title: Complications corner: Anterior thoracic disc surgery with dural tear/CSF fistula and low-pressure pleural drain led to severe intracranial hypotension.
abstract: BACKGROUND
  Thoracic disc surgery can lead to a life-threatening complication: intracranial hypotension due to a subarachnoid-pleural fistula.
  
  
  METHODS
  We report a 63-year-old male with paraparesis due to multiple herniated thoracic discs, with compressive myelopathy. The patient required a circumferential procedure including a laminectomy/fusion followed by an anterior thoracic decompression to address both diffuse idiopathic skeletal hyperostosis (DISH) anteriorly and posterior stenosis. The postoperative course was complicated by severe intracranial hypotension attributed to the erroneous placement of a low-pressure drain placed in the pleural cavity instead of a lumbar drain; this resulted in subdural hematoma's necessitating subsequent surgery.
  
  
  CONCLUSIONS
  Severe neurological deterioration occurring after thoracic decompressive surgery may rarely be attributed to intracranial hypotension due to a subarachnoid-pleural fistula. Patients should be treated with external lumbar drainage of cerebrospinal fluid for 3-5 days rather than a low-pressure pleural drain to avoid the onset of intracranial hypotension leading to symptomatic subdural hematomas.
authors.affiliation: Department of Neurosurgery, Slotervaart Hospital, Louwesweg 6 1066 EC Amsterdam, The Netherlands ; Current Work Address: Department of Neurology, Saint Lucas Andreas Hospital, Jan Tooropstraat 164 1061 AE Amsterdam, The Netherlands.
authors.forename: Eline A
authors.initials: EA
authors.lastname: Oudeman
authors.affiliation: Department of Neurosurgery, Slotervaart Hospital, Louwesweg 6 1066 EC Amsterdam, The Netherlands ; Department of Neurosurgery, Medical Center Haaglanden, Leyweg 275, 2545 CH The Hague, The Netherlands.
authors.forename: Rishi D S
authors.initials: RD
authors.lastname: Nandoe Tewarie
authors.affiliation: Department of Neurology, Slotervaart Hospital, Louwesweg 6 1066 EC Amsterdam, The Netherlands.
authors.forename: G Joost
authors.initials: GJ
authors.lastname: Jöbsis
authors.affiliation: Department of Neurosurgery, Medical Center Haaglanden, Leyweg 275, 2545 CH The Hague, The Netherlands.
authors.forename: Mark P
authors.initials: MP
authors.lastname: Arts
authors.affiliation: Department of Neurology, Slotervaart Hospital, Louwesweg 6 1066 EC Amsterdam, The Netherlands ; Current Work Address: Department of Neurology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA 2300 RC Leiden, The Netherlands.
authors.forename: Nyika D
authors.initials: ND
authors.lastname: Kruyt
keywords: Cerebrospinal fluid leak; herniated disc; intracranial hypotension; spine; subarachnoid-pleural fistula; surgery