Pneumocephalus leading to the diagnosis of cerebrospinal fluid leak and esophageal perforation after cervical spine surgery

Journal of Clinical Neuroscience : Official Journal of the Neurosurgical Society of Australasia
C Rory GoodwinTimothy F Witham

Abstract

Pneumocephalus is a collection of air within in the intracranial cavity, most commonly seen following traumatic injury or cranial surgeries. Esophageal injury and cerebrospinal fluid (CSF) leak are rare complications that may occur following anterior cervical discectomy and fusion (ACDF). We present a novel case of pneumocephalus arising from unrestricted leakage of CSF via coincident esophageal injury and durotomy in a patient who underwent an ACDF after trauma. A 21-year-old man presented to an outside hospital with C5/C6 subluxation, complete spinal cord injury, and quadriplegia from a motor vehicle accident. He underwent an ACDF, during which a CSF leak was observed. He was then transferred to our institution for rehabilitation and tracheostomy placement 1week after the ACDF surgery. Following the tracheostomy, the patient developed intractable fevers and nonspecific symptoms. A CT scan demonstrated frontal pneumocephalus without mass effect. Air was found in the retropharyngeal space. There were no accumulations of CSF in the neck. Extravasation of contrast around instrumentation at C5/C6 on a cine esophagogram demonstrated an esophageal perforation at that level. Pneumocephalus may form when large volumes of CSF escape fr...Continue Reading

References

May 29, 2007·Journal of Clinical Neuroscience : Official Journal of the Neurosurgical Society of Australasia·Mehmet Turgut, Orhan Akyüz
Nov 3, 2007·Surgical Neurology·Naresh P PatelUlrich Batzdorf
Sep 11, 2010·Journal of Pediatric Orthopedics. Part B·Roman NowakLech Krawczyk
Nov 18, 2010·Journal of Korean Neurosurgical Society·Jung Ho YunJung Ho Ko
Jul 27, 2014·Canadian Journal of Anaesthesia = Journal Canadien D'anesthésie·Karen K LamLashmi Venkatraghavan

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Citations

Aug 30, 2018·Case Reports in Otolaryngology·Wyatt J WeinheimerPhilip G Chen
Sep 4, 2021·International Journal of Surgery Case Reports·Osama J Abu-HamdiyahMohammad J Athamneh

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