Anjana Kundu1, Yuko Sano, Paul S Pagel. 1. Department of Anesthesiology and Pain Medicine, Children's Hospital and Regional Medical Center, University of Washington School of Medicine, Seattle, Washington 98105, USA. anjana.kundu@seattlechildrens.org
Abstract
PURPOSE: To discuss the diagnostic and therapeutic challenges presented by an adolescent girl with delayed postural headaches and photophobia that occurred three months after an apparently uncomplicated microscopic lumbar discectomy. CLINICAL FEATURES: A previously healthy girl was admitted to our hospital with a one-week history of an unremitting, frontal-retroorbital postural headache and photophobia. Three months before admission, the patient had undergone a L5-S1 left hemilaminotomy and foraminotomy with microdiscectomy for excision of a herniated intervertebral disc. Conservative treatment failed to provide symptomatic relief. Cranial magnetic resonance imaging showed enhancement of the pachymeninges, consistent with intracranial hypotension. A chronic cerebrospinal leak was identified by high-resolution computed tomography (CT) myelography. Epidural blood patches were performed, with and without CT guidance, that provided temporary relief of the patient's symptoms; however, direct suture plication of the dural tear was eventually required for definitive treatment. CONCLUSION: This case emphasizes that delayed presentation of dural injury may occur after lumbar surgery and describes the potential therapeutic implications for this unusual complication.
PURPOSE: To discuss the diagnostic and therapeutic challenges presented by an adolescent girl with delayed postural headaches and photophobia that occurred three months after an apparently uncomplicated microscopic lumbar discectomy. CLINICAL FEATURES: A previously healthy girl was admitted to our hospital with a one-week history of an unremitting, frontal-retroorbital postural headache and photophobia. Three months before admission, the patient had undergone a L5-S1 left hemilaminotomy and foraminotomy with microdiscectomy for excision of a herniated intervertebral disc. Conservative treatment failed to provide symptomatic relief. Cranial magnetic resonance imaging showed enhancement of the pachymeninges, consistent with intracranial hypotension. A chronic cerebrospinal leak was identified by high-resolution computed tomography (CT) myelography. Epidural blood patches were performed, with and without CT guidance, that provided temporary relief of the patient's symptoms; however, direct suture plication of the dural tear was eventually required for definitive treatment. CONCLUSION: This case emphasizes that delayed presentation of dural injury may occur after lumbar surgery and describes the potential therapeutic implications for this unusual complication.
Authors: Lukas Faltings; Kay O Kulason; Victor Du; Julia R Schneider; Shamik Chakraborty; Kevin Kwan; Bidyut Pramanik; John Boockvar Journal: Cureus Date: 2018-11-26