• Journal of Korean Neurosurgical Society
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• v.53 no.1
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• pp.52-56
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• 2013

Four patients underwent lumbar surgery. In all four patients, the dura was minimally torn during the operation. However, none exhibited signs of postoperative cerebrospinal fluid leakage. In each case, a few days after the operation, the patient suddenly experienced severe recurring pain in the leg. Repeat magnetic resonance imaging showed transdural nerve rootlets entrapped in the intervertebral disc space. On exploration, ventral dural tears and transdural nerve rootlet entrapment were confirmed. Midline durotomy, herniated rootlet repositioning, and ventral dural tear repair were performed, and patients' symptoms improved after rootlet repositioning. Even with minimal dural tearing, nerve rootlets may become entrapped, resulting in severe recurring symptoms. Therefore, the dural tear must be identified and repaired during the first operation.

• Journal of Korean Neurosurgical Society
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• v.48 no.3
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• pp.288-290
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• 2010

The common etiologies of pneumocephalus, presence of air in the intracranial cavity, are trauma and cranial surgery. Pneumocephalus after spinal surgery is an unusual postoperative complication. We report the case of a male 59-year-old man who developed a pneumacephalus after posterior lumbar surgery for spinal stenosis. Intraoperatively, a cerebrospinal fluid leak following a dural tear was noted and immediately repaired. The next day, the patient complained of headache and dizziness. Head and lumbar computed tomography scans revealed significant air in the frontal region, several cisterns, intraventricle, and extra-dural area in the spine canal. Symptoms were spontaneously resolved within 2 weeks with conservative management.

• Journal of Chest Surgery
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• v.23 no.3
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• pp.556-560
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• 1990

A 22 year old soldier was discovered on routine study for discharge to have a mass in the posterior mediastinum He was admitted due to high fever and improved by antibiotic treatment for 2 weeks. Chest PA, apicogram, myelogram and CT scan demonstrated enlargement of the neural foramen at the T1 level with erosion of the posterior aspect of the vertebral body and the pedicle contiguous with the intrathoracic mass, A myelogram showed a large extradural defect at the T1 level on the left. There were no clinical signs of cord compression. A standard posterolateral thoracotomy incision was made with extension to high thoracic vertebra. The 3rd rib was resected and the angles of the posterior portion of 1st and 2nd ribs were cut and rib heads were removed. Extrapleural neurilemmoma 6x6 cm was resected intrathoracically. And after removal of the pedicle and the lamina, intraspinal extradural mass 3 X 2 cm was resected carefully with trivial tearing of the dura which was sealed with gel-foam and pleura. There was ma postoperative neurological complication.

• The Korean Journal of Pain
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• v.1 no.2
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• pp.203-206
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• 1988

Evaluation of inadvertent dural puncture occuring among 308 epidural blocks done for the relief of pain from various conditions was performed. Dural puncture was suspected in 5 out of 308 epidural bloks. (1.6%) Aspiration of CSF was negative in 3 cases in which dural puncture was suspected only after developing spinal anesthesia. Of the 3 negative CSF aspirations, one case had a history of laminectomy. Adhesions of the adjacent tissues might result in the loss of flexibility and a decrease in potential epidural space which might cause dural tearing during injection and subarachoid injection of the local anesthetic followed by high spinal anesthesia. In another case, the needle tip was obstructed by tissue which led to negative aspiration of CSF and failure to feel loss of resistance. The second injection at the same site may cause subarachnoid injection of the local anesthetic through the previously perforated dura mater and in turn, lead to spinal anesthesia. In the last case, there was no reason to suspect dural puncture since the loss of resistance plus air rebound were definite and aspiration of CSF was negative, but dural puncture was suspected after the patient developed spinal anesthesia.