Treatment of a persistent iatrogenic cerebrospinal fluid-pleural fistula with a cadaveric dural-pleural graft

Raffa, Scott J.; Benglis, David M.; Levi, Allan D.

doi:10.1016/j.spinee.2008.07.002

Cited by 19 publications

(12 citation statements)

References 18 publications

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“…A review of the literature reveals 44 described cases of massive pleura-dural fistula. It can be observed that 77 % of these cases were caused by trauma of varying aetiologies and only two (4.5 %) of the cases were described as subsequent to post-operative thoracic disc resection [2,9,[14][15][16][17]. Recently, two cases of spontaneous thoracic CSF leakage in the presence of thoracic disc hernias were described [18].…”

Section: Epidemiology Pathology and Rationale For Treatmentmentioning

confidence: 99%

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

et al. 2013

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Background Thoracic cerebrospinal fluid (CSF) hygroma is a rare and potentially devastating complication of the anterior thoracic approach to the spine. We present two cases in which this complication resulted in acute cranial nerve palsy and discuss the pathoanatomy and management options in this scenario. Case reports Two male patients presented to our department with neurological deterioration due to a giant herniated thoracic disc. The extruded disc fragment was noted preoperatively to be calcified in both patients. A durotomy was performed at primary disc prolapse resection in the first patient, whereas an incidental durotomy during the

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Section: Epidemiology Pathology and Rationale For Treatmentmentioning

confidence: 99%

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

et al. 2013

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“…10,20 This surgical intervention most commonly requires the use of a dural substitute or sealant (Tisseel, DuraSeal) and can be augmented with a vascularized graft. 7,8,19 Other authors have reported success with secondary occlusion of fistulas by using an epidural blood patch (EBP) 1 or synthetic material such as DuraSeal, Tisseel, and even Onyx; 4,6,11 however, all of these successes occurred in adult patients. Kurata et al reported that 5-14 days of continuous noninvasive positive pressure ventilation (NIPPV) can be used as an adjunct to chest tube drainage, with the goal of increasing intrathoracic pressure and reducing the pressure gradient between the pleural and subarachnoid spaces.…”

Section: Discussionmentioning

confidence: 99%

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

Chu¹,

Miller²,

Bazylewicz

et al. 2016

PED

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Subarachnoid-pleural fistulas (SPFs) are rare clinical entities that occur after severe thoracic trauma or iatrogenic injury during anterolateral approaches to the spine. Treatment of these fistulas often entails open repair of the dural defect. The authors present the case of an SPF in a 2-year-old female after a penetrating injury to the chest. The diagnosis of an SPF was suspected given the high chest tube output and was confirmed with a positive β2-transferrin test of the chest tube fluid, as well as visualization of dural defects on MRI. The dural defects were successfully repaired with CT-guided percutaneous epidural injection of fibrin glue alone. This case represents the youngest pediatric patient with a traumatic SPF to be treated percutaneously. This technique can be safely used in pediatric patients, offers several advantages over open surgical repair, and could be considered as an alternative first-line therapy for the obliteration of SPFs.

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“…Intervention is almost always required because subarachnoid‐pleural fistulas do not resolve with conservative therapies 1 . Previously reported conservative therapies consist of lumbar/cervical spinal catheter or passive CSF drainage by the chest tube, positive pressured non‐invasive ventilation, serial thoracentesis, epidural blood patch or fibrin glue insertion and bed rest 6 . The larger fistula often require invasive treatment.…”

Section: Discussionmentioning

confidence: 99%

“…In the present case, the allograft materials have been used to repair the subarachnoid‐pleural fistula in pediatric patients. There are reports of the treatment for subarachnoid fistula with open thoracotomy procedure and muscular flap, methylcellulose and fibrin adhesives 1,6,8 . Recently, video‐assisted thorascopic surgery was used safely in a pediatric patient 1 .…”

Section: Discussionmentioning

confidence: 99%

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

Karabayır

Demirkol

et al. 2012

Pediatrics International

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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.

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Treatment of a persistent iatrogenic cerebrospinal fluid-pleural fistula with a cadaveric dural-pleural graft

Cited by 19 publications

References 18 publications

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

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

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

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

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