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J Neurol Surg A Cent Eur Neurosurg 2024; 85(01): 112-115
DOI: 10.1055/s-0042-1757173
Case Report

Postoperative Intracranial Hypotension-Associated Venous Congestion after Spinal Surgery Managed with Multiple Blood Patches: Case Report

Arthur Robert Kurzbuch 
1   Department of Neurosurgery, Hôpital du Valais, Centre Hospitalier du Valais Romand (CHVR), Hôpital de Sion, Sion, Switzerland
,
Baudouin Bourlond
2   Department of Intensive Care Medicine, Hôpital du Valais, Centre Hospitalier du Valais Romand (CHVR), Hôpital de Sion, Sion, Switzerland
,
Juan José García Martínez 
2   Department of Intensive Care Medicine, Hôpital du Valais, Centre Hospitalier du Valais Romand (CHVR), Hôpital de Sion, Sion, Switzerland
,
Thierry Bonjour
2   Department of Intensive Care Medicine, Hôpital du Valais, Centre Hospitalier du Valais Romand (CHVR), Hôpital de Sion, Sion, Switzerland
,
Natalia P. Novaes
3   Department of Neurology, Hôpital du Valais, Centre Hospitalier du Valais Romand (CHVR), Hôpital de Sion, Sion, Switzerland
,
Constantin Tuleasca
4   Department of Clinical Neurosciences, Neurosurgery Service and Gamma Knife Center, Lausanne University Hospital (CHUV), Lausanne, Switzerland
5   Faculty of Biology and Medicine (FBM), University of Lausanne (Unil), Lausanne, Switzerland
6   Signal Processing Laboratory (LTS 5), Ecole Polytechnique Fédérale de Lausanne, (EPFL), Lausanne, Switzerland
,
Diego San Millán
7   Unit of Neuroradiology, Service of Diagnostic and Intervention Radiology, Hôpital du Valais, Centre Hospitalier du Valais Romand (CHVR), Hôpital de Sion, Sion, Switzerland
› Author Affiliations Funding None.
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Abstract

Background Postoperative intracranial hypotension-associated venous congestion (PIHV) is a rare event. The authors report the case of a patient presenting with PIHV after spinal surgery following the sudden loss of cerebrospinal fluid (CSF) induced by suction drainage.

Methods A 69-year-old patient underwent uneventful revision surgery for wound dehiscence after lumbar surgery with placement of a subfascial suction drain.

Results Postoperatively, the patient presented with fluctuating consciousness and a generalized tonic–clonic seizure. Computed tomography (CT) and serial magnetic resonance imaging (MRI) were performed showing convexity subarachnoid hemorrhages (SAHs), diffuse swelling of the brain and thalami and striatum bilaterally without diffusion restriction, and signs of intracranial hypertension resulting in pseudohypoxic brain swelling in PIHV. A dural leak at L3–L4 was treated with several CT-guided patches combining autologous blood and fibrin glue injections. The patient recovered without neurologic deficit and follow-up MRI revealed progressive complete reversal of brain swelling, and re-expansion of CSF spaces.

Conclusion PIHV is a rare but potentially fatal entity. Awareness of PIHV after cranial or spinal surgery leads to early treatment of CSF hypovolemia and possibly better clinical outcome. Following acute CSF volume loss, an acute elevation of cerebral blood volume overcoming autoregulatory mechanisms seems a likely explanation for diffuse cerebral vasogenic edema and SAH in PIHV.

Keywords

CSF loss - hypoxic brain swelling - intracranial hypotension - postoperative intracranial hypotension-associated venous congestion - suction drain

Statement of Ethics

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Ethical approval by the local Ethics Committee was not necessary.


Informed Consent

The patient has consented to submission of this case report.




Publication History

Received: 13 February 2022

Accepted: 13 June 2022

Article published online:
27 October 2022

© 2022. Thieme. All rights reserved.

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