Mario Giordano1, Concezio Di Rocco2. 1. Department of neurosurgery, International Neuroscience Institute, Rudolf Pichlmayr Str. 4, 30625, Hannover, Germany. mario.giordano@alice.it. 2. Department of neurosurgery, International Neuroscience Institute, Rudolf Pichlmayr Str. 4, 30625, Hannover, Germany.
Abstract
BACKGROUND: Cases of intradiploic cerebrospinal fluid (CSF) collections have been previously reported in the literature with various underlying causes. We focus specifically on the iatrogenic cases of this rare but possible neurosurgical complication discussing the possible pathophysiological mechanisms and management strategy. CASE DESCRIPTION: A 14-year-old boy was admitted in our institute with recurrent headache and worsening attention deficits. He was previously treated twice for a Chiari malformation type I. The performed imaging showed the persisting lower position of the cerebellar tonsils with a syrinx within the cervical spinal cord and a fluid collection within the occipital bone with thinning of outer and inner table. Occipital bone decompression with resection of the intradiploic cavity and enlarging duraplasty was performed. Postoperative imaging confirmed the removal of the iatrogenic-induced focal bone alteration. DISCUSSION AND CONCLUSION: Iatrogenic intradiploic focal fluid accumulation can occur when a dural defect combines with an inner table defect of the calvaria or vertebral bones. Though rare, such a complication should be taken into account when postoperative imaging suggests a focal fluid collection inside the theca. The surgical excision of the lesion is mandatory due to the natural history of progression.
BACKGROUND: Cases of intradiploic cerebrospinal fluid (CSF) collections have been previously reported in the literature with various underlying causes. We focus specifically on the iatrogenic cases of this rare but possible neurosurgical complication discussing the possible pathophysiological mechanisms and management strategy. CASE DESCRIPTION: A 14-year-old boy was admitted in our institute with recurrent headache and worsening attention deficits. He was previously treated twice for a Chiari malformation type I. The performed imaging showed the persisting lower position of the cerebellar tonsils with a syrinx within the cervical spinal cord and a fluid collection within the occipital bone with thinning of outer and inner table. Occipital bone decompression with resection of the intradiploic cavity and enlarging duraplasty was performed. Postoperative imaging confirmed the removal of the iatrogenic-induced focal bone alteration. DISCUSSION AND CONCLUSION: Iatrogenic intradiploic focal fluid accumulation can occur when a dural defect combines with an inner table defect of the calvaria or vertebral bones. Though rare, such a complication should be taken into account when postoperative imaging suggests a focal fluid collection inside the theca. The surgical excision of the lesion is mandatory due to the natural history of progression.
Authors: Gurpreet S Gandhoke; Jason S Hauptman; David J Salvetti; Gregory M Weiner; Ashok Panigrahy; Sabri Yilmaz; Ian F Pollack Journal: J Neurosurg Pediatr Date: 2015-05-15 Impact factor: 2.375