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Intracranial subdural hematoma after unintended durotomy during spine surgery

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

From the Department of Anesthesiology, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan.

Address correspondence to: Dr. Chih-Shung Wong, Department of Anesthesiology, Tri-Service General Hospital and National Defense Medical Center, #325, Chengkung Road, Section 2, Nei-Hu, 114, Taipei, Taiwan, R.O.C. Phone: +886 (2) 87927126; Fax: +886 (2) 87927127; E-mail: w82556{at}ndmctsgh.edu.tw

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 anti-inflammatory 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.

This article has been cited by other articles:

				R. M. Zimmerman and K. M. Kebaish Intracranial Hemorrhage Following Incidental Durotomy During Spinal Surgery. A Report of Four Patients J. Bone Joint Surg. Am., October 1, 2007; 89(10): 2275 - 2279. [Full Text] [PDF]