title: A case of chronic subdural hematoma following lumbar drainage for the management of iatrogenic cerebrospinal fluid rhinorrhea: pitfalls and lessons.
abstract: Chronic subdural hematoma as a complication of lumbar drain placement for the management of iatrogenic cerebrospinal fluid (CSF) leak has not been previously documented in the literature. We describe such a case in a 69-year-old man who presented with right nasal obstruction secondary to an inverted papilloma involving the paranasal sinuses. The patient underwent endoscopic sinus surgery, which included a medial maxillectomy. Surgery was complicated by a small CSF leak, which was repaired intraoperatively. Five days later, the patient experienced CSF rhinorrhea, and a lumbar drain was inserted. He developed overdrainage symptoms but was well when he was discharged. However, 22 days later he returned with right hemiparesis. Computed tomography of the brain showed a left frontoparietal subdural hematoma with a mass effect. The neurosurgical team performed an emergency drainage procedure, and the patient experienced a complete neurologic recovery. We discuss the pitfalls of lumbar drainage, the possible pathophysiology of overdrainage, and the lessons learned from this case.
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Sarawak General Hospital, Jalan Tun Ahmad Zaidi Adruce, Kuching, Sarawak 93400, Malaysia. drvincenttan@gmail.com.
authors.forename: Vincent Eng-Soon
authors.initials: VE
authors.lastname: Tan
authors.forename: Donald
authors.initials: D
authors.lastname: Liew
mesh_terms: D000368:Aged; D002559:Cerebrospinal Fluid Rhinorrhea / Q000209:etiology / Q000628:therapy; D004322:Drainage / Q000009:adverse effects*; D004724:Endoscopy / Q000009:adverse effects; D020200:Hematoma, Subdural, Chronic / Q000209:etiology*; D006801:Humans; D008161:Lumbosacral Region; D008297:Male; D018308:Papilloma, Inverted / Q000601:surgery*; D010255:Paranasal Sinus Neoplasms / Q000601:surgery*