Background:
Posttraumatic spinal cerebrospinal fluid leak (CSFL) without neurological deficit is a rare entity. Historically, the first-line treatment is a nonsurgical approach, which includes Trendelenburg positioning, carbonic anhydrase inhibitor (acetazolamide), and subarachnoid catheter, with a high successful rate of leak correction. However, in some cases, this first-line treatment could fail, being necessary the surgical approach.
Case Description:
A 23-year-old male with a recent stab wound to his lumbar region, complained of positional headache and fluid outflow through his wound. On physical examination, an active CSFL was detected without evidence of neurologic deficit. Imaging studies showed a CSF collection extending from the right L4 lamina to the subcutaneous tissue. CSF studies revealed bacterial meningitis. The treatment with carbonic anhydrase inhibitors, Trendelenburg position, lumbar subarachnoid catheter, and antibiotics was initiated. Failure of conservative measures prompted a surgical treatment to resolve the CSFL. Intraoperatively, a dura mater defect was identified, and an autologous paravertebral muscle flap was used for water-tight closure of the defect. The patient recovered without further complications and with CSFL resolution.
Conclusion:
Even though the nonsurgical approach is the first-line of treatment of traumatic CSFL cases, failures can occur. The evidence of a CSF trajectory in imaging studies could be a predictor of treatment failure of the nonsurgical treatment. The surgical treatment as second-line treatment has outstanding results regarding CSFL correction and should be considered when the prediction rate to nonsurgical approach failure is high.
Background: We report the rare case of an adult with a primary extranodal polymorphous hemangioendothelioma at dorsum, treated with endovascular coiling followed by open surgery resection. Clinical history, findings of spinal arteriography, histopathological findings and combined surgical procedure are reported.Case report: A 22-year-old male patient complained of a dorsal mass that has been increasing in size, painful, soft, no mobile and without neurological symptoms. A vascular tumor was suspected and an endovascular followed by an open surgical approach was performed. Histopathological diagnosis of an extranodal polymorph hemangioendothelioma was documented and a total resection was confirmed by free-tumor resection margin. The postoperative course was uneventful. Conclusion: Polymorph hemangioendothelioma is a rare vascular tumor. given the high vascular features of the lesion and, therefore, the high rate of bleeding during surgery.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.