 of them had been using antibiotics. All 4 of those patients were treated without complications and discharged. Among the 122 patients, 1 patient was discharged with left hemiparesis due to cerebral venous infarction (CVI) and hemorrhage after LDP, and 1 patient underwent re-operation because the CSF collection was not resolved. CONCLUSIONS No major complications such as systemic infection, deep vein thrombosis, or aspiration pneumonia occurred during the lumbar drainage, except for 1 patient (0.8%) with CVI caused by over-drainage. One patient (0.8%) required open surgery after LDP, but no cases of systemic infection occurred while maintaining lumbar drainage, irrespective of antibiotic use. In conclusion, LDP is a safe and effective treatment for CSF leakage after spinal surgery.
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Affiliation(s)
- Jee Yong Kim
- Department of Neurosurgery, St. Vincent Hospital, The Catholic University of Korea, College of Medicine, Suwon, Korea
| | - Byeong Ho Oh
- Department of Neurosurgery, Chungbuk National University Hospital, College of Medicine, Cheongju, Korea
| | - Il Sup Kim
- Department of Neurosurgery, St. Vincent Hospital, The Catholic University of Korea, College of Medicine, Suwon, Korea
| | - Jae Taek Hong
- Department of Neurosurgery, Eunpyeong St. Mary's Hospital, The Catholic University of Korea, College of Medicine, Seoul, Korea
| | - Jae Hoon Sung
- Department of Neurosurgery, St. Vincent Hospital, The Catholic University of Korea, College of Medicine, Suwon, Korea
| | - Ho Jin Lee
- Department of Neurosurgery, St. Vincent Hospital, The Catholic University of Korea, College of Medicine, Suwon, Korea.
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Saffarini S, Kamil S, Suradi Y. Superior Sagittal Sinus Thrombosis in a Patient With Iatrogenic Intracranial Hypotension: A Case Report. Cureus 2023; 15:e42787. [PMID: 37664397 PMCID: PMC10469742 DOI: 10.7759/cureus.42787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2023] [Indexed: 09/05/2023] Open
Abstract
Cerebral venous thrombosis is a rarely reported complication of iatrogenic intracranial hypotension. We discuss a rare case of a 46-year-old woman presenting with a week-long history of severe orthostatic headaches two weeks following L4-L5 microscopic discectomy for symptomatic lumbar disc herniation. Computed tomography venography of the head revealed evidence of superior sagittal sinus thrombosis while contrast-enhanced magnetic resonance imaging of the brain revealed signs of intracranial hypotension consisting of pachymeningeal enhancement, bilateral subdural hygromas, enlarged pituitary gland, effacement of the basal ambient cisterns, and low-lying cerebellar tonsils. Additional lumbar spine imaging revealed the culprit to be a large epidural fluid collection extending from the epidural space to the superficial subcutaneous fat, suggestive of a cerebrospinal fluid leak. The patient was managed with admission, bed rest, isotonic intravenous fluids, caffeine, and therapeutic dosing of low molecular weight heparin. In such cases, clinical suspicion and early recognition and management are of paramount importance to prevent devastating consequences. Management, whether conservatively or with surgical intervention, should be made on a case-by-case basis.
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Affiliation(s)
- Sulafa Saffarini
- Neurology, Wayne State University Detroit Medical Center, Detroit, USA
| | - Sally Kamil
- Care of the Elderly, Glan Clwyd Hospital, Rhyl, GBR
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Hara T, Akutsu H, Tanaka S, Kino H, Miyamoto H, Ii R, Takano S, Ishikawa E. Risk Factors for Postoperative Cerebrospinal Fluid Leak after Graded Multilayer Cranial Base Repair with Suturing via the Endoscopic Endonasal Approach. Neurol Med Chir (Tokyo) 2023; 63:48-57. [PMID: 36436977 PMCID: PMC9995146 DOI: 10.2176/jns-nmc.2022-0132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This study analyzed risk factors for postoperative cerebrospinal fluid (CSF) leak after graded multilayer cranial base repair method with dural suturing. We performed surgery via the endoscopic endonasal approach (EEA) from 2012.6 to 2018.4, and those consecutive clinical data were prospectively accumulated and retrospectively analyzed. We tailored the repair method according to the intraoperative CSF leak grade. Among 388 surgeries via the EEA, there were 10 (2.6%) cases of postoperative CSF leak after graded repair with suturing. Postoperative CSF leak occurred in two of the 150 cases without intraoperative CSF leak (grade 0), one of the 104 cases with small (grade 1) intraoperative CSF leak, two of the 60 cases with moderate (grade 2) leak, and five of the 74 cases with large (grade 3) leak. Univariate analysis indicated that chordoma (P = 0.023), estimated tumor volume ≥ 7400 mm3 (P = 0.003), and maximum tumor diameter ≥ 32.5 mm (P = 0.001) were significant risk factors for postoperative CSF leak. Additionally, among cases with intraoperative grade 3 CSF leak, chordoma (P = 0.021), estimated tumor volume ≥ 23000 mm3 (P = 0.003), and maximum tumor diameter ≥ 45.5 mm (P = 0.001) were significant risk factors for postoperative CSF leak. Maximum tumor diameter, estimated tumor volume, and chordoma tumor pathology are related to a higher risk of postoperative CSF leak.
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Affiliation(s)
- Takuma Hara
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba.,Department of Neurosurgery, Tsukuba Medical Center Hospital
| | - Hiroyoshi Akutsu
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba.,Department of Neurosurgery, Dokkyo Medical University
| | - Shuho Tanaka
- Department of Otolaryngology, Faculty of Medicine, University of Tsukuba
| | - Hiroyoshi Kino
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba
| | - Hidetaka Miyamoto
- Department of Otolaryngology, Faculty of Medicine, University of Tsukuba
| | - Rieko Ii
- Department of Otolaryngology, Faculty of Medicine, University of Tsukuba
| | - Shingo Takano
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba
| | - Eiichi Ishikawa
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba
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Zhao J, Jiang H, Jiang H, Meng Y, Gao R, Ma J, Wang C, Zhou X. Analysis of Risk Factors Related to Acute Subarachnoid Hemorrhage After Spinal Surgery. World Neurosurg 2021; 160:e111-e117. [PMID: 34973438 DOI: 10.1016/j.wneu.2021.12.098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 12/23/2021] [Accepted: 12/24/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Subarachnoid hemorrhage (SAH) is a rare complication secondary to cerebrospinal fluid (CSF) leakage during spinal surgery, but the specific cause of bleeding is still unclear. In this retrospective single-center study, we studied cases of acute SAH after spinal surgery to identify the related risk factors for bleeding. METHODS A total of 441 patients with CSF leakage who underwent spinal surgery from 2011 to 2020 were retrospectively analyzed. According to whether postoperative SAH occurred, the patients were divided into the SAH group and the control group. By comparing the demographic data, past history, imaging data, intraoperative findings, perioperative complications, and treatment conditions in the 2 groups to identify the risk factors for SAH, we aimed to provide guidance for the prevention of SAH after spinal surgery. RESULTS In our study, the incidence of CSF during spinal surgery is 3.04%, and the rate for SAH associated with spine operation is 0.16%. In the SAH group, 17 patients (73.9%) had preoperative hypertension, and 3 patients (13.0%) had diabetes. The intraoperative CSF leakage was approximately 118.4 ± 56.9 mL. The mean postoperative drainage was 15.4 ± 5.8 mL/hour. Compared with the SAH group, the control group had 123 patients (29.4%) with hypertension before the operation and 40 patients (9.6%) with diabetes. The intraoperative CSF leakage was approximately 76.3 ± 23.0 mL, and the mean postoperative continuous drainage was 9.7 ± 2.1 mL/hour. Binary logistic regression analysis showed that hypertension, intraoperative CSF leakage, and postoperative CSF continuous drainage speed were related to SAH. CONCLUSIONS The rapid leakage of CSF caused by rupture of the dural sac during surgery and the rapid drainage of CSF after surgery were closely related to the occurrence of SAH. In addition, hypertension was a factor related to SAH during spinal surgery.
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Affiliation(s)
- Jianquan Zhao
- Department of Orthopedic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, People's Republic of China
| | - Heng Jiang
- Department of Orthopedic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, People's Republic of China
| | - Huan Jiang
- Department of General Practice, Rui'an People's Hospital, Wenzhou Medical University, Rui'an 325299, People'
| | - Yicheng Meng
- Department of Orthopedic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, People's Republic of China
| | - Rui Gao
- Department of Orthopedic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, People's Republic of China
| | - Jun Ma
- Department of Orthopedic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, People's Republic of China
| | - Ce Wang
- Department of Orthopedic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, People's Republic of China
| | - Xuhui Zhou
- Department of Orthopedic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, People's Republic of China.
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Tan J, Song R, Huan R, Huang N, Chen J. Intraoperative lumbar drainage can prevent cerebrospinal fluid leakage during transsphenoidal surgery for pituitary adenomas: a systematic review and meta-analysis. BMC Neurol 2020; 20:303. [PMID: 32799821 PMCID: PMC7429471 DOI: 10.1186/s12883-020-01877-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 08/04/2020] [Indexed: 12/11/2022] Open
Abstract
Background Perioperative cerebrospinal fluid (CSF) leakage is a major complication of pituitary adenomas transsphenoidal surgery. Lumbar drainage (LD) is a common method of treating CSF leakage. But whether intraoperative LD can prevent CSF leakage during the perioperative period of pituitary adenomas transsphenoidal surgery remains controversial. Clarity on the appropriate use of LD is needed. Methods A systematic literature review was conducted in the PubMed, EMBASE, and Web of science databases. Articles were included when they compared intraoperative LD with intraoperative no-LD CSF leakage rates during pituitary adenomas transsphenoidal surgery. Results Overall, 5 studies containing 678 cases met the inclusion criteria. When data were provided on intraoperative CSF leakage rates, the meta-analysis showed a significant difference in favor of intraoperative LD. When data were provided on postoperative CSF leakage rates, the meta-analysis also demonstrated a significant difference in favor of intraoperative LD. Conclusions Although the results of this meta-analysis suggest intraoperative LD can reduce the risk of CSF leakage during the perioperative period of pituitary adenomas transsphenoidal surgery, the available evidence is indefinite. To some extent the results suggest intraoperative LD’s potential positive role. Further studies that include well-designed prospective, randomized controlled clinical trials are necessary for further verification.
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Affiliation(s)
- Jiahe Tan
- Department of Neurosurgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China
| | - Rui Song
- Department of Gastroenterology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China
| | - Renzheng Huan
- Department of Neurosurgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China
| | - Ning Huang
- Department of Neurosurgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China
| | - Jin Chen
- Department of Neurosurgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China.
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Mascitti H, Calin R, Dinh A, Makhloufi S, Davido B. Testicular pain associated with clear fluid meningitis: How many cases of Toscana virus are we missing? Int J Infect Dis 2020; 93:198-200. [PMID: 32062059 DOI: 10.1016/j.ijid.2020.02.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 02/07/2020] [Accepted: 02/08/2020] [Indexed: 11/18/2022] Open
Abstract
Toscana virus (TOSV) is a common cause of meningitis in Mediterranean area. However, rare publications reported extra-meningeal signs. We report the third case of testicular pain associated with TOSV meningitis despite the fact that there is no evidence of semen involvement in other well-known arboviruses, except in Zika virus.
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Affiliation(s)
- Hélène Mascitti
- Maladies Infectieuses, Hôpitaux Universitaires Paris-Île-de-France Ouest, AP-HP, Garches, F92380, France
| | - Ruxandra Calin
- Maladies Infectieuses, Hôpitaux Universitaires Paris-Île-de-France Ouest, AP-HP, Garches, F92380, France
| | - Aurélien Dinh
- Maladies Infectieuses, Hôpitaux Universitaires Paris-Île-de-France Ouest, AP-HP, Garches, F92380, France
| | - Sabrina Makhloufi
- Maladies Infectieuses, Hôpitaux Universitaires Paris-Île-de-France Ouest, AP-HP, Garches, F92380, France
| | - Benjamin Davido
- Maladies Infectieuses, Hôpitaux Universitaires Paris-Île-de-France Ouest, AP-HP, Garches, F92380, France.
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Zwagerman NT, Wang EW, Shin SS, Chang YF, Fernandez-Miranda JC, Snyderman CH, Gardner PA. Does lumbar drainage reduce postoperative cerebrospinal fluid leak after endoscopic endonasal skull base surgery? A prospective, randomized controlled trial. J Neurosurg 2019; 131:1172-1178. [PMID: 30485224 DOI: 10.3171/2018.4.jns172447] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 04/17/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Based on a null hypothesis that the use of short-term lumbar drainage (LD) after endoscopic endonasal surgery (EES) for intradural pathology does not prevent postoperative CSF leaks, a trial was conducted to assess the effect of postoperative LD on postoperative CSF leak following standard reconstruction. METHODS A prospective, randomized controlled trial of lumbar drain placement after endoscopic endonasal skull base surgery was performed from February 2011 to March 2015. All patients had 3-month follow-up data. Surgeons were blinded to which patients would or would not receive the drain until after closure was completed. An a priori power analysis calculation assuming 80% of power, 5% postoperative CSF leak rate in the no-LD group, and 16% in the LD group determined a planned sample size of 186 patients. A routine data and safety check was performed with every 50 patients being recruited to ensure the efficacy of randomization and safety. These interim tests were run by a statistician who was not blinded to the arms they were evaluating. This study accrued 230 consecutive adult patients with skull base pathology who were eligible for endoscopic endonasal resection. Inclusion criteria (high-flow leak) were dural defect greater than 1 cm2 (mandatory), extensive arachnoid dissection, and/or dissection into a ventricle or cistern. Sixty patients were excluded because they did not meet the inclusion criteria. One hundred seventy patients were randomized to either receive or not receive a lumbar drain. RESULTS One hundred seventy patients were randomized, with a mean age of 51.6 years (range 19-86 years) and 38% were male. The mean BMI for the entire cohort was 28.1 kg/m2. The experimental cohort with postoperative LD had an 8.2% rate of CSF leak compared to a 21.2% rate in the control group (odds ratio 3.0, 95% confidence interval 1.2-7.6, p = 0.017). In 106 patients in whom defect size was measured intraoperatively, a larger defect was associated with postoperative CSF leak (6.2 vs 2.9 cm2, p = 0.03). No significant difference was identified in BMI between those with (mean 28.4 ± 4.3 kg/m2) and without (mean 28.1 ± 5.6 kg/m2) postoperative CSF leak (p = 0.79). Furthermore, when patients were grouped based on BMI < 25, 25-29.9, and > 30 kg/m2, no difference was noted in the rates of CSF fistula (p = 0.97). CONCLUSIONS Among patients undergoing intradural EES judged to be at high risk for CSF leak as defined by the study's inclusion criteria, perioperative LD used in the context of vascularized nasoseptal flap closure significantly reduced the rate of postoperative CSF leaks.Clinical trial registration no.: NCT03163134 (clinicaltrials.gov).
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Affiliation(s)
| | - Eric W Wang
- 2Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | | | | | | | - Carl H Snyderman
- 2Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Abstract
INTRODUCTION Hyperpyrexia is a severely elevated core body temperature secondary to an elevated hypothalamic set thermo-regulatory threshold. Hyperthermia is an elevated core body temperature beyond the normal hypothalamic set thermo-regulatory threshold. Intracranial hypotension can present with a wide variety of symptoms ranging from orthostatic headache up to coma. We report a rare case of hyperpyrexia associated with intracranial hypotension. METHODS A case report of a 55-year-old female patient with a history of angiogram-negative subarachnoid hemorrhage status post-ventriculoperitoneal (VP) shunt placement six years prior to admission who suddenly developed encephalopathy and high fever. Conventional management of the fever was unsuccessful. RESULTS AND MANAGEMENT Brain magnetic resonance imaging revealed signs of significant intracranial hypotension. When the VP shunt was tapped, no cerebrospinal fluid (CSF) could be obtained. Once the VP shunt settings were adjusted, the patient's encephalopathy and hyperpyrexia resolved. CONCLUSION Hyperpyrexia might be a presenting symptom of intracranial hypotension, likely, secondary to hypothalamic dysfunction and compression. In our case, hyperpyrexia was reversible as the intracranial hypotension was emergently treated. Spontaneous intracranial hypotension might be difficult to diagnose, especially if it presented with non-classical symptoms like fever; thus, physicians should be aware of such association.
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Affiliation(s)
- Omar Hussein
- Cerebrovascular and Neurocritical Care Division, Department of Neurology, Ohio State University Wexner Medical Center, 395 W. 12th Avenue, 7th Floor, Columbus, OH, 43210, USA.
| | - Michel Torbey
- Cerebrovascular and Neurocritical Care Division, Department of Neurology, Ohio State University Wexner Medical Center, 395 W. 12th Avenue, 7th Floor, Columbus, OH, 43210, USA
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Sawarkar D, Satyarthee GD, Singh P, Gurjar H, Singh MM, Sharma BS. Developing Cerebral Venous infarct presenting with seizure occurring after lumbar drain placement following Trans-sphenoidal Surgery of Cushing's disease: Review of literature. J Neurosci Rural Pract 2019; 8:148-150. [PMID: 28149109 PMCID: PMC5225708 DOI: 10.4103/0976-3147.193567] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Dattaraj Sawarkar
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Guru Dutta Satyarthee
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Pankaj Singh
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Hitesh Gurjar
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - M M Singh
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - B S Sharma
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
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Berry B, Ghannam M, Bell C, Ghazaleh S, Boss S, Streib C, Ezzeddine M. Basal ganglia hemorrhage in a case report following spinal surgery. BMC Neurol 2018; 18:204. [PMID: 30547770 PMCID: PMC6293582 DOI: 10.1186/s12883-018-1218-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 12/05/2018] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Intracranial hemorrhage is a rare but potentially severe complication of spinal surgery. Most reported post-operative ICH cases consist of cerebellar hemorrhage. There are fewer reported cases of supratentorial ICH following spinal surgery. CASE PRESENTATION A 56-year-old woman underwent spinal surgery complicated by bilateral supratentorial intraparenchymal basal ganglia hemorrhage with both intraventricular extension and subarachnoid hemorrhage in both cerebral hemispheres. CONCLUSION The occurrence of neurological deterioration post-operatively following spinal surgery should alert physicians to the possibility of intracranial hemorrhage in order to facilitate rapid and optimal management. To our knowledge, this is the first case reporting basal ganglia hemorrhage following spinal surgery. Moreover, consideration should be given to the possibility of this complication prior to recommendation of elective spinal surgery.
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Affiliation(s)
- Brent Berry
- Neurology Department, University of Minnesota, Minneapolis, MN USA
| | - Malik Ghannam
- Neurology Department, University of Minnesota, Minneapolis, MN USA
| | | | - Sami Ghazaleh
- Internal Medicine Department, University of Toledo, Toledo, OH USA
| | - Sherief Boss
- Neurology Department, University of Minnesota, Minneapolis, MN USA
| | | | - Mustapha Ezzeddine
- Neurosurgery and Radiology, Neurology Department, University of Minnesota, Minneapolis, MN USA
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Idiopathic Intracranial Hypertension Progressing to Venous Sinus Thrombosis, Subarachnoid Hemorrhage, and Stroke. J Neuroophthalmol 2017; 38:60-64. [PMID: 28742639 DOI: 10.1097/wno.0000000000000540] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Idiopathic intracranial hypertension (IIH) is a syndrome characterized by increased intracranial pressure (ICP), the absence of structural lesions on neuroimaging, and normal cerebrospinal fluid composition. Cerebral venous sinus thrombosis (CVST) is a common cause of increased ICP and can be differentiated from IIH with magnetic resonance venography. We describe a young woman with typical IIH who underwent lumbar puncture and was treated with a short course of high-dose corticosteroids followed by acetazolamide. She subsequently developed CVST, subarachnoid hemorrhage, and stroke. Risk factors that may have resulted in CVST are discussed.
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12
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Subarachnoid Hemorrhage and Spinal Subdural Hematoma Due to Acute CSF Hypotension. Neurocrit Care 2016; 26:109-114. [DOI: 10.1007/s12028-016-0327-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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13
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Guryildirim M, Jhaveri MD. Isolated intraventricular hemorrhage after spinal surgery. Clin Imaging 2016; 40:889-91. [DOI: 10.1016/j.clinimag.2016.04.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 03/30/2016] [Accepted: 04/22/2016] [Indexed: 10/21/2022]
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The role of ICP monitoring in patients with persistent cerebrospinal fluid leak following spinal surgery: a case series. Acta Neurochir (Wien) 2016; 158:1813-9. [PMID: 27393191 DOI: 10.1007/s00701-016-2882-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 06/15/2016] [Indexed: 01/30/2023]
Abstract
BACKGROUND Cerebrospinal fluid (CSF) leak following spinal surgery is a relatively common surgical complication. A disturbance in the underlying CSF dynamics could be the causative factor in a small group of patients with refractory CSF leaks that require multiple surgical repairs and prolonged hospital admission. METHODS A retrospective case series of patients with persistent post spinal surgery CSF leak referred to the hydrocephalus service for continuous intracranial pressure (ICP) monitoring. Patients' notes were reviewed for medical history, ICP data, radiological data, and subsequent management and outcome. RESULTS Five patients (two males/three females, mean age, 35.4 years) were referred for ICP monitoring over a 12-month period. These patients had prolonged CSF leak despite multiple repair attempts 252 ± 454 days (mean ± SD). On ICP monitoring, all five patients had abnormal results, with the mean ICP 8.95 ± 4.41 mmHg. Four had abnormal pulse amplitudes, mean 6.15 mmHg ± 1.22 mmHg. All five patients underwent an intervention. Three patients underwent insertion of ventriculoperitoneal (VP) shunts. One patient had venous sinus stent insertion and one patient underwent medical management with acetazolamide. All five of the patients' CSF leak resolved post intervention. The mean time to resolution of CSF leak post intervention was 10.8 ± 12.9 days. CONCLUSIONS Abnormal cerebrospinal fluid dynamics could be the underlying factor in patients with a persistent and treatment-refractory CSF leak post spinal surgery. Treatments aimed at lowering ICP may be beneficial in this group of patients. Whether abnormal pressure and dynamics represent a pre-existing abnormality or is induced by spinal surgery should be a subject of further study.
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15
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Tanweer O, Kalhorn SP, Snell JT, Wilson TA, Lieber BA, Agarwal N, Huang PP, Sutin KM. Epidural Blood Patch Performed for Severe Intracranial Hypotension Following Lumbar Cerebrospinal Fluid Drainage for Intracranial Aneurysm Surgery. Retrospective Series and Literature Review. J Cerebrovasc Endovasc Neurosurg 2015; 17:318-23. [PMID: 27065093 PMCID: PMC4823429 DOI: 10.7461/jcen.2015.17.4.318] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2014] [Revised: 09/21/2014] [Accepted: 08/10/2015] [Indexed: 01/29/2023] Open
Abstract
Intracranial hypotension (IH) can occur following lumbar drainage for clipping of an intracranial aneurysm. We observed 3 cases of IH, which were all successfully treated by epidural blood patch (EBP). Herein, the authors report our cases.
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Affiliation(s)
- Omar Tanweer
- Department of Neurosurgery, New York University School of Medicine, New York, NY, USA
| | - Stephen P Kalhorn
- Department of Neurosurgery, Medical University of South Carolina, SC, USA
| | - Jamaal T Snell
- Department of Anesthesiology, New York University School of Medicine, New York, NY, USA
| | - Taylor A Wilson
- Department of Neurosurgery, New York University School of Medicine, New York, NY, USA
| | - Bryan A Lieber
- Department of Neurosurgery, New York University School of Medicine, New York, NY, USA
| | - Nitin Agarwal
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Paul P Huang
- Department of Neurosurgery, New York University School of Medicine, New York, NY, USA
| | - Kenneth M Sutin
- Department of Anesthesiology, New York University School of Medicine, New York, NY, USA
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Yılmaz B, Ekşi MŞ, Akakın A, Toktaş ZO, Demir MK, Konya D. Cerebral venous thrombosis following spinal surgery in a patient with Factor V Leiden mutation. Br J Neurosurg 2015; 30:456-8. [PMID: 26414646 DOI: 10.3109/02688697.2015.1091915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Cerebral venous thrombosis is a devastating event leading to high mortality and morbidity rates. We present a case of cerebral venous thrombosis that occurred following spinal surgery in a patient with Factor V Leiden mutation and G1691A heterozygosity. Possible prevention and treatment strategies have been discussed.
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Affiliation(s)
- Baran Yılmaz
- a Bahçeşehir University Medical Faculty , Department of Neurosurgery , Istanbul , Turkey
| | - Murat Şakir Ekşi
- b University of California at San Francisco , Department of Orthopedic Surgery-Spine Center , California , USA
| | - Akın Akakın
- a Bahçeşehir University Medical Faculty , Department of Neurosurgery , Istanbul , Turkey
| | - Zafer Orkun Toktaş
- a Bahçeşehir University Medical Faculty , Department of Neurosurgery , Istanbul , Turkey
| | - Mustafa Kemal Demir
- c Bahçeşehir University Medical Faculty , Department of Radiology , Istanbul , Turkey
| | - Deniz Konya
- a Bahçeşehir University Medical Faculty , Department of Neurosurgery , Istanbul , Turkey
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Sillero Sánchez M, Rodriguez Fernandez N, Sánchez Vera L, Gómez González B, Asencio Marchante J. Cerebral venous thrombosis after lumbar puncture and treatment with high-dose corticosteroids. NEUROLOGÍA (ENGLISH EDITION) 2014. [DOI: 10.1016/j.nrleng.2012.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Kate MP, Thomas B, Sylaja PN. Cerebral venous thrombosis in post-lumbar puncture intracranial hypotension: case report and review of literature. F1000Res 2014; 3:41. [PMID: 24627803 PMCID: PMC3945949 DOI: 10.12688/f1000research.3-41.v1] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/03/2014] [Indexed: 11/20/2022] Open
Abstract
The spectrum of presentation of intracranial hypotension is clinically perplexing. We report a case of 31-year-old post-partum woman who underwent an uneventful caesarean section under spinal anesthesia. From the second day of surgery she developed postural headache, the headache lost its postural character after few days. She then developed seizures and ataxic hemiparesis. Magnetic resonance imaging showed features of severe intracranial hypotension in the brain and the spinal cord, and magnetic resonance venography showed cortical vein and partial superior sagittal sinus thrombosis. Prothrombotic (etiological) work-up showed Protein C and S deficiency. She responded to anticoagulation therapy and recovered completely. On review of literature two distinct groups could be identified obstetric and non-obstetric. The non-obstetric group included patients who underwent diagnostic lumbar puncture, intrathecal injection of medications and epidural anesthesia for non-obstetric surgeries. Poor outcome and mortality was noted in non-obstetric group, while obstetric group had an excellent recovery.
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Affiliation(s)
- Mahesh P Kate
- Department of Medicine, University of Alberta, Edmonton, T6G0T1, Canada
| | - Bejoy Thomas
- Department of Imaging Sciences & Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Medical College Campus, Medical College, Thiruvananthapuram, Kerala, 695011, India
| | - P N Sylaja
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Medical College Campus, Medical College, Thiruvananthapuram, Kerala, 695011, India
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MATSUBARA T, AYUZAWA S, AOKI T, IKEDA G, SHIIGAI M, MATSUMURA A. Cerebral Venous Thrombosis after Ventriculoperitoneal Shunting: A Case Report. Neurol Med Chir (Tokyo) 2014; 54:554-7. [DOI: 10.2176/nmc.cr2012-0312] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Teppei MATSUBARA
- Department of Neurosurgery, Graduate School of Comprehensive Human Sciences, University of Tsukuba
| | - Satoshi AYUZAWA
- Department of Neurosurgery, Graduate School of Comprehensive Human Sciences, University of Tsukuba
| | - Tsukasa AOKI
- Department of Neurosurgery, Ryugasaki Saiseikai Hospital
| | - Go IKEDA
- Department of Neurosurgery, Graduate School of Comprehensive Human Sciences, University of Tsukuba
| | - Masanari SHIIGAI
- Department of Radiology, Graduate School of Comprehensive Human Sciences, University of Tsukuba
| | - Akira MATSUMURA
- Department of Neurosurgery, Graduate School of Comprehensive Human Sciences, University of Tsukuba
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Cerebral venous thrombosis: an unexpected complication from spinal surgery. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2013; 23 Suppl 2:253-6. [DOI: 10.1007/s00586-013-3147-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Revised: 12/15/2013] [Accepted: 12/19/2013] [Indexed: 10/25/2022]
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Cohen JE, Duck M, Gomori JM, Itshayek E, Leker RR. Isolated cortical vein thrombosis: a rare cause of venous stroke with good prognosis after timely diagnosis and treatment. Neurol Res 2013; 35:127-30. [PMID: 23452574 DOI: 10.1179/1743132812y.0000000148] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND Isolated cortical vein thrombosis (ICoVT) is a rare condition representing approximately 6% of cerebral vein thromboses (CVT). In all its forms, CVT is more prevalent in women. ICoVT shares the same group of predisposing conditions typical of other CVT. It may thus be easily missed due to its non-specific clinical presentation and confounding radiological findings, which may lead to a delay in appropriate diagnosis and treatment. METHODS A comprehensive literature search was conducted to identify manuscripts discussing epidemiology, risk factors, clinical presentation, radiological techniques and presentation, management, and outcome in patients with ICoVT. RESULTS We identified 40 papers published between 1991 and 2012 that met our criteria for review. DISCUSSION MR techniques are essential in the diagnosis of this entity. Without appropriate therapy, these thromboses may extend bidirectionally and even compromise the dural sinuses. Correction of predisposing factors for venous thrombosis and anticoagulation is the therapy of choice for most patients. The overall prognosis with adequate and timely therapy is very good.
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Affiliation(s)
- José E Cohen
- Department of Neurosurgery, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Israel.
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Kaloostian PE, Kim JE, Bydon A, Sciubba DM, Wolinsky JP, Gokaslan ZL, Witham TF. Intracranial hemorrhage after spine surgery. J Neurosurg Spine 2013; 19:370-80. [PMID: 23848351 DOI: 10.3171/2013.6.spine12863] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECT The authors describe the largest case series of 8 patients with intracranial hemorrhage (ICH) after spinal surgery and identify associated pre-, intra-, and postoperative risk factors in relation to outcome. METHODS The authors retrospectively reviewed the cases of 8 patients treated over 16 years at a single institution and also reviewed the existing literature and collected demographic, treatment, and outcome information from 33 unique cases of remote ICH after spinal surgery. RESULTS The risk factors most correlated with ICH postoperatively were the presence of a CSF leak intraoperatively and the use of drains postoperatively with moderate hourly serosanguineous output in the early postoperative period. CONCLUSIONS Intracranial hemorrhage is a rare complication of spinal surgery that is associated with CSF leakage and use of drains postoperatively, with moderate serosanguinous output. These associations do not justify a complete avoidance of drains in patients with CSF leakage but may guide the treating physician to keep in mind drain output and timing of drain removal, while noting any changes in neurological examination status in the meantime. Additionally, continued and worsening neurological symptoms after spinal surgery may warrant cranial imaging to rule out intracranial hemorrhage, usually within the first 24 hours after surgery. The presence of cerebellar hemorrhage and hydrocephalus indicated a trend toward worse outcome.
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Affiliation(s)
- Paul E Kaloostian
- Department of Neurological Surgery, The Johns Hopkins Hospital, Baltimore, Maryland, USA.
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Cerebral venous thrombosis after lumbar puncture and treatment with high-dose corticosteroids. Neurologia 2013; 29:315-6. [PMID: 23318159 DOI: 10.1016/j.nrl.2012.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2012] [Revised: 10/22/2012] [Accepted: 11/02/2012] [Indexed: 11/23/2022] Open
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Number reading in pure alexia--a review. Neuropsychologia 2011; 49:2283-98. [PMID: 21554892 DOI: 10.1016/j.neuropsychologia.2011.04.028] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2010] [Revised: 03/31/2011] [Accepted: 04/22/2011] [Indexed: 11/23/2022]
Abstract
It is commonly assumed that number reading can be intact in patients with pure alexia, and that this dissociation between letter/word recognition and number reading strongly constrains theories of visual word processing. A truly selective deficit in letter/word processing would strongly support the hypothesis that there is a specialized system or area dedicated to the processing of written words. To date, however, there has not been a systematic review of studies investigating number reading in pure alexia and so the status of this assumed dissociation is unclear. We review the literature on pure alexia from 1892 to 2010, and find no well-documented classical dissociation between intact number reading and impaired letter identification in a patient with pure alexia. A few studies report strong dissociations, with number reading less impaired than letter reading, but when we apply rigorous statistical criteria to evaluate these dissociations, the difference in performance across domains is not statistically significant. There is a trend in many cases of pure alexia, however, for number reading to be less affected than letter identification and word reading. We shed new light on this asymmetry by showing that, under conditions of brief exposure, normal participants are also better at identifying digits than letters. We suggest that the difference observed in some pure alexic patients may possibly reflect an amplification of this normal difference in the processing of letters and digits, and we relate this asymmetry to intrinsic differences between the two types of symbols.
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