A rare case of concomitant pneumocephalus and pneumorachis after lumbar spine surgery with late presenting dural leak

• Published in: Spinal cord series and cases 2019-10, Vol.5 (1), p.86-4, Article 86
• Main Authors: Gupta, Mayank, Kumar Varma, Kalidindi Kalyan, Singh Chhabra, Harvinder
• Format: Article
• Language: English
• Subjects: 631/378/1689/2609; 692/499; Aged; Analgesics; Anatomy; Antibiotics; Back surgery; Biomedical and Life Sciences; Biomedicine; Case Report; Cerebrospinal Fluid Leak - complications; Cerebrospinal Fluid Leak - diagnostic imaging; Dura Mater; Headaches; Human Physiology; Humans; Hydration; Lumbar Vertebrae - diagnostic imaging; Lumbar Vertebrae - surgery; Male; Meningitis; Neurochemistry; Neuropsychology; Neurosciences; Neurosurgical Procedures - adverse effects; Neurosurgical Procedures - trends; NMR; Nuclear magnetic resonance; Pneumocephalus - complications; Pneumocephalus - diagnostic imaging; Pneumorrhachis - complications; Pneumorrhachis - diagnostic imaging; Postoperative Complications - diagnostic imaging; Postoperative Complications - etiology; Spinal cord; Surgery; Time Factors; Trauma; Traumatic brain injury
• ISSN: 2058-6124; 2058-6124
• DOI: 10.1038/s41394-019-0235-3

Introduction We report a case of pneumocephalus and pneumorachis i.e., air in the cranial cavity and the spinal canal, which are rarely associated with a primary spinal cause. Their concomitant occurrence and association with a late presenting dural leak are also uncommon. Case presentation A 70-year-old man presented 1 month after decompressive surgery for lumbar canal stenosis with leakage of cerebrospinal fluid (CSF) from the wound site and severe headache. There were no signs of surgical site infection or meningitis. There was no intraoperative or immediate postoperative evidence of dural tear. He was neurologically intact. On detailed work-up, he was found to have air collections in the subarachnoid and intraventricular spaces in the brain and intraspinal air in both the cervical and the lumbar regions. He showed gradual resolution of these findings radiologically and symptomatic improvement through conservative management with analgesics, empirical antibiotics, high flow oxygen, and maintenance of hydration within 1 month. Discussion Pneumocephalus and pneumorachis are commonly seen after trauma. Spine surgery is a rare cause. They may present with symptoms similar to meningitis and may be erroneously diagnosed and treated. No standard treatment guidelines exist in the literature. Most cases have been managed conservatively. Early detection may allow noninvasive management leading to complete resolution.