Intracranial hypotension after intraoperative lumbar cerebrospinal fluid drainage.
OBJECTIVE
Intraoperative lumbar cerebrospinal fluid drainage is frequently performed in a variety of neurosurgical procedures. A retrospective review is presented of the complications of lumbar cerebrospinal fluid drainage.


METHODS
The records from 75 consecutive operations requiring intraoperative lumbar cerebrospinal drainage during a 1-year period at the Hospital of the University of Pennsylvania were reviewed to assess the types of complications attributable to spinal drainage and their rates of occurrence. The operations were categorized into 46 aneurysm clippings, 21 craniotomies for tumors, and 8 other cranial base procedures.


RESULTS
Two patients developed transient postoperative neurological complications as a result of intracranial hypotension that resolved after epidural blood patching, with a reexploration craniotomy to drain an epidural collection performed in one patient. A third patient in the study developed a persistent deficit when intracranial hypotension led to intraoperative transtentorial herniation, which resulted in an unusual constellation of multiple brainstem infarcts that caused cranial neuropathy.


CONCLUSIONS
Complications of intraoperative lumbar cerebrospinal fluid drainage resulting in transient (2 of 75 patients, 3%) or persistent (1 of 75 patients, 1%) neurological deficits caused by intracranial hypotension occur infrequently and may be related to preexisting conditions such as hydrocephalus.
Samadani
Uzma
U
Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA. uzmasam@yahoo.com
Huang
Jason H
JH
Baranov
Dmitriy
D
Zager
Eric L
EL
Grady
M Sean
MS
D000328:Adult; D017217:Blood Patch, Epidural; D001929:Brain Edema / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D001932:Brain Neoplasms / Q000601:surgery*; D003399:Craniotomy; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery*; D019585:Intracranial Hypotension / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D007427:Intracranial Pressure / Q000502:physiology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D012189:Retrospective Studies; D019291:Skull Base / Q000601:surgery*; D013129:Spinal Puncture; D014057:Tomography, X-Ray Computed