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European Spine Journal

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01-05-2016 | Case Report

Communicating hydrocephalus, a long-term complication of dural tear during lumbar spine surgery

Authors: David T. Endriga, John R. Dimar II, Leah Y. Carreon

Published in: European Spine Journal | Special Issue 1/2016

Abstract

Purpose

Iatrogenic dural tears during lumbar spine surgery are not uncommon and may have multiple long-term sequelae if not managed promptly and definitively. Sequelae include pseudomeningocoeles due to a persistent cerebrospinal fluid leak, which may result in a subarachnoid hemorrhage or subdural hematoma. These, in turn, can lead to adult communicating hydrocephalus. The purpose of this study is to describe a case of an intraoperative iatrogenic dural tear leading to the formation of a pseudomeningocoele and progressing to hydrocephalus.

Methods

We present a case of a 62-year-old female who had an iatrogenic dural tear during a lumbar decompression and instrumented fusion. Attempts at closure were unsuccessful, which led to the formation of a pseudomeningocoele and an ascending subdural hygroma, progressing into a communicating hydrocephalus which was treated with a ventriculoperitoneal shunt.

Results

Imaging studies and clinical follow up after the incidental durotomy demonstrate complications arising from the persistent cerebrospinal fluid leak, beginning with the formation of the pseudomeningocoele and progression to hydrocephalus. Based on these imaging studies, it was possible to illustrate the development of each of the complications.

Conclusion

The need for prompt recognition and proper management of iatrogenic dural tears are emphasized in order to avoid future complications that may arise from inadequate or proper treatment.

Al Maach N, Vogels OJ, Bollen TL, Wessels PH (2010) Arachnoiditis and communicating hydrocephalus as a complication of epidural blood patch. J Neurol 257(4):672–673CrossRefPubMed

Aldrete JA, Ghaly R (1995) Postlaminectomy pseudomeningocele. An unsuspected cause of low back pain. Reg Anesth 20(1):75–79PubMed

Baker GA, Cizik AM, Bransford RJ, Bellabarba C, Konodi MA, Chapman JR, Lee MJ (2012) Risk factors for unintended durotomy during spine surgery: a multivariate analysis. Spine 12(2):121–126CrossRef

Beier AD, Soo TM, Claybrooks R (2009) Subdural hematoma after microdiscectomy: a case report and review of the literature. Spine J 9(10):e9–e12CrossRefPubMed

Bosacco SJ, Gardner MJ, Guille JT (2001) Evaluation and treatment of dural tears in lumbar spine surgery: a review. Clin Orthop Relat Res 389:238–247CrossRefPubMed

Cavanilles-Walker JM, Tomasi SO, Sgier F, Kröber M (2013) Remote cerebellar haemorrhage after lumbar spine surgery: case report. Arch Orthop Trauma Surg 133(12):1645–1648

Cohodarevic T, Mailia A, Mantanera W (2000) Syringomyelia: pain, sensory abnormalities, and neuroimaging. J Pain 1(1):54–66CrossRef

Guerin P, El Fegoun AB, Obeid I, Gille O, Lelong L, Luc S, Bourghli A, Cursolle JC, Pointillart V, Vital JM (2012) Incidental durotomy during spine surgery: incidence, management and complications. A retrospective review. Injury 43(4):397–401CrossRefPubMed

Hawk MW, Kim KD (2000) Review of spinal pseudomeningoceles and cerebrospinal fluid fistulas. Neurosurg Focus 9(1):e5CrossRefPubMed

10.

Jones AA, Stambough JL, Balderston RA, Rothman RH, Booth RE Jr (1989) Long-term results of lumbar spine surgery complicated by unintended incidental durotomy. Spine (Phila Pa 1976) 14(4):443–446

11.

Kato N, Tanaka T, Nagashima H, Arai T, Hasegawa Y, Tani S, Abe T (2010) Syrinx disappearance following laminoplasty in cervical canal stenosis associated with chiari malformation. Neurol Med Chir (Tokyo) 50:172–174CrossRef

12.

Khan MH, Rihn J, Steele G, Davis R, Donaldson WF 3rd, Kang JD, Lee JY (2006) Postoperative management protocol for incidental dural tears during degenerative lumbar spine surgery: a review of 3,183 consecutive degenerative lumbar cases. Spine (Phila Pa 1976) 31(22):2609–2613

13.

Koerts G, Rooijakkers H, Abu-Serieh B, Cosnard G, Raftopoulos C (2008) Postoperative spinal adhesive arachnoiditis presenting with hydrocephalus and cauda equine syndrome. Clin Neurol Neurosurg 110(2):171–175CrossRefPubMed

14.

Koyanago I, Iwasaki Y, Hida K, Houkin K (2005) Clinical features and pathomechanisms of syringomyelia associated with spinal arachnoiditis. Surg Neurol 63(4):350–356

15.

Massicotte EM, Del Bigio MR (1999) Human arachnoid villi response to subarachnoid hemorrhage: possible relationship to chronic hydrocephalus. J Neurosurg 91(1):80–84CrossRefPubMed

16.

Morofuji Y, Tsunoda K, Takeshita T, Hayashi K, Kitagawa N, Suyama K, Nagata I (2009) Remote cerebellar hemorrhage following thoracic spinal surgery. Neurol Med Chir (Tokyo) 49(3):117–119CrossRef

17.

Saliou G, Paradot G, Gondry C, Bouzerar R, Lehmann P, Meyers ME, Gars DL, Deramond H, Balédent O (2012) A phase-contrast MRI study of acute and chronic hydrodynamic alterations after hydrocephalus induced by subarachnoid hemorrhage. J Neuroimaging 22(4):343–350CrossRefPubMed

18.

Sin AH, Caldito G, Smith D, Rashidi M, Willis B, Nanda A (2006) Predictive factors for dural tear and cerebrospinal fluid leakage in patients undergoing lumbar surgery. J Neurosurg Spine 5(3):224–227CrossRefPubMed

19.

Tafazal SI, Sell PJ (2005) Incidental durotomy in lumbar spine surgery: incidence and management. Eur Spine J 14(3):287–290CrossRefPubMedPubMedCentral

20.

Wolff S, Kheirredine W, Riouallon G (2012) Surgical dural tears: prevalence and updated management protocol based on 1359 lumbar vertebra interventions. Orthop Traumatol Surg Res. 98(8):879–886CrossRefPubMed

Title: Communicating hydrocephalus, a long-term complication of dural tear during lumbar spine surgery
Authors: David T. Endriga
John R. Dimar II
Leah Y. Carreon
Publication date: 01-05-2016
Publisher: Springer Berlin Heidelberg
Published in: European Spine Journal / Issue Special Issue 1/2016
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-015-4308-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Communicating hydrocephalus, a long-term complication of dural tear during lumbar spine surgery

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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