Intracranial hypotension with a sixth cranial nerve palsy subsequent to massive thoracic CSF hygroma: a rare complication of thoracic disc excision

Khurana, Ashish; Brousil, James; Russo, Antonino; Evans, Amy; Quraishi, Nasir A.; Boszczyk, Bronek M.

doi:10.1007/s00586-013-2818-1

Cited by 18 publications

(20 citation statements)

References 33 publications

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“…The patient underwent a surgical repair of the dural defect. Both these patients with intra-pleural CSF hygromas developed an Abducens nerve palsy resulting in the visual symptoms suffered by the patients and have been reported by us previously [17].…”

Section: Resultssupporting

confidence: 72%

Calcified giant thoracic disc herniations: considerations and treatment strategies

et al. 2014

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Introduction Giant herniated thoracic discs (GHTD) remain a surgical challenge. When combined with calcification, these discs require altered surgical strategies and have only been infrequently described. Our objective was to describe our surgical approaches in the management of calcified GHTD. Methods This was a retrospective cohort study of all patients with calcified GHTD operated between 2004 and 2012. Data were collected from review of patients' notes and radiographs and included basic demographic and radiological data, clinical presentation and outcome, operative procedure and complications. Results During the study period, there were 13 patients with calcified GHTD, including 6 males and 7 females (mean age 55 years, range 31-83 years). The average canal encroachment was 62 % (range 40-90 %); mean follow-up 37 months (12-98). All patients were treated with anterior thoracotomy, varying degrees of vertebral resection, removal of calcified disc and with or without reconstruction. The average time for surgery was 344 min (range 212-601 min) and estimated blood loss 1,230 ml (range 350-3,000 ml). Post-operatively, 8 patients improved by 1 Frankel grade (62 %), 2 improved by 2 grades (15 %) and 3 did not change their grade (23 %). The complication rate was 4/13 (31 %; 3 patients with durotomies (2 incidental, 1 intentional) and 1 with recurrence). Discussion Calcified GHTD remain a surgical challenge. Anterior decompression through a thoracotomy approach, and varying degrees of vertebral resection with or without reconstruction allowed us to safely remove the calcified fragment. All patients remained the same (23 %) or improved by at least 1 grade (77 %) neurologically, without radiographic failure at final follow-up.

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Section: Resultssupporting

confidence: 72%

Calcified giant thoracic disc herniations: considerations and treatment strategies

et al. 2014

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“…Diplopia is a rare complication after spine surgery, but several cases have been reported [2][3][4][5][6][7][8][9]. In non-spine surgery, diplopia has been reported mainly in patients undergoing spinal anesthesia, and only rarely in patients undergoing general anesthesia [10].…”

Section: Discussionmentioning

confidence: 99%

Diplopia developed by cervical traction after cervical spine surgery

Kim

Kang

et al. 2021

Yeungnam Univ J Med

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Perioperative ocular complications are rare yet important. The American Society of Anesthesiologists (ASA) Closed Claims database was initiated in 1984 to analyze anesthesia malpractice and improve patient safety. Data from the ASA Closed Claims have shown that intraoperative eye injuries account for 4% of medico-legal claims, indicating that eye care is an important part of anesthesia-related care [1]. Diplopia can rarely present after spine surgery. As a result, there have been a few investigations on this condition, and the mechanism by which diplopia develops follow

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“…Thus, until there is a definite correction of the spinal fluid fistula, a significant and progressive loss of spinal fluid can occur. Ultimately, abundant CSF leakage can cause intracranial hypotension and lead to serious consequences for the patient [9]. …”

Section: Discussionmentioning

confidence: 99%

“…Orthopaedic scienceNakagawa et al [10]Spinal tumor ResectionFemale22CervicalNoNot identified3 days PostopConservative1 year2009J. Korean Neur SocietyCho et al [14]Posterior FusionMale61Lumbo-SacralNoNot identified2 days PostopConservative5 weeks2012SpineThomas et al [11]DiscectomyMale53LumbarYesIdentified7 days PostopDural Repair2 weeks2012Eur Spine JournalJoo et al [15]DiscectomyMale48Lumbo-SacralNoIdentified3 days PostopDural Repair1 week2013Eur Spine JournalKhurana et al [9]DiscectomyMale48ThoracicNoIdentified>3 weeks PostopDural Repair + Chest drain3 monthsDiscectomyMale46ThoracicNoIdentified"Few days" PostopConservative5 months…”

Section: Discussionmentioning

confidence: 99%

Abducens nerve palsy as a postoperative complication of minimally invasive thoracic spine surgery: a case report

et al. 2016

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BackgroundThoracic disc surgeries make up only a small number of all spine surgeries performed, but they can have a considerable number of postoperative complications. Numerous approaches have been developed and studied in an attempt to reduce the morbidity associated with the procedure; however, we still encounter cases that develop serious and unexpected outcomes.Case PresentationThis case report presents a patient with abducens nerve palsy after minimally invasive surgery for thoracic disc herniation with an intraoperative spinal fluid fistula. A literature review of all cases related to this complication after spine surgery is included.Despite the uncommon nature of this type of complication, understanding the procedure itself, the principle occurrences and outcomes following the procedure, the physiopathogical features of abducens nerve palsy, and the possible adverse effects of spinal surgery, including minimally invasive procedures, can enable an early diagnosis of complications and facilitate the procedure.ConclusionsIn spite of being very rare and multifactorial, uni- or bilateral abducens nerve paralysis carries significant morbidity and can occur as a postoperative complication after conventional or minimally invasive spine surgery. This condition requires an accurate diagnosis and adequate multidisciplinary follow up.

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Intracranial hypotension with a sixth cranial nerve palsy subsequent to massive thoracic CSF hygroma: a rare complication of thoracic disc excision

Cited by 18 publications

References 33 publications

Calcified giant thoracic disc herniations: considerations and treatment strategies

Calcified giant thoracic disc herniations: considerations and treatment strategies

Diplopia developed by cervical traction after cervical spine surgery

Abducens nerve palsy as a postoperative complication of minimally invasive thoracic spine surgery: a case report

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