Spinal intradural granuloma as a complication of an infected cerebrospinal fluid drainage tube fragment--case report.
A 69-year-old man presented with subarachnoid hemorrhage due to a ruptured anterior communicating artery aneurysm. The aneurysm neck was clipped and a lumbar drainage tube was inserted for cerebrospinal fluid drainage. However, the tube was accidentally cut during removal and a fragment remained in the spinal canal. A subarachnoid, subcutaneous abscess appeared 7 days later, which was treated with antibiotics. He noted numbness of his left leg after 6 months, and gait disturbance manifested 3 months later. T(1)-weighted magnetic resonance (MR) imaging disclosed a well-enhanced extramedullary mass at the T9-10 intervertebral level, and T(2)-weighted MR imaging showed moderate edema around the peri-lesional spinal cord. The mass containing a drainage tube fragment was surgically removed. Histological examination confirmed granuloma due to chronic infection. This case suggests that retained tube fragments should be removed surgically, especially in the presence of infectious complications.
Aoyama
Takeshi
T
Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido. taoya@sirius.ocn.ne.jp
Hida
Kazutoshi
K
D000368:Aged; D002408:Catheters, Indwelling / Q000009:adverse effects; D002557:Cerebrospinal Fluid Shunts / Q000592:standards; D019299:Decompression, Surgical; D020802:Epidural Abscess / Q000209:etiology / Q000473:pathology* / Q000503:physiopathology; D004824:Epidural Space / Q000382:microbiology / Q000473:pathology / Q000601:surgery; D004866:Equipment Contamination / Q000517:prevention & control*; D005548:Foreign-Body Migration / Q000473:pathology* / Q000503:physiopathology; D015745:Granuloma, Foreign-Body / Q000209:etiology / Q000473:pathology* / Q000503:physiopathology; D006801:Humans; D006849:Hydrocephalus / Q000517:prevention & control / Q000601:surgery; D002532:Intracranial Aneurysm / Q000601:surgery; D007796:Laminectomy; D008159:Lumbar Vertebrae / Q000382:microbiology / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D013115:Spinal Canal / Q000382:microbiology / Q000473:pathology / Q000601:surgery; D013117:Spinal Cord Compression / Q000209:etiology / Q000473:pathology* / Q000503:physiopathology; D013129:Spinal Puncture / Q000009:adverse effects* / Q000295:instrumentation; D013130:Spinal Stenosis / Q000382:microbiology / Q000473:pathology / Q000503:physiopathology; D013396:Suction / Q000009:adverse effects / Q000295:instrumentation; D016896:Treatment Outcome