Iatrogenic intracranial hypotension secondary to subarachnoid-pleural fistula after transthoracic surgery for the treatment of lateral thoracic meningocele

Subarachnoid-pleural fistula (SPF), a rare complication following transthoracic spinal surgery, results in the accumulation of cerebrospinal fluid (CSF) in the pleural space. Hindered spontaneous closure, attributed to negative pleural pressure, gives rise to CSF hypotension and subdural blood colle...

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Bibliographic Details
Published in:Journal of craniovertebral junction and spine 2024-07, Vol.15 (3), p.375-379
Main Authors: Signorelli, Francesco, Santi, Samuele, Leone, Antonio, Visocchi, Massimiliano
Format: Article
Language:English
Subjects:
Abnormalities
Care and treatment
Case Report
Causes of
Complications and side effects
Diagnosis
Fistula
Hypotension
intracranial hypotension
Neural tube
Risk factors
Spine
subarachnoid-pleural fistula
Surgery
thoracic meningocele
Titanium
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Summary:Subarachnoid-pleural fistula (SPF), a rare complication following transthoracic spinal surgery, results in the accumulation of cerebrospinal fluid (CSF) in the pleural space. Hindered spontaneous closure, attributed to negative pleural pressure, gives rise to CSF hypotension and subdural blood collections. Despite numerous reported cases, achieving consensus on management remains elusive. Treatment options encompass conservative measures, surgical repair, epidural blood patch, and diverse approaches such as multilayer dural closure or meningocele resection. Presented herein is a distinctive case following lateral thoracic meningocele surgery, where SPF-induced CSF hypotension found successful resolution through the innovative use of titanium hemostatic clips to occlude the meningocele. This novel approach, emphasizing the utility of titanium clips, deviates from conventional strategies. Surgical SPF exclusion, particularly leveraging titanium clips, emerges as a potential solution, effectively alleviating symptoms of CSF hypotension. The article also aims to present a personal experience, contributing an effective and alternative approach for the etiological treatment of thoracic meningocele.
ISSN:0974-8237
0976-9285
DOI:10.4103/jcvjs.jcvjs_39_24