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PubMed2005

Acute intracranial subdural hematoma following a lumbar CSF leak caused by spine surgery.

STUDY DESIGN: Case report. OBJECTIVE: To report a case of an acute intracranial subdural hematoma that formed due to cerebrospinal fluid (CSF) leak following lumbar surgery. SUMMARY OF BACKGROUND DATA: Intracranial hypotension may occur when CSF is removed from the subarachnoid space. Intracranial subdural hematoma formation has been observed following significant CSF drainage during lumbar puncture or ventricular shunt placement. However, formation has been described only twice in the literature following spine surgery. METHODS: Retrospective review of the patient's medical record and head CT imaging. RESULTS: A 55-year-old woman underwent lumbar surgery for failed back syndrome. Intraoperatively, a dural tear was noted and repaired. One week later, she developed expressive aphasia, and CSF drainage from her lumbar wound was noted. A head CT revealed an acute intracranial subdural hematoma with mass effect. Evacuation of the hematoma occurred via craniotomy, and the lumbar dura was repaired intraoperatively. CONCLUSIONS: We report the rare case of an acute intracranial subdural hematoma caused by a CSF leak following lumbar surgery. This report illustrates the potential morbidity associated with CSF leaks occurring after spinal surgery.

Female↗
PubMed1977

[Post-shunt subdural hematoma in infants and children--analysis of eleven cases (author's transl)].

Out of 122 hydrocephalic infants and children treated by cerebrospinal fluid shunt, post-shunt subdural hematoma was found in 11 patients in total, 8 cases with non-tumorous hydrocephalus and 3 cases with brain tumors obstructing the cerebrospinal fluid pathway. In most cases the diagnosis of subdural hematoma was delayed since signs of increased intracranial pressure were absent initially. The signs of increased intracranial pressure appeared later, when the shunted venricle collapsed and could not give any more space to the growing subdural hematoma. At this stage those cases were easily misdiagnosed as shunt dysfunction. Post-shunt subdural hematoma was apparently induced by the tear of the bridging vein or leakage of the cerebrospinal fluid into the subdural space through the torn arachnoid membrane due to over-drainage of the cerebrospinal fluid, especially when the patients took the erect position. Since such a complication is not rare and difficult to be diagnosed, intensive follow-up is necessary in the post-shunt period. The precautionary measures as well as the treatment for these subdural hematoma were also discussed.

Cerebrospinal Fluid Shunts↗
PubMed1986

MRI studies after treatment of brain tumors in childhood and adolescence.

Forty-seven children and adolescents with brain tumors were examined by magnetic resonance imaging (MRI) after tumor resection. The typical changes and complications after surgery and chemotherapy, as well as the corresponding MRI findings, are discussed. Typical examples of boundary-layer lesions, tumor recurrences, hydrocephalus, porencephalic cysts, and hygromas are given.

Adolescent↗
PubMed1997

[Techniques for measuring intracranial hypertension].

A wide variety of monitoring devices have been used for intracranial pressure measurement. The aim of this article is to present the most common devices and to assess their accuracy, stability and complications, with reference to current literature. Measurement with an intraventricular catheter remains, the reference method. However new techniques with distal measurement (fiberoptic or strain gauge) seem to be accurate, but have a higher cost. Some practical problems, such as the zero pressure reference level and the side of measurement, are also discussed.

Brain↗
PubMed1977

Subdural haematoma (effusion) and internal hydrocephalus.

It is unusual to encounter a case where subdural haematoma (effusion and internal hydrocephalus coexist and are progressive. Often, when the two diseases are concomitantly present, the pathology of one complicated the other. The pathology of subdural haematoma (effusion), complicated by internal hydrocephalus, and problems involved in the diagnosis and treatment of such cases are described, with particular reference to three such cases treated by the authors, and a review of the literature. When cerebral angiography is used as a follow-up study for postoperative subdural haematoma (effusion), it is necessary to direct attention not only to the disappearance of the subdural clear space but also to the possibility of the occurrence of hydrocephalus. If the intracranial pressure is increased and convulsive seizures appear after a shunting operation for hydrocephalus, it is necessary to consider not only shunt dysfunction but also post-shunt subdural haematoma (effusion).

Cerebral Angiography↗
PubMed1986

[Treatment of recurrent chronic subdural hematoma--setting an Ommaya tube].

The rate of postoperative recurrences of chronic subdural hematomas is high. Several methods have been advocated, but each one remains controversial. We proposed a simple method of setting an Ommaya tube after burr-hole evacuation. The reservoir was placed in the subcutaneous space, the tip of the tube was placed in the subdural space. The reservoir was punctured with a needle, thereby allowing aspiration of fluid from the subdural space. Sixty one cases of chronic subdural hematomas were operated by simple burr-hole evacuation. The Ommaya tube was used in 46 selected patients.: 1) the volume of hematoma was more than 100 ml and, or 2) older than 70 years of age. Reaccumulation of subdural effusion was detected in 10 cases. The subdural effusions were drained by percutaneously needling the reservoir of the Ommaya tube. This procedure was curative in 9 of the patients. However 1 patient required a small craniotomy. The patient had two outer membranes therefore inner hematoma could not be removed. The authors propose this technique and discuss about it.

Aged↗
PubMed1991

Effect of lidocaine on the meninges in an experimental animal model.

Arachnoiditis has been reported in patients who had received previous epidural injections of anesthetic agents. The purpose of this study was to determine if epidural injections of lidocaine are sufficient to cause arachnoiditis. Four monkeys that received a single epidural injection of lidocaine hydrochloride 1% were compared to four controls that had epidural injections of 0.9% saline. Four dogs that had multiple epidural injections of lidocaine hydrochloride 1% were compared to four controls that had multiple injections of saline. All animals were killed on the eighty-fourth day of the experiment. The dural sac, containing nerve roots and spinal cord, was removed intact from the lumbar spinal canal, fixed, sectioned, stained, and examined microscopically for evidence of arachnoid inflammation and fibrosis. No significant changes were found in the treated animals. Lidocaine hydrochloride 1% injected singly or repeatedly in the epidural space does not appear to be a cause of significant chronic meningeal reaction.

Animals↗
PubMed2000

Free disc fragment: a retrospective case analysis.

Preoperative diagnosis of free disc fragment is important in order to avoid treatment by chymopapain and percutaneous method of disc removal or anterior discectomy. This retrospective case analysis was to study the cause, physical findings and appropriate investigation to identify free disc fragment before surgery. One hundred and thirteen operative patients of herniated lumbar disc were studied. Of these, eleven patients (9.7%) were diagnosed with free disc fragment. The results revealed that one patient was diagnosed preoperatively with free disc fragment by myelography and MRI and three other patients using MRI alone. We concluded that preoperative diagnosis of free disc fragment can be made through identification of a large myelographic defect and/or sagittal scan MRI showing migration of disc material from native disc space.

Adult↗
PubMed1992

[Subdural intra-arachnoid spread of local anesthetics. A complication of spinal anesthesia].

Accidental subdural injections and catheterisations are a complication of epidural and spinal anaesthesia. The incidence of subdural spread in myelographies is estimated to be over 10% by the spinal technique. With spinaloscopy in an anatomic human model, we analysed the puncture process and the influence of different needle types on the incidence of subdural injection. We compared 22-gauge Sprotte, Quincke, and 18-gauge Tuohy needles in median and paramedian approaches with various bevel orientations. METHOD. The studies were performed in a preserved and recently expired cadaver donated to the Institut für Anatomie, Westfälische Wilhelms-Universität, Münster. The spinal column from T12 to S1, together with the back musculature (in order to preserve the normal curvature of the spine), were removed from the cadaver. Spinaloscopy was performed with a 4-mm endoscope with a 0 degree optic (Storz, Tuttlingen, Germany). All observations were made in the lumbosacral region of the dissected preparation. The endoscope was inserted from the caudal end of the spinal canal and, depending on the observations being made, the spinal canal was filled with air or artificial cerebrospinal fluid (CSF). To obtain information on the distribution of local anaesthetics injected into the subarachnoid space, 0.5% bupivacaine was coloured with a small amount of 1% methylene blue. The distribution of the coloured anaesthetic was clearly visible during and after injection. RESULTS. Needle insertion: Multiple observations were made using median or paramedian advancement of the needle into the spinal canal. With all needles, including the pencil-point, we saw an unexpected inward movement of the dura to the epidural space before penetration. This dural movement was independent of the direction of the dural fibres in the lumbar area. Distribution of local anaesthetics: Our observations indicate that difficulty with injecting drugs occurred when needle insertion was stopped too close to the dura, especially with the Sprotte needle. After manually registered penetration of the dura, the lateral opening of the needle only partially penetrates the dura. This allows CSF to appear in the needle hub, and injection into the vertical subdural space is possible. In all cases with the Sprotte needle, we could reproduce deposition of methylene-blue-coloured local anaesthetics into the subdural space. With the Quincke and Thuohy needles, it was not possible to deposit local anaesthetics into the subdural space in this model. CONCLUSION. Spinaloscopy was done in a non-fixated anatomic preparation of a spinal column with a 4-mm, 0 degree endoscope. From these observations we conclude that both manually registered penetration of the dural and the appearance of CSF in the needle hub can mimic correct needle position. Especially with the lateral opening of the Sprotte needle, deposition of local anaesthetics in the subdural space is possible.

Anesthesia, Spinal↗
PubMedDate not supplied

[Usefulness of trans-fontanel ultrasonography in the diagnosis of various pathological changes in the brain of infants. II. Evaluation of the width of cerebral ventricles and morphology of extra-cerebral fluid spaces].

The analysis of the morphology of the extracerebral fluid space and the assessment of the cerebral ventricles width were done on the ground of 200 ultrasound cerebral scans in infants with an open anterior fontanel. A classification of lesions according to their morphologic picture and the level of progression of disease is proposed.

Anthropometry↗
PubMedDate not supplied

[Incisural block. Radiological diagnosis].

Radioisotope cisternography is the best method for studying the third circulation. A new mode of representation is proposed for understanding the importance of the various foramina and the main direction of the bulk flow. The incisura tentorii plays an important role in the cranial leptomeningeal space. Particular emphasis is given to the cisternographic and pneumographic patterns of its stenosis and occlusion. Incisural block may be anatomical (primary) or functional (secondary). That distinction gives the choice between different shunting procedures. Its significance is demonstrated and illustrated in various situations.

Cerebral Ventricles↗
PubMed1975

[The use of nitrous oxide as a contrast medium during fractionated gas encephalography in halane-nitrous-oxide anesthesia].

40 children were employed as test cases in fractionated gas encephalography using Halan-nitrous oxide anesthesia, and the level of cerebrospinal pressure, the röntgenoparent quality of the extracerebral spaces and the duration of postencephalographical symptoms were examined using air and nitrous oxide as contrast media. In the course of the examination the cerebrospinal pressure showed a tendency to rise when air was introduced, to fall when nitrous oxide was introduced. After instillation of N2O however the filling of the subarachnoid space was over so quickly that it could not be included in the assessment. Sufficient röntgenograms were obtained for all diagnostic demands through 'hybrid filling', (introduction of nitrous oxide into the ventricles, introduction of air into the subarachnoid spaces). With the aid of the results obtained from this examination attempts will be made to derive differentiated indications for filling with nitrous oxide.

Adolescent↗
PubMed2002

Subdural empyema with extension to vertebral canal secondary to salmonellosis in a patient with systemic lupus erythematosus.

CASE REPORT: A case of supratentorial subdural empyema extending to the superior subdural cervical space in a 14-year-old patient with systemic lupus erythematosus is presented. The presumed etiology of the empyema was an intestinal nontyphoidal salmonella infection. DISCUSSION: We review the neurological and neurosurgical complications in systemic lupus erythematosus.

Adolescent↗