Pseudohypoxic brain swelling and secondary hydrocephalus with pseudomeningocele after lumbar surgery: a case report

• Published in: British journal of neurosurgery 2024-06, Vol.ahead-of-print (ahead-of-print), p.1-6
• Main Authors: Miyaoka, Yoshinari, Uehara, Masashi, Oba, Hiroki, Kamanaka, Takayuki, Ikegami, Shota, Kuraishi, Shugo, Futatsugi, Toshimasa, Tsutsumimoto, Takahiro, Kaneko, Tomoki, Fujinaga, Yasunari, Nakao, Satoshi, Kodaira, Minori, Sekijima, Yoshiki, Maruyama, Takahiro, Hamano, Yujiro, Ichikawa, Michitaro, Imamura, Hiroshi, Kuroiwa, Masafumi, Horiuchi, Tetsuyoshi, Tanaka, Satoshi, Kawamata, Mikito, Takahashi, Jun
• Format: Article
• Language: English
• Subjects: Aged; Back surgery; Brain damage; Brain Edema - diagnostic imaging; Brain Edema - etiology; Consciousness; dural injury; Edema; Epidural; epidural suction drainage; Humans; Hydrocephalus; Hydrocephalus - etiology; Hydrocephalus - surgery; Ischemia; lumbar spine surgery; Lumbar Vertebrae - surgery; Male; Meningocele - diagnostic imaging; Meningocele - etiology; Meningocele - surgery; Postoperative Complications - etiology; Pseudohypoxic brain swelling; Spinal Fusion - adverse effects; Spondylolisthesis - surgery; Tomography, X-Ray Computed; Ventriculoperitoneal Shunt - adverse effects
• ISSN: 0268-8697; 1360-046X
• DOI: 10.1080/02688697.2021.1958157

Postoperative intracranial complications are rare in spine surgery not including cranial procedures. We describe an uncommon case of pseudohypoxic brain swelling (PHBS) and secondary hydrocephalus after transforaminal lumbar interbody fusion (TLIF) presenting as impaired consciousness and repeated seizures. A 65-year-old man underwent L4-5 TLIF for lumbar spondylolisthesis and began experiencing generalized seizures immediately postoperatively. Computed tomography (CT) revealed diffuse cerebral edema-like hypoxic ischemic encephalopathy. He was transported to our hospital, at which time epidural drainage was halted and anti-edema therapy was commenced. His impaired consciousness improved. However, he suffered secondary hydrocephalus due to continuous bleeding from a dural defect and spinal epidural fluid collection 3 months later. Following the completion of dural repair and insertion of a ventriculoperitoneal shunt, his neurologic symptoms and neuroimaging findings improved significantly. PHBS can be considered in patients with unexpected neurological deterioration following lumbar spine surgery even with the absence of documented durotomy. This might be due to postoperative intracranial hypotension-associated venous congestion, and to be distinguished from the more common postoperative cerebral ischemic events-caused by arterial or venous occlusions-or anesthetics complications.