title: Subarachnoidal pleural fistula after resection of intradural thoracic disc herniation and multimodal treatment with noninvasive positive pressure ventilation (NPPV).
abstract: Subarachnoid pleural fistula (SPF) is a type of cerebrospinal fluid (CSF) fistula that can arise as a complication following transthoracic resection of intervertebral disc herniation in the thoracic spine. It is an abnormal communication between the subarachnoid and pleural space. Negative intrapleural pressure promotes CSF leak due to a suction effect into the pleural cavity, with little chance of spontaneous closure. Due to the risk of severe complications with CSF leak into the thoracic cavity, early diagnosis and treatment are mandatory. However, management can be challenging. We report a case of a 72-year-old woman who underwent anterior thoracic surgery to treat thoracic myelopathy caused by an ossified intradural disc herniation. The postoperative period was complicated by a subarachnoidal pleural fistula. We describe our successful treatment of this using noninvasive positive pressure ventilation and lumbar CSF drainage and review other methods reported in the literature.
authors.affiliation: Centre of Spinal Studies and Surgery, Queens Medical Centre, Campus of Nottingham University Hospitals NHS Trust, West Block, D Floor, Derby Road, Nottingham, NG7 2UH, UK. h.schlag@gmx.net.
authors.forename: Holger R
authors.initials: HR
authors.lastname: Schlag
authors.affiliation: Centre of Spinal Studies and Surgery, Queens Medical Centre, Campus of Nottingham University Hospitals NHS Trust, West Block, D Floor, Derby Road, Nottingham, NG7 2UH, UK.
authors.forename: Samiul
authors.initials: S
authors.lastname: Muquit
authors.affiliation: Department of Neurosurgery, Cologne-Merheim Medical Center, University of Witten-Herdecke, Campus Cologne-Merheim, Witten, Germany.
authors.forename: Tanyo B
authors.initials: TB
authors.lastname: Hristov
authors.affiliation: Centre of Spinal Studies and Surgery, Queens Medical Centre, Campus of Nottingham University Hospitals NHS Trust, West Block, D Floor, Derby Road, Nottingham, NG7 2UH, UK.
authors.forename: Guiseppe
authors.initials: G
authors.lastname: Morassi
authors.affiliation: Centre of Spinal Studies and Surgery, Queens Medical Centre, Campus of Nottingham University Hospitals NHS Trust, West Block, D Floor, Derby Road, Nottingham, NG7 2UH, UK.
authors.forename: Bronek Maximilian
authors.initials: BM
authors.lastname: Boszczyk
authors.affiliation: Centre of Spinal Studies and Surgery, Queens Medical Centre, Campus of Nottingham University Hospitals NHS Trust, West Block, D Floor, Derby Road, Nottingham, NG7 2UH, UK.
authors.forename: Masood
authors.initials: M
authors.lastname: Shafafy
mesh_terms: D000368:Aged; D003131:Combined Modality Therapy; D004322:Drainage / Q000379:methods*; D005260:Female; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000601:surgery*; D010995:Pleural Diseases / Q000209:etiology / Q000628:therapy*; D011175:Positive-Pressure Respiration; D011183:Postoperative Complications / Q000209:etiology / Q000628:therapy*; D016156:Respiratory Tract Fistula / Q000209:etiology / Q000628:therapy*; D013346:Subarachnoid Space; D013904:Thoracic Vertebrae / Q000601:surgery*
keywords: Intradural disc herniation; Subarachnoidal pleural fistula; Thoracic spine