Positive-pressure ventilation attenuates subarachnoid-pleural fistula after thoracic spinal surgery: A report of two cases

Journal of Orthopaedic Surgery
Mamoru KonoMasashi Yamazaki

Abstract

Dural tear and cerebrospinal fluid (CSF) leakage is known to be a complication of anterior thoracic spine surgery. If dural tear occurs on the ventral side of dura in combination with a pleural injury, it potentially becomes a subarachnoid-pleural fistula. The pressure gradient permits continuous flow of CSF from the subarachnoid space into the cavum thorax, resulting in an intractable subarachnoid-pleural fistula. We report two cases of successfully treated subarachnoid-pleural fistula using noninvasive positive-pressure ventilation (NPPV). Two patients, a 52-year-old man and a 54-year-old woman, underwent anterior thoracic spine surgery to treat thoracic myelopathy caused by spinal tumor and ossification of the posterior longitudinal ligament. During surgery, dural tear and CSF leakage to the cavum thorax due to perforation of the dura was observed. We treated with polyglycolic acid sheet (Neovel®) in combination with fibrin glue; a suction drainage tube was placed at the subfascial level and the wound was drained with negative pressure. However, after removal of the drainage tube, subarachnoid-pleural fistula was proven. We applied NPPV to the patients. We used the application of NPPV for 2 weeks in the first patient and 1 w...Continue Reading

References

Jul 29, 2015·European Spine Journal : Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society·Holger R SchlagMasood Shafafy
Mar 25, 2017·Chinese Journal of Traumatology = Zhonghua Chuang Shang Za Zhi·Zhao FangYang Liu

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Citations

Jun 24, 2021·Radiology Case Reports·Noura AlnajdiElham Rawah
Jul 9, 2021·Respiratory Medicine and Research·E MoncombleB Planquette

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