• Journal of Korean Neurosurgical Society
• /
• 제53권1호
• /
• pp.59-61
• /
• 2013

Authors report a rare case of acute intracranial subdural and intraventricular hemorrhage that were caused by intracranial hypotension resulted from cerebrospinal fluid leakage through an unidentified dural tear site during spinal surgery. The initial brain computed tomography image showed acute hemorrhages combined with preexisting asymptomatic chronic subdural hemorrhage. One burr hole was made over the right parietal skull to drain intracranial hemorrhages and subsequent drainage of cerebrospinal fluid induced by closure of the durotomy site. Among various methods to treat cerebrospinal fluid leakage through unidentified dural injury site, primary repair and spinal subarachnoid drainage are well known treatment options. The brain imaging study to diagnose intracranial hemorrhage should be taken before selecting the treatment method, especially for spinal subarachnoid drainage. Similar mechanism to its spinal counterpart, cranial cerebrospinal fluid drainage has not been mentioned in previous article and could be another treatment option to seal off an unidentified dural tear in particular case of drainage of intracranial hemorrhage is needed.

• Journal of Korean Neurosurgical Society
• /
• 제59권1호
• /
• pp.62-64
• /
• 2016

Cerebrospinal fluid leakage may commonly occur during spinal surgeries and it may cause dural tears. These tears may result in hemorrhage in the entire compartments of the brain. Most common site of such hemorrhages are the veins in the cerebellar region. We report a case of hemorrhage, mimicking aneurysmal subarachnoid hemorrhage due to a cerebrospinal fluid leakage following lumbar spinal surgery and discuss the possible mechanisms of action.

• The Korean Journal of Physiology
• /
• 제11권1호
• /
• pp.21-26
• /
• 1977

Many cases have been reported that a post spinal headache can be relieved immediately by an epidural injection of saline; and autologous blood also has recently been used successfully instead of saline. The changes of the cerebrospinal fluid pressure in 40 cases were observed in the present study in support of the concept; that a continuous leakage in association with hypovolemia and hypotension of the cerebrospinal fluid is the primary cause of a post spinal headache. Subarachnoid pressure increased immediately with saline injection into the lumber epidural space. A spinal needle was inserted into the subarachnoid space at the level of $L2{\sim}3$ and opening pressure of the cerebrospinal fluid was read. An epidural Tuohy needle was insertad at the$L3{\sim}4$ and 25m1 of saline was injected into the epidural space and the cerebrospinal fluid pressure was read in the sitting position. $\underline{Sitting\;Position:}$ Mean pressure after injection $555{\pm}(110.9)mm\;H_2O$, Pressure rise rise (%) 51.3%, Mean opening pressure $366{\pm}(52.2)mm\;H_{2}O$, $\underline{Lateral\;position:}$ Mean pressure after injection $308{\pm}(70.8)mm\;H_{2}O$, Pressure(%) 86.7%, Mean opening pressure $165{\pm}(42.6)mm\;H_{2}O$. These pressure changes responded almost simultaneously as saline was injected. This pressure rise of 51.3% in the sitting position and 86.7% in the lateral position are clinically very significant. Therefore, it is most possible that the immediate relieve of post, spinal headache by injection of fluid into the epidural space is simultaneous with the increase of the cerebrospinal fluid pressure.

• Journal of Korean Neurosurgical Society
• /
• 제49권5호
• /
• pp.296-298
• /
• 2011

Spinal intradural cysticercosis is a rare manifestation of neurocysticercosis. We report a unique patient who showed visual symptoms and normal imaging of the brain caused by isolated spinal neurocysticercosis. A 59-year-old male patient was admitted to the emergency unit with a history of severe headache and progressive blurred vision. Brain computed tomographic scanning and magnetic resonance imaging showed normal cerebral anatomy without hydrocephalus. The fundoscopic evaluation by an ophthalmologist showed bilateral papilledema. Perimetry studies revealed visual field defects in both eyes. With the diagnosis of pseudotumor cerebri, a lumbar tap was attempted; however, we could not drain the cerebrospinal fluid in spite of appropriate attempts. Lumbar magnetic resonance imaging revealed multilevel intraspinal lesions that were confirmed histologically to be neurocysticercosis. An intraoperative lumbar puncture revealed an increased opening pressure and cytochemical analysis showed elevated cerebrospinal fluid protein level. The headache resolved immediately after surgery. However, the visual symptoms remained and recovered only marginally despite antihelminthic medications after six months of operation.

• Investigative Magnetic Resonance Imaging
• /
• 제17권2호
• /
• pp.149-153
• /
• 2013

척추 수술의 합병증으로 뇌척수액 누출이 발생할 수 있는데 이를 영상학적으로 진단하는 것은 어려움이 있다. 이 연구에서는 자기공명척수조영술을 이용하여 척추 수술 후 뇌척수액 누출을 확인하였던 두 환자의 증례를 보고하고자 한다. 두 환자는 각기 요추 추간판 절제술과 척추 수막종 제거술을 받은 뒤 심한 두통을 호소하였다. 두 환자의 자기공명척수조영영상에서 척추 뇌수막액 누출 부위가 확인되었고, 이에 대해 환자들은 각각 epidural blood patch와 재수술을 받았다. 이 두 사례에서 자기공명척수조영술은 척추 뇌수막액의 누출 부위를 정확히 보여주었고, 척수강과 가성수막류 (pseudomeningocele) 사이의 교통로를 잘 나타내주었다. 척수 수술 후 뇌수막액 누출을 확인하기 위한 검사로 자기공명척수조영술이 유용한 것으로 생각된다.

• Journal of Korean Neurosurgical Society
• /
• 제46권5호
• /
• pp.501-504
• /
• 2009

Remote cerebellar hemorrhage (RCH) is rare but potentially lethal as a complication of spinal surgery. We recently experienced a case of RCH in a 61-year-old man who showed mental deterioration after lumbar spinal surgery. There was dural tearing with subsequent cerebrospinal fluid (CSF) loss during the surgery. Brain computed tomography scan revealed cerebellar hemorrhage, 3rd and 4th ventricular hemorrhage and pneumocephalus. He underwent suboccipital craniectomy and hematoma removal. The most important pathomechanism leading to RCH after spinal surgery has been known to be venous bleeding due to caudal sagging of cerebellum by rapid leak of large amount of CSF which seems to be related with this case. Dural repair and minimizing CSF loss after intraoperative dural tearing would be helpful to prevent postoperative RCH.

• Journal of Korean Neurosurgical Society
• /
• 제42권6호
• /
• pp.475-477
• /
• 2007

Choroid plexus papillomas (CPPs) are typically considered as benign tumors, with a favorable long-term prognosis. Drop metastasis of CPP into the spinal subarachnoid space is rare. We report a 42-year-old woman who presented with headache and back pain 6 years after removal of a posterior fossa CPP. Magnetic resonance imaging revealed mass lesions in the lumbosacral subarachnoid space and recurrent intracranial tumor. The lesions were resected and histologically diagnosed was CPP. We consider that CPP can spread via cerebrospinal fluid pathways and cause spinal drop metastasis. Therefore, it is necessary to evaluate the whole spinal axis and to perform periodic follow-up examinations in patients with CPP.

• Journal of Korean Neurosurgical Society
• /
• 제51권4호
• /
• pp.240-243
• /
• 2012

Dural tears can occur during spinal surgery and may lead to cerebrospinal fluid (CSF) leakage which is rarely involved in remote cerebellar hemorrhage. Only a few of cases of simultaneous cerebral and cerebellar hemorrhage have been reported in the English literature. We experienced a case of multiple remote cerebral and cerebellar hemorrhages in a 63-year-old man who exhibited no significant neurologic deficits after spinal surgery. Magnetic resonance imaging (MRI) performed 4 days after the surgery showed a large amount of CSF leakage in the lumbosacral space. The patient underwent the second surgery for primary repair of the dural defect, but complained of headache after dural repair surgery. Brain MRI taken 6 days after the dural repair surgery revealed multifocal remote intracerebral and cerebellar hemorrhages in the right temporal lobe and both cerebellar hemispheres. We recommend diagnostic imaging to secure early identification and treatment of this complication in order to prevent serious neurologic deficits.

• Neurospine
• /
• 제15권4호
• /
• pp.338-347
• /
• 2018

Objective: Patients with extradural spine tumors are at an increased risk for intraoperative cerebrospinal fluid (CSF) leaks and postoperative wound dehiscence due to radiotherapy and other comorbidities related to systemic cancer treatment. In this case series, we discuss our experience with the management of intraoperative durotomies and wound closure strategies for this complex surgical patient population. Methods: We reviewed our recent single-center experience with spine surgery for primarily extradural tumors, with attention to intraoperative durotomy occurrence and postoperative wound-related complications. Results: A total of 105 patients underwent tumor resection and spinal reconstruction with instrumented fusion for a multitude of pathologies. Twelve of the 105 patients (11.4%) reviewed had intraoperative durotomies. Of these, 3 underwent reoperation for a delayed complication, including 1 epidural hematoma, 1 retained drain, and 1 wound infection. Of the 93 uncomplicated index operations, there were a total of 9 reoperations: 2 for epidural hematoma, 3 for wound infection, 2 for wound dehiscence, and 2 for recurrent primary disease. One patient was readmitted for a delayed spinal fluid leak. The average length of stay for patients with and without intraoperative durotomy was 7.3 and 5.9 days, respectively, with a nonsignificant trend for an increased length of stay in the durotomy cases (p=0.098). Conclusion: Surgery for extradural tumor resections can be complicated by CSF leaks due to the proximity of the tumor to the dura. When encountered, a variety of strategies may be employed to minimize subsequent morbidity.

• Journal of Korean Neurosurgical Society
• /
• 제64권5호
• /
• pp.799-807
• /
• 2021

Objective : Cerebrospinal fluid leakage related complications (CLC) occasionally occur after intradural spinal surgery. We sought to investigate the effectiveness of early ambulation after intradural spinal surgery and analyze the risk factors for CLC. Methods : For this retrospective cohort study, we enrolled 314 patients who underwent intradural spinal surgery at a single institution. The early group contained 79 patients who started ambulation after 1 day of bedrest without position restrictions, while the late group consisted of 235 patients who started ambulation after at least 3 days of bed rest and were limited to the prone position after surgery. In the early group, Prolene 6-0 was used as the dura suture material, while black silk 5-0 was used as the dura suture material in the late group. Results : The overall incidence rate of CLC was 10.8%. Significant differences between the early and late groups were identified in the rate of CLC (2.5% vs. 13.6%), surgical repair required (1.3% vs. 7.7%), and length of hospital stay (2.99 vs. 9.29 days) (p<0.05). Logistic regression analysis revealed that CLC was associated with practices specific to the late group (p=0.011) and the revision surgery (p=0.022). Conclusion : Using Prolene 6-0 as a dura suture material for intradural spinal surgery resulted in lower CLC rates compared to black silk 5-0 sutures despite a shorter bed rest period. Our findings revealed that suture - needle ratio related to dura defect was the most critical factor for CLC. One-day ambulation after primary dura closure using Prolene 6-0 sutures appears to be a costeffective and safe strategy for intradural spinal surgery.