BACKGROUND Hydrocephalus following dural tear after spinal surgery is rare.Although a few cases of obstructive hydrocephalus caused by subdural fluid collection and communicating hydrocephalus associated with meningit...BACKGROUND Hydrocephalus following dural tear after spinal surgery is rare.Although a few cases of obstructive hydrocephalus caused by subdural fluid collection and communicating hydrocephalus associated with meningitis have been reported,the mechanism remains uncertain.Herein we describe a patient complicated with hydrocephalus after cervical laminoplasty in whom subdural fluid collection in the cervical spine and posterior cranial fossa rather than chronic meningitis was the main mechanism.CASE SUMMARY A 45-year-old man underwent cervical laminoplasty for cervical spondylotic myelopathy at a local hospital.Ten days postoperatively,a high fever occurred and magnetic resonance imaging(MRI)showed cerebrospinal fluid(CSF)leakage.Pseudomeningocele liquid test showed high levels of protein and white blood cell(WBC)count with negative bacterial culture.The patient was treated with shortterm intravenous antibiotic and discharged with normal body temperature.The patient was uneventful during the first 8 mo follow-up although repeated MRI showed persistent pseudomeningocele.At the 9th mo postoperatively,the patient gradually presented with dizziness and headache accompanied by recurrent weakness of his left arm.Imaging examinations demonstrated hydrocephalus and a cystic lesion around the cervical spinal cord.CSF test from lumbar puncture indicated chronic meningitis.MRI on 1 d after pseudomeningocele drainage showed a significant decrease in the cystic volume,suggesting that the cystic lesion would be subdural fluid collection rather than adhesive arachnoiditis.After dural defect repair,the patient’s symptoms completely resolved and hydrocephalus gradually disappeared.CSF analysis at the 21-mo follow-up revealed significantly decreased protein level and WBC count.CONCLUSION Subdural fluid collection rather than meningitis contributes to the hydrocephalus formation after cervical laminoplasty.展开更多
Background:In neurosurgery,the necessity of having a drainage tube is controversial.Subgaleal fluid collection(SFC)often occurs,especially in a craniotomy near the“parietal site”.This study aimed to reassess the ben...Background:In neurosurgery,the necessity of having a drainage tube is controversial.Subgaleal fluid collection(SFC)often occurs,especially in a craniotomy near the“parietal site”.This study aimed to reassess the benefit of using a prophylactic epidural drainage(ED)and non-watertight dura suture in a craniotomy near the parietal site.Methods:A retrospective review was conducted on 63 consecutive patients who underwent a craniotomy near the parietal site.The patients were divided into two groups according to different period.The deal group received ED and a non-watertight dura suture(drain group,DG),the control group that did not(non-drain group,NDG).Complications and patient recovery were evaluated and analysed.Results:Three patients(11.5%,26)in DG and 20 patients(54.1%,37)in NDG presented with SFC(p<0.05).One patient(3.8%)in DG and three patients(8.1%)in NDG presented with subdural tensile hydrops(STH)(p>0.05).Six developed an infection in NDG(four intracranial infections,one abscess,one pulmonary infection),while none in DG(p>0.05)developed infection.Three(11.5%)cases in DG and one(2.7%)case in NDG had muscle strength that improved postoperatively(p>0.05).Fifteen(57.7%)in DG and 14(37.8%)in NDG had epileptic seizures less frequently postoperatively(p<0.05).The average temperature(37.4°C vs 37.6°C,p>0.05),the maximum temperature(37.9°C vs 38.1°C,p>0.05)on 3 PODs,the postoperative hospital stay day(7.5 days vs 8.0 days,p>0.05),and the postoperative medicine fee(¥29762.0 vs¥28321.0,p>0.05)were analysed.Conclusion:In patients who undergo a craniotomy near the parietal site,the prophylactic use of ED and a nonwatertight dura suture helps reduce SFC,infection,and control epilepsy.展开更多
文摘BACKGROUND Hydrocephalus following dural tear after spinal surgery is rare.Although a few cases of obstructive hydrocephalus caused by subdural fluid collection and communicating hydrocephalus associated with meningitis have been reported,the mechanism remains uncertain.Herein we describe a patient complicated with hydrocephalus after cervical laminoplasty in whom subdural fluid collection in the cervical spine and posterior cranial fossa rather than chronic meningitis was the main mechanism.CASE SUMMARY A 45-year-old man underwent cervical laminoplasty for cervical spondylotic myelopathy at a local hospital.Ten days postoperatively,a high fever occurred and magnetic resonance imaging(MRI)showed cerebrospinal fluid(CSF)leakage.Pseudomeningocele liquid test showed high levels of protein and white blood cell(WBC)count with negative bacterial culture.The patient was treated with shortterm intravenous antibiotic and discharged with normal body temperature.The patient was uneventful during the first 8 mo follow-up although repeated MRI showed persistent pseudomeningocele.At the 9th mo postoperatively,the patient gradually presented with dizziness and headache accompanied by recurrent weakness of his left arm.Imaging examinations demonstrated hydrocephalus and a cystic lesion around the cervical spinal cord.CSF test from lumbar puncture indicated chronic meningitis.MRI on 1 d after pseudomeningocele drainage showed a significant decrease in the cystic volume,suggesting that the cystic lesion would be subdural fluid collection rather than adhesive arachnoiditis.After dural defect repair,the patient’s symptoms completely resolved and hydrocephalus gradually disappeared.CSF analysis at the 21-mo follow-up revealed significantly decreased protein level and WBC count.CONCLUSION Subdural fluid collection rather than meningitis contributes to the hydrocephalus formation after cervical laminoplasty.
文摘Background:In neurosurgery,the necessity of having a drainage tube is controversial.Subgaleal fluid collection(SFC)often occurs,especially in a craniotomy near the“parietal site”.This study aimed to reassess the benefit of using a prophylactic epidural drainage(ED)and non-watertight dura suture in a craniotomy near the parietal site.Methods:A retrospective review was conducted on 63 consecutive patients who underwent a craniotomy near the parietal site.The patients were divided into two groups according to different period.The deal group received ED and a non-watertight dura suture(drain group,DG),the control group that did not(non-drain group,NDG).Complications and patient recovery were evaluated and analysed.Results:Three patients(11.5%,26)in DG and 20 patients(54.1%,37)in NDG presented with SFC(p<0.05).One patient(3.8%)in DG and three patients(8.1%)in NDG presented with subdural tensile hydrops(STH)(p>0.05).Six developed an infection in NDG(four intracranial infections,one abscess,one pulmonary infection),while none in DG(p>0.05)developed infection.Three(11.5%)cases in DG and one(2.7%)case in NDG had muscle strength that improved postoperatively(p>0.05).Fifteen(57.7%)in DG and 14(37.8%)in NDG had epileptic seizures less frequently postoperatively(p<0.05).The average temperature(37.4°C vs 37.6°C,p>0.05),the maximum temperature(37.9°C vs 38.1°C,p>0.05)on 3 PODs,the postoperative hospital stay day(7.5 days vs 8.0 days,p>0.05),and the postoperative medicine fee(¥29762.0 vs¥28321.0,p>0.05)were analysed.Conclusion:In patients who undergo a craniotomy near the parietal site,the prophylactic use of ED and a nonwatertight dura suture helps reduce SFC,infection,and control epilepsy.
