Treatment of the subarachnoid-pleural fistula. Case report.
Subarachnoid-pleural fistula is a rare type of cerebrospinal fluid (CSF) fistula, and there are only several cases reported in the literature. The authors describe a 65-year-old male patient in whom a diagnosis of T7-8 disc herniation had been made. He underwent surgery via a right lateral extracavitary approach. Postoperatively he developed progressive respiratory distress and headache. A chest x-ray film revealed a pleural effusion, and computerized tomography (CT) myelography demonstrated a subarachnoidal-pleural fistula at the level at which the herniated disc had been removed. The patient had been managed via a CSF drainage system and a chest tube. He was discharged after relief of symptoms was attained. Subarachnoid-pleural fistulas can be secondary to traumatic injury and surgery, or they can be spontaneous. Patients present with rapidly filling pleural effusion and headache. A diagnosis can be established using CT myelography or myeloscintigraphy. Treatment is conservative, with the placement of a chest tube and insertion of a CSF drainage catheter, and surgical repair should be considered only if the conservative therapy fails.
Ozgen
S
S
Marmara University, Department Of Neurosurgery, Istanbul-Turkey. omurga@turk.net
Boran
B O
BO
Elmaci
I
I
Ture
U
U
Pamir
M N
MN
D000368:Aged; D015170:Cerebrospinal Fluid Pressure / Q000502:physiology; D002557:Cerebrospinal Fluid Shunts; D015505:Chest Tubes; D017586:Diskectomy / Q000009:adverse effects; D004388:Dura Mater / Q000293:injuries* / Q000503:physiopathology; D005402:Fistula / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000601:surgery; D008297:Male; D035422:Pleural Cavity / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D010996:Pleural Effusion / Q000209:etiology* / Q000503:physiopathology; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D013346:Subarachnoid Space / Q000000981:diagnostic imaging / Q000293:injuries* / Q000503:physiopathology; D013353:Subdural Effusion / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D013904:Thoracic Vertebrae / Q000601:surgery; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome