Positive-pressure ventilation attenuates subarachnoid-pleural fistula after thoracic spinal surgery: A report of two cases

Abstract

Background: Dural tear and cerebrospinal fluid (CSF) leakage is known to be a complication of anterior thoracic spine surgery. If dural tear occurs on the ventral side of dura in combination with a pleural injury, it potentially becomes a subarachnoid-pleural fistula. The pressure gradient permits continuous flow of CSF from the subarachnoid space into the cavum thorax, resulting in an intractable subarachnoid-pleural fistula. We report two cases of successfully treated subarachnoid-pleural fistula using noninvasive positive-pressure ventilation (NPPV). Methods: Two patients, a 52-year-old man and a 54-year-old woman, underwent anterior thoracic spine surgery to treat thoracic myelopathy caused by spinal tumor and ossification of the posterior longitudinal ligament. During surgery, dural tear and CSF leakage to the cavum thorax due to perforation of the dura was observed. We treated with polyglycolic acid sheet (Neovel®) in combination with fibrin glue; a suction drainage tube was placed at the subfascial level and the wound was drained with negative pressure. However, after removal of the drainage tube, subarachnoid-pleural fistula was proven. We applied NPPV to the patients. Results: We used the application of NPPV for 2 weeks in the first patient and 1 week in the second patient. In both of them, subarachnoid-pleural fistula was attenuated without apparent adverse events. Conclusion: NPPV is noninvasive and potentially useful therapy to attenuate subarachnoid-pleural fistula after thoracic spinal surgery.

Pneumocephalus resulting from chest infection complicated by pleural-subarachnoid fistula

“…Pleural-subarachnoid fistula cause hydrostatic pressure differences between the pleural cavity and the CSF spaces, Thus, during inspiration the low intrathoracic pressure acts as a cavum and allows for the CSF to accumulates in the pleura, results in pleural effusion, and vice versa during the expiration where the air will be pushed to the CSF space resulting in pneumocephalous [ 4 , 7 , 8 ]. Nevertheless, the clinical manifestation is most commonly pleural effusion and pneumothorax respectively.…”

Fístula subaracnoidea pleural secundaria a resección de ganglioneuroblastoma paravertebral izquierdo toracoretroperitoneal: reporte de un caso

“…La incidencia de la fístula subaracnoidea de líquido cefalorraquídeo (LCR) como complicación neuroquirúrgica raquídea se estima en un 1.4%, comunicándose 56 casos de fístula subaracnoidea pleural de LCR en una revisión sistemática reciente [1][2][3][4][5][6] . La resonancia en secuencias T2 y mielográ ca es un estudio no invasivo con alta sensibilidad (88.9%) para diagnóstico de fístulas de LCR 6 .…”