Subarachnoid-pleural fistula treated with noninvasive positive-pressure ventilation. Case report.
The authors describe the case of a 24-year-old man who underwent an L-1 corpectomy for spinal decompression and stabilization following an injury that caused an L-1 burst fracture. Postoperatively, an accumulation of spinal fluid developed in the pleural space, which was refractory to 1 week of thoracostomy tube drainage and lumbar cerebrospinal fluid (CSF) diversion. The authors then initiated a regimen of positive-pressure ventilation in which a bi-level positive airway pressure (PAP) mask was used. After 5 days, the CSF collection in the pleural space resolved. Use of a bi-level PAP mask represents a safe, noninvasive method of reducing the negative intrathoracic pressure that promotes CSF leakage into the pleural cavity and may be a useful adjunct in the treatment of subarachnoid-pleural fistula.
Yoshor
D
D
Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA. dyoshor@tmh.tmc.edu
Gentry
J B
JB
LeMaire
S A
SA
Dickerson
J
J
Saul
J
J
Valadka
A B
AB
Robertson
C S
CS
D000328:Adult; D002555:Cerebrospinal Fluid / Q000378:metabolism; D019299:Decompression, Surgical; D004322:Drainage; D006801:Humans; D008297:Male; D010994:Pleura / Q000378:metabolism; D011175:Positive-Pressure Respiration; D011183:Postoperative Complications; D016156:Respiratory Tract Fistula / Q000209:etiology / Q000628:therapy*; D016103:Spinal Fractures / Q000601:surgery; D013346:Subarachnoid Space; D013907:Thoracostomy