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Canadian Journal of Anesthesia

, Volume 49, Issue 1, pp 100–102 | Cite as

Intracranial subdural hematoma after unintended durotomy during spine surgery

  • Chueng-He Lu
  • Shung-Tai Ho
  • Shang-Shung Kong
  • Chen-Hwan Cherng
  • Chih-Shung Wong
Neuroanesthesia and Intensive Care

Abstract

Purpose

To report a case of intracranial subdural hematoma occurring after a spinal dural tear that was made unintentionally during the course of a posterior laminectomy and spinal fusion at the L5-S1 level. The possible physiopathological mechanisms are discussed.

Clinical features

On the fourth postoperative day, a 59-yr-old woman displayed persistent headache following unintended durotomy during spine implant revision. Perioperative blood loss was 2840 mL and intravascular replacement was about 3000 mL. She was hydrated with iv fluids and treated with non-steroidal antiinflammatory drugs. The symptoms improved but persisted. With the aggravation of the headache complicated with unconsciousness and the appearance of focal neurological signs on the eighth day, a computed tomography was obtained and revealed a right subdural hematoma. Following surgical drainage, the patient made an uneventful recovery.

Conclusion

This case reminds us that subdural hematoma formation can complicate durotomy during spine surgery. Neurological deterioration in the postoperative period should prompt clinicians to rule out the diagnosis and intervene rapidly as appropriate.

Keywords

Subdural Hematoma Dural Tear Glascow Coma Scale Posterior Laminectomy Autologous Iliac Bone Graft 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Un hématome sous-dural intracrânien causé par la durotomie involontaire lors d’une opération à la colonne vertébrale

Résumé

Objectif

Rapporter un cas d’hématome sous-dural intracrânien survenu après une brèche involontaire de la dure-mère spinale au cours d’une laminectomie postérieure et d’une arthrodèse au niveau L5-S1. Les mécanismes physiopathologiques possibles sont discutés.

Éléments cliniques

Au quatrième jour postopératoire, une femme de 59 ans présentait des céphalées persistantes après une durotomie involontaire survenue pendant la reprise d’un implant rachidien. La perte sanguine périopératoire a été de 2 840 mL et le remplissage vasculaire d’environ 3 000 mL. La patiente a été hydratée avec des liquides iv et traitée par des anti-inflammatoires non stéroïdiens. Ce qui a diminué les symptômes sans les éliminer. Étant donné l’aggravation des céphalées, compliquées d’inconscience, et de l’apparition de signes neurologiques le huitième jour, on a demandé un examen tomodensitométrique qui a révélé un hématome sous-dural droit. Après le drainage chirurgical, la patiente s’est bien rétablie.

Conclusion

Ce cas rappelle que la formation d’un hématome sousdural peut compliquer la durotomie survenant pendant une opération à la colonne vertébrale. La détérioration neurologique postopératoire incite à poser rapidement le diagnostic et à intervenir en conséquence.

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Copyright information

© Canadian Anesthesiologists 2002

Authors and Affiliations

  • Chueng-He Lu
    • 1
  • Shung-Tai Ho
    • 1
  • Shang-Shung Kong
    • 1
  • Chen-Hwan Cherng
    • 1
  • Chih-Shung Wong
    • 1
  1. 1.Department of AnesthesiologyTri-Service General Hospital and National Defense Medical CenterTaipeiTaiwan, R.O.C.

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