Pseudohypoxic Brain Swelling: A Newly Defined Complication after Uneventful Brain Surgery, Probably Related to Suction Drainage

Roost, Dirk Van; Thees, Christof; Brenke, Christopher; Oppel, F.; Winkler, Peter; Schramm, Johannes

doi:10.1227/01.neu.0000093498.08913.9e

Cited by 86 publications

(85 citation statements)

References 22 publications

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“…The authors came to the conclusion that intracranial hypotension after intracranial and spinal surgery with dural opening is potentially life threatening if patients are left with a subfascial suction drainage. Similar cases about comatose patients with secondary pseudohypoxic brain swelling after lumbar laminectomy [5] and after thoracic and lumbar spondylodiscitis surgery have been reported [25]. The initial operative procedure in these cases was extradural.…”

Section: Reported Complications By Application Of Negative Pressure Ssupporting

confidence: 62%

“…Features include thickening and enhancement of the dura after contrast application, enlargement of venous structures with dilation of the intracranial dural sinuses and spinal epidural plexuses, and engorgement of the pituitary gland [1,19]. Moreover hyperintensities in the thalamus/basal ganglia, brain stem, and cerebellum have been reported as a possible result of impaired drainage through the internal cerebral veins and the vein of Galen into the straight sinus [19,25]. Subdural hygromas, often bihemispheric and with an infratentorial predominance, usually are named as a typical imaging finding [3,19].…”

Section: Radiological Examinationmentioning

confidence: 99%

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Undetected Dural Leaks Complicated by Accidental Drainage of Cerebrospinal Fluid (CSF) can Lead to Severe Neurological Deficits

Sporns¹,

Schwindt²,

Cnyrim³

et al. 2016

Fortschr Röntgenstr

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Purpose: Intracranial hypotension has been reported as a complication of accidental drainage after surgical treatment in several cases. Application of negative pressure systems (wound drains, VAC?-therapy, chest tube drainage) had typically led to severe intracranial hypotension including intracranial hemorrhage and tonsillar herniation. In the last year the authors observed 2 cases of accidental spinal drainage of CSF in patients with neurological deficits, regressing after reduction of the device suction. Material and Methods: We conducted a systematic PubMed-based research of the literature to study the variety and frequency of the reported symptoms from 1st of January 1980 until 1st of October 2015. Results: Reviewing the literature 24 relevant citations including 27 reported cases of posttraumatic or postoperative loss of CSF leading to neurological symptoms were identified. All 15 reported cases in which a negative pressure suction device had been applied showed severe neurological and radiological symptoms such as coma or brain herniation and intracranial hemorrhage. In all cases patients recovered rapidly after removal of the suction device. Milder symptoms were observed in the patients without negative pressure suction, mainly only presenting with headaches or cranial nerve involvement. Additionally, we give an overview about current recommendations regarding cranial and spinal imaging to rule out dural laceration and cranial hypotension. Conclusion: Patients with dural laceration complicated by accidental drainage of CSF can present with life-threatening conditions. Increasing use of negative pressure suction devices makes the reported condition an important differential diagnosis. A precise radiological examination can help to rule out dural laceration and intracranial hypotension. Key Points: ??Undetected dural laceration complicated by negative pressure suction drains can induce life-threatening symptoms. ??Increasing use of negative pressure suction devices makes the reported condition an important differential diagnosis for radiologists Citation Format: ??Sporns PB, Schwindt W, Cnyrim CD et?al. Undetected Dural Leaks Complicated by Accidental Drainage of Cerebrospinal Fluid (CSF) can Lead to Severe Neurological Deficits. Fortschr R?ntgenstr 2016; 188: 451???458

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Section: Reported Complications By Application Of Negative Pressure Ssupporting

confidence: 62%

Section: Radiological Examinationmentioning

confidence: 99%

Undetected Dural Leaks Complicated by Accidental Drainage of Cerebrospinal Fluid (CSF) can Lead to Severe Neurological Deficits

Sporns¹,

Schwindt²,

Cnyrim³

et al. 2016

Fortschr Röntgenstr

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“…4,10,12,32,33,35,55,86 Its etiology remains controversial; therefore recommendations on avoiding it are difficult to outline. Reports of infratentorial bleeds following supratentorial surgery and vice versa have been recently reviewed by Garg et al 35 The most common hemorrhage pattern is cerebellar hemorrhage following supratentorial surgery.…”

Section: Remote Site Intracranial Hemorrhagementioning

confidence: 99%

Cerebral venous overdrainage: an under-recognized complication of cerebrospinal fluid diversion

Barami

2016

FOC

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Understanding the altered physiology following cerebrospinal fluid (CSF) diversion in the setting of adult hydrocephalus is important for optimizing patient care and avoiding complications. There is mounting evidence that the cerebral venous system plays a major role in intracranial pressure (ICP) dynamics especially when one takes into account the effects of postural changes, atmospheric pressure, and gravity on the craniospinal axis as a whole. An evolved mechanism acting at the cortical bridging veins, known as the “Starling resistor,” prevents overdrainage of cranial venous blood with upright positioning. This protective mechanism can become nonfunctional after CSF diversion, which can result in posture-related cerebral venous overdrainage through the cranial venous outflow tracts, leading to pathological states. This review article summarizes the relevant anatomical and physiological bases of the relationship between the craniospinal venous and CSF compartments and surveys complications that may be explained by the cerebral venous overdrainage phenomenon. It is hoped that this article adds a new dimension to our therapeutic methods, stimulates further research into this field, and ultimately improves our care of these patients.

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“…1 MR imaging signs include thickening and enhancement of the dura after contrast administration, subdural fluid collections, sagging of the brain, engorgement of venous structures with dilation of the intracranial dural sinuses and spinal epidural plexuses, and enlargement of the pituitary gland. [1][2][3][4][5][6] CSF loss is suggested as a possible pathogenetic mechanism, though the exact location of CSF loss often remains undetected. 7,8 According to the Monro-Kellie doctrine, in a closed compartment (as within the skull) the volume loss of 1 compartment-CSF in this disease entity-is compensated by an increase of the volume in the other ones.…”

mentioning

confidence: 99%

“…5 In 2003, we had reported on rare, but occasionally fatal, outcomes after uneventful brain surgery. 6 This condition is likely related to intracranial hypotension because no additional cases have been noted after cessation of wound suction drainage following intracranial surgery. Here, we extend the spectrum with 3 more cases.…”

mentioning

confidence: 99%

Postsurgical Intracranial Hypotension: Diagnostic and Prognostic Imaging Findings

Hadizadeh

Kovács²,

Tschampa³

et al. 2009

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE: CSF loss with consecutive intracranial hypotension has been discussed as a possible pathogenetic mechanism in poor clinical outcome after uneventful neurosurgery and appears to be correlated to specific imaging findings. The purpose of this study was to describe the clinical and imaging findings of symptomatic intracranial hypotension likely induced by wound suction drainage.

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Pseudohypoxic Brain Swelling: A Newly Defined Complication after Uneventful Brain Surgery, Probably Related to Suction Drainage

Abstract: Indications of intracranial hypotension, induced by suction drainage, being the main pathomechanism of PHBS are discussed. A serious warning is issued regarding the use of suction drainage after intracranial surgery.

Cited by 86 publications

References 22 publications

Undetected Dural Leaks Complicated by Accidental Drainage of Cerebrospinal Fluid (CSF) can Lead to Severe Neurological Deficits

Undetected Dural Leaks Complicated by Accidental Drainage of Cerebrospinal Fluid (CSF) can Lead to Severe Neurological Deficits

Cerebral venous overdrainage: an under-recognized complication of cerebrospinal fluid diversion

Postsurgical Intracranial Hypotension: Diagnostic and Prognostic Imaging Findings

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