Subarachnoid-Pleural Fistula As a Complication of the Lateral-Extracavitary Approach to Thoracic Intraspinal Neurinoma

Pneumocephalus and Pneumorrhachis due to a Subarachnoid Pleural Fistula That Developed after Thoracic Spine Surgery

“…Only 13 cases of SAPF following surgery have been reported in the literature135681112131416171819) (Table 1). Postoperative pneumocephalus could result from combination of a dural tear and a pneumorrhachis.…”

“…Another rare condition is a communication between the spinal subarachnoid space and pleural space after thoracic spine surgery. Pneumocephalus may manifest as severe headache4579) and acute neurologic changes that mimic brain metastasis, seizure, or stroke. However, the physiology and management of pneumocephalus are not widely recognized.…”

Subarachnoid—pleural fistula after resection of thoracic tumors

“…The most common presentation is CSF accumulation in the thoracic cavity, which may manifest as either continued high output through a chest tube or as a pleural effusion. 8,13 This is sometimes mistaken for the typical pleural effusion that occurs after thoracic surgery but is notable for its persistent high volume and the presence of ␤ 2 -transferrin, which is specific for CSF in this setting. 21 Other presentations of SPF include postural headaches secondary to intracranial hypotension, which may also result in subdural effusions or hematomas and manifest as an altered mental state or even as focal neurological deficits.…”

“…Reportedly it usually occurs after trauma, either blunt 5,14,22,26 or penetrating. 12,17,18 Reports of cases of SPF following surgery are almost always limited to single-patient case reports in the literature, 4,8,9,16,27 with the largest single series containing only three patients. 3 Subarachnoid-pleural fistulas can be difficult to diagnose and may not be suspected clinically at initial presentation.…”

Midline Ventral Intradural Schwannoma of the Cervical Spinal Cord Resected via Anterior Corpectomy with Reconstruction: Technical Case Report and Review of the Literature

“…Reluctance to use anterior approaches to ventrally located spinal cord tumors has stemmed largely from concerns about 1) inadequate access to the tumor because of a deep and constrained operative field of view, 2) excessive bleeding from Batson's epidural venous plexus, 3) the need for spinal reconstruction, and 4) postoperative CSF fistula formation through anterior dead space created during surgical dissection (24). These concerns seem particularly justified in anterior approaches to tumors of the thoracic spine, where access can be very restricted and a CSF-pleural fistula may arise because of negative intrathoracic pressure and persistent thoracostomy tube drainage (6). And even though contemporary series have not reliably correlated rates of CSF leak with a surgical approach, most authors do stress the relatively higher risk of leak with transpleural and transperitoneal approaches.…”