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 Table of Contents  
CASE REPORT
Year : 2020  |  Volume : 4  |  Issue : 1  |  Page : 24-25

Delayed hydrocephalus secondary to cervical spinal tumor surgery


Department of Neurosurgery, Advanced Medicare and Research Institute, Kolkata, West Bengal, India

Date of Submission18-Nov-2019
Date of Decision29-Dec-2019
Date of Acceptance19-Jan-2020
Date of Web Publication30-Apr-2020

Correspondence Address:
Indranil Ghosh
Sudha, Flat No. 4, 3rd Floor, 75/65 S N Roy Road, Kolkata - 700 038, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/sccj.sccj_23_19

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  Abstract 


Cerebrospinal fluid (CSF) leakage is a common complication after spinal tumor resection that resolves naturally in many cases. Hydrocephalus with CSF leakage as a complication after spinal surgery is rare. Here, we report a rare case of delayed hydrocephalus due to CSF leakage after cervical cord tumor surgery.

Keywords: Cerebrospinal fluid leakage, cervical cord tumor, delayed hydrocephalus, ventriculoperitoneal shunt


How to cite this article:
Ghosh I, Guha S, Vijay Kumar G R, Singh NP. Delayed hydrocephalus secondary to cervical spinal tumor surgery. Saudi Crit Care J 2020;4:24-5

How to cite this URL:
Ghosh I, Guha S, Vijay Kumar G R, Singh NP. Delayed hydrocephalus secondary to cervical spinal tumor surgery. Saudi Crit Care J [serial online] 2020 [cited 2020 Dec 2];4:24-5. Available from: https://www.sccj-sa.org/text.asp?2020/4/1/24/283641




  Introduction Top


In the present communication we describe a patient who developed hydrocephalus after surgery for spinal tumour in the cervical region. We also discuss the possible pathophysiological mechanism of such neurological compromise.


  Case Report Top


A 60-year-old lady with gait disturbance and numbness of both hands was diagnosed to have upper cervical intradural extramedullary tumor [Figure 1]. She underwent uneventful surgery comprising dural incision with C1–2 partial laminectomy. The tumor was completely resected, and histopathology showed that it was a schwannoma. Her postoperative period was uneventful, and she made a good neurological recovery. Three months after surgery, she was readmitted with symptoms and signs of meningitis. Wound was healthy and cerebrospinal fluid (CSF) examination was normal. She improved with antipyretics and empirical antibiotics. Two months after this episode, she presented in deep comatose state. Computed tomographic brain revealed gross hydrocephalus [Figure 2]. A CSF culture test did not detect bacteria, glucose and protein levels in CSF were normal, the cell number was within the normal range, and mononuclear cells dominated. Ventriculoperitoneal shunt was performed after which she became conscious and started obeying commands. She was soon weaned off from ventilator and was discharged after few days in neurologically stable condition. The cause of hydrocephalus was suspected to be CSF leakage which must have occurred during the first surgery and went unnoticed.
Figure 1: Magnetic resonance imaging showing upper cervical spinal tumor

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Figure 2: Computed tomography showing hydrocephalus

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  Discussion Top


CSF leakage is a common complication after spinal tumor resection that resolves naturally in many cases.[1] Hydrocephalus is a state in which abnormal dilation of the ventricle occurs due to a circulatory or absorptive disorder of the CSF.[2] A relationship between hydrocephalus and meningitis has been proposed,[3],[4] with Uehara et al. suggesting that bacteria causing meningitis may cause exudative inflammation and infiltration of many neutrophils in the arachnoid space in 2 months after resection of a cervical cord tumor.[3] Kumaki et al. reported that a fibrinous component also develops, which spreads to the brain surface or subarachnoid space and causes adhesion, which impairs CSF circulation and finally leads to hydrocephalus in 5 months after cervical laminoplasty.[4] There are also several reports of a relationship between meningitis and CSF leakage,[1],[5] with incidence of meningitis after CSF leakage of 3%[1] and 13%.[5] In our case, CSF did not prove septic meningitis. However, inflammation may have been caused by aseptic meningitis, and microhemorrhage and fibrinogenic components might have been the causes of CSF circulation disorder and absorption disorder in the subarachnoid space. This situation may have then led to delayed hydrocephalus. This is a rare case in which hydrocephalus developed sometime after CSF leakage following spine tumor surgery.

Typically, postoperative CSF leakage could be expected for spontaneous cure; thus, surgical closure with dural repair is not necessarily performed if there is no infection. However, in our case, CSF leakage did not improve and the patient complicated with hydrocephalus and aseptic meningitis. This case shows the need for prevention of CSF leakage after spinal tumor surgery and indicates that delayed hydrocephalus can occur in a patient, presenting with altered sensorium after surgery for a spinal tumor in the cervical region.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Ohtani K. Natural course of postoperative cerebrospinal fluid fistula. RinshoSeikei Geka Zasshi 1997;32:413-8.  Back to cited text no. 1
    
2.
McComb JG. Cerebrospinal fluid physiology of the developing fetus. AJNR Am J Neuroradiol 1992;13:595-9.  Back to cited text no. 2
    
3.
Uehara M, Yara T, Arakaki K. Hydrocephalus following resection of cervical cord tumor: A case report. Seikeigeka to Saigaigeka2001;50:703-7.  Back to cited text no. 3
    
4.
Kumaki S, Hirabayashi K, Katsuragawa Y, Miyamoto Y, Saito A, Yamamoto T. Late hydrocephalus treated conservatively secondary to liquorrhea after cervical laminoplasty: A case report. J Spine Res 2017;8:1314-6.  Back to cited text no. 4
    
5.
Tokuhashi Y, Matsuzaki H, Okawa A. Drainage for postoperative cerebrospinal fluid leakage. Nihon Sekituigekagakkai-Zasshi 1998;9:418-24.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2]



 

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