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

Martínez‐Lage, Juan F.; Almagro, María-José; Izura, Virginia; Serrano, Cristina; Ruiz-Espejo, A.; Sanchez-Del-Rincon, Isabel

doi:10.1007/s00381-009-0950-3

Cited by 24 publications

(11 citation statements)

References 27 publications

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“…In conclusion, it is well-known that several theories have been proposed to explain the development of cervical cord infarction as a complication of operations performed for infratentorial lesions [1]. One theory refers to the position of the patient (sitting versus prone) during surgery, which results in compromised flow of the anterior spinal artery.…”

Section: Discussionmentioning

confidence: 98%

“…Ischemic infarcts of the spinal cord after posterior fossa tumor resections are well documented in the literature, especially when the procedure is performed with the patient in the classical prone position [1]. Infarct are associated with dysfunctional blood regulation either as an insufficiency of compressed arterial [5] or venous compartments, or to microcirculatory disorders such as hypotension and venous air emboli [6].…”

Section: Discussionmentioning

confidence: 99%

“…Each individual position has its own inherent risks and benefits, with no one position having been proven to be superior regarding safety and efficacy. The most devastating position-related complication reported is cervical cord infarction with subsequent quadriplegia [1].…”

Section: Introductionmentioning

confidence: 99%

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Postoperative Tetraplegia to a Child after Cerebellar Pilocytic Astrocytoma Excision at Prone Position: Case Report and Literature Review

et al. 2020

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Unusual clinical course Background: Various factors have been implicated in the pathogenesis of infarction after posterior fossa surgery such as venous air embolism, patient's position (seated or prone), hyperflexion of the neck, excessive spinal cord traction, cervical canal stenosis, and systemic arterial hypotension. The main aim of this case report was to elucidate a case in which hydrogen peroxide was implicated in a major and systemic complication after a neurosurgical procedure. Case Report: We describe the case of a 5-year-old female patient who was admitted to our hospital because of a cerebellar hemispheric astrocytoma associated with obstructive hydrocephalus and accompanied by 2 syringomyelic cavities in the cervicothoracic portion of the spinal cord. Immediately after gross total resection of the lesion, impaired mobility of the upper and lower extremities was observed, a finding that was not consistent with intraoperative neurophysiologic monitoring data. Hydrogen peroxide had been judiciously used to irrigate the resection tumor cavity. In the next few postoperative days, the patient suffered from transient diabetes insipidus and hyperpyrexia, indicative of hypothalamic injury. Conclusions: Neurological evaluation of the patient, after stabilization of her medical condition, revealed residual spasticity of upper and lower extremities, rendering her able to mobilize via the aid of wheelchair only. The most possible pathophysiologic explanation of her neurological deterioration, including hypothalamic dysfunction, was analyzed. The role of hydrogen peroxide as a source of free radical formation, and its co-responsibility for vascular platelet aggregation and vasoconstriction was considered, upon case review, the main responsible etiologic factor.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

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Postoperative Tetraplegia to a Child after Cerebellar Pilocytic Astrocytoma Excision at Prone Position: Case Report and Literature Review

et al. 2020

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“…This has been linked to vascular compromise from atherosclerosis, abdominal aortic surgery and hypotension [5, 6]. Cervical spondylosis is also implicated in reduced cervical vascular supply and has been described following posterior fossa surgery in the sitting position in at least eight cases with age ranges between 4 and 45 years [7, 8]. …”

Section: Discussionmentioning

confidence: 99%

Paediatric spinal cord infarction—a review of the literature and two case reports

Sheikh

Warren

Childs³

et al. 2016

Childs Nerv Syst

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Ischemic spinal cord infarction is rare in the paediatric population, and when it does occur, it is usually associated with traumatic injury. Other potential causes include congenital cardiovascular malformations, cerebellar herniation, thromboembolic disease and infection. Magnetic resonance imaging (MRI) findings can be subtle in the early evaluation of such patients. The outcome is variable and depends on the level and extent of the spinal cord infarct and subsequent rehabilitation. Here, we present two cases of ischemic spinal cord infarction in children.

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“…Cervical myelopathy and spinal cord injury may result from hyperflexion/hyperextension occurring during surgical positioning. [ 9 ] Other etiologies of spinal cord ischemia, however, include: epidural anesthesia, embolism, cardiovascular arrest, global ischemia, hypovolemia/hypotension, and anemia. [ 3 ] Cord ischemia is most frequently attributed to interruption of the segmental arterial vascular supply to the spinal cord following thoracic or abdominal vascular surgery.…”

Section: Introductionmentioning

confidence: 99%

Acute tetraplegia following laryngotracheal reconstruction surgery

Erhan¹,

Kemerdere²,

Kızılkılıç³

et al. 2018

Surg Neurol Int

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Background:Paraplegia following thoracic spinal surgery or abdominal operations is usually attributed to spinal cord ischemia due to interruption of the segmental spinal vascular supply. Alternatively, the etiology of spinal cord ischemia following cervical surgery is less clear.Case Description:A 14-year-old male became acutely tetraplegic with a C4 sensory level and sphincteric dysfunction 12 h following surgery for tracheal stenosis due to prior intubation. Signs included loss of pain and temperature below the level of C4 with preservation of deep sensations (position and vibration) and mute plantar responses. The cervical magnetic resonance imaging revealed diffuse intramedullary cord swelling between C2-C7 and hyperintense signal changes in the anterior and posterior columns of the cord on T2-weighted images. Various etiologies for this finding included a cervical hyperextension or hyperflexion injury vs. anterior spinal artery syndrome.Conclusions:Postoperative treatment of spinal cord ischemia attributed to cervical and thoracoabdominal surgery is largely ineffective in reversing major neurological deficits. Therefore, it is critical to prevent ischemia during these procedures by the avoidance of coagulopathies, anemia, hypotension, and hyperflexion/hyperextension maneuvers.

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

Cited by 24 publications

References 27 publications

Postoperative Tetraplegia to a Child after Cerebellar Pilocytic Astrocytoma Excision at Prone Position: Case Report and Literature Review

Postoperative Tetraplegia to a Child after Cerebellar Pilocytic Astrocytoma Excision at Prone Position: Case Report and Literature Review

Paediatric spinal cord infarction—a review of the literature and two case reports

Acute tetraplegia following laryngotracheal reconstruction surgery

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