Subarachnoid‐pleural fistula in a child: The cause and treatment

Abstract

Hydrothorax of the cerebrospinal fluid after a subarachnoid-pleural fistula is a rare condition. Subarachnoid-pleural fistula may appear after a trauma at the thoracolumbar vertebral column or iatrogenically after thoracotomy. A two years and four months old boy who was operated because of ganglioneuroblastoma was admitted to hospital due to respiratory distress. The chest roentgenogram obtained two months after thoracotomy, showed a pleural effusion at the left side and a chest tube was inserted. The craniospinal magnetic resonance imagining revealed subarachnoid-pleural fistula and lumbar external cerebrospinal fluid drainage was performed. The chest tube was removed by application of tetracycline between pleural layers. After the patient was discharged, respiratory distress reoccurred after 3 weeks and a chest tube was reinserted due to fluid at the left hemithorax. An external lumbar drainage was reapplied. The location of the fistula was determined by craniospinal magnetic resonance imagining and myelography. The fistula was surgically restored by a posterior approach and laminectomy. The cerebrospinal fluid drainage and chest tube was removed three days and seven days after the operation respectively. The patient was discharged at the 13 days after the operation. During periodical outpatient follow up the patient has no symptoms and is neurologically intact. Subarachnoid-pleural fistulas, usually do not regress spontaneously or respond to conservative methods. Invasive approaches including surgery may be needed to treat patients with subarachnoid-pleural fistulae.

Transosseous cerebrospinal fluid fistula 14 years after Chiari decompression: presentation and management

“…Although subarachnoid-pleural and subarachnoid-mediastinal fistulas 7,16,17,20 have been noted in the spine after trauma (either as a result of rupture of a known spinal meningocele or in association with significant spinal column disruption and concomitant dural laceration), the existence of an acquired intraosseous CSF fistula similar to our case has, to our knowledge, not been previously reported. A very recent report by Mahaney and Menezes 11 described an occipital intradiploic pseudomeningocele, arising within the dorsal occipitocervical fusion mass and resulting in dorsal hindbrain compression in a patient with a remote history of Chiari decompression.…”

Diagnose and treatment of traumatic pleural-subarachnoid fistula in children: A case report and systematic review

“…Of course, open surgery is suitable for large fistula, which is difficult to be cured by nonsurgical measures [21]. Each method has its pros and cons.…”

“…In a word, doctors are attempting to find more and more conservative methods to treat the PSF due to the difficulty to find the lesion during operation, especially for traumatic PSF. Of course, open surgery is suitable for large fistula, which is difficult to be cured by non-surgical measures [ 21 ]. Each method has its pros and cons.…”

Repair of a traumatic subarachnoid-pleural fistula with the percutaneous injection of fibrin glue in a 2-year-old

“…24 There are few reports of SPF in the pediatric neurosurgical literature, with sporadic single cases that mainly occur after thoracic tumor resection and trauma. 9,10,18,24 Common to these cases were requirements for open surgery and repair of the dural defect. Postoperatively, patients in these cases remained in the hospital for 7-14 days for observation and chest tube management.…”