Cervical spinal cord infarction after posterior fossa surgery: a case-based update

• Published in: Child's nervous system 2009-12, Vol.25 (12), p.1541-1546
• Main Authors: Martínez-Lage, Juan F, Almagro, María-José, Izura, Virginia, Serrano, Cristina, Ruiz-Espejo, Antonio M, Sánchez-del-Rincón, Isabel
• Format: Article
• Language: English
• Subjects: Case-Based Update; Cervical Vertebrae - blood supply; Cervical Vertebrae - surgery; Child; Cranial Fossa, Posterior - surgery; Disease Progression; Female; Humans; Infarction - complications; Infarction - diagnosis; Infarction - surgery; Magnetic Resonance Imaging; Medicine; Medicine & Public Health; Neurosciences; Neurosurgery; Neurosurgical Procedures - adverse effects; Paraplegia - etiology; Prone Position; Quadriplegia - etiology; Spinal Cord - blood supply; Spinal Cord - surgery; Spinal Cord Ischemia - complications; Spinal Cord Ischemia - surgery
• ISSN: 0256-7040; 1433-0350
• DOI: 10.1007/s00381-009-0950-3

Background Several positions are currently utilized for operating patients with posterior fossa lesions. Each individual position has its own risks and benefits, and none has demonstrated its superiority. A dreaded, and probably underreported, complication of these procedures is cervical cord infarction with quadriplegia. Discussion We reviewed eight previous reported instances of this devastating complication aimed at ascertaining its pathogenesis to suggest preventive strategies. Several hypotheses have been put forward to explain the occurrence of this complication. Some factors involved in the production of cervical cord infarction include patient's position (seated or prone), hyperflexion of the neck, excessive spinal cord traction, canal stenosis, and systemic arterial hypotension. We hypothesize that spinal cord infarction in our patient might have resulted from compromised blood supply to the midcervical cord caused by tumor infiltration of the cervical leptomeninges in addition to a brief episode of arterial hypotension during venous air embolism. Case report We treated an 8-year-old girl who developed quadriplegia after surgery for a fourth ventricular ependymoma. Postoperative magnetic resonance imaging demonstrated cervical cord infarction. Evoked potentials confirmed the diagnosis. Conclusions With this report, we want to draw the attention of neurosurgeons to the possibility of the occurrence of this dreadful complication during posterior fossa procedures. Retrospectively, the only measures that might have helped to avoid this complication in our patient would have been using the prone position and intraoperative monitoring of evoked potentials.