Intracranial subdural hematoma after unintended durotomy during spine surgery.
OBJECTIVE
To report a case of intracranial subdural hematoma occurring after a spinal dural tear that was made unintentionally during the course of a posterior laminectomy and spinal fusion at the L(5)-S(1) level. The possible physiopathological mechanisms are discussed.


METHODS
On the fourth postoperative day, a 59-yr-old woman displayed persistent headache following unintended durotomy during spine implant revision. Perioperative blood loss was 2840 mL and intravascular replacement was about 3000 mL. She was hydrated with iv fluids and treated with non-steroidal anti-inflammatory drugs. The symptoms improved but persisted. With the aggravation of the headache complicated with unconsciousness and the appearance of focal neurological signs on the eighth day, a computed tomography was obtained and revealed a right subdural hematoma. Following surgical drainage, the patient made an uneventful recovery.


CONCLUSIONS
This case reminds us that subdural hematoma formation can complicate durotomy during spine surgery. Neurological deterioration in the postoperative period should prompt clinicians to rule out the diagnosis and intervene rapidly as appropriate.
Lu
Chueng-He
CH
Department of Anesthesiology, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan.
Ho
Shung-Tai
ST
Kong
Shang-Shung
SS
Cherng
Chen-Hwan
CH
Wong
Chih-Shung
CS
D004322:Drainage; D004388:Dura Mater / Q000293:injuries*; D005260:Female; D006261:Headache / Q000209:etiology; D020199:Hematoma, Subdural, Acute / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D006801:Humans; D007796:Laminectomy / Q000009:adverse effects; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D013116:Spinal Cord / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects