A rare case of concomitant pneumocephalus and pneumorachis after lumbar spine surgery with late presenting dural leak

Article metrics

  • 11 Accesses

Abstract

Introduction

We report a case of pneumocephalus and pneumorachis i.e., air in the cranial cavity and the spinal canal, which are rarely associated with a primary spinal cause. Their concomitant occurrence and association with a late presenting dural leak are also uncommon.

Case presentation

A 70-year-old man presented 1 month after decompressive surgery for lumbar canal stenosis with leakage of cerebrospinal fluid (CSF) from the wound site and severe headache. There were no signs of surgical site infection or meningitis. There was no intraoperative or immediate postoperative evidence of dural tear. He was neurologically intact. On detailed work-up, he was found to have air collections in the subarachnoid and intraventricular spaces in the brain and intraspinal air in both the cervical and the lumbar regions. He showed gradual resolution of these findings radiologically and symptomatic improvement through conservative management with analgesics, empirical antibiotics, high flow oxygen, and maintenance of hydration within 1 month.

Discussion

Pneumocephalus and pneumorachis are commonly seen after trauma. Spine surgery is a rare cause. They may present with symptoms similar to meningitis and may be erroneously diagnosed and treated. No standard treatment guidelines exist in the literature. Most cases have been managed conservatively. Early detection may allow noninvasive management leading to complete resolution.

Access options

Rent or Buy article

Get time limited or full article access on ReadCube.

from$8.99

All prices are NET prices.

Fig. 1
Fig. 2
Fig. 3

References

  1. 1.

    Karavelioglu E, Eser O, Haktanir A. Pneumocephalus and pneumorrhachis after spinal surgery: case report and review of the literature. Neurol Med Chir (Tokyo) 2013;54:405–7. https://doi.org/10.2176/nmc.cr2013-0118.

  2. 2.

    Akyüz O, Gökpınar D, Aydın E, et al. Pneumocephalus and pneumorrhachis after spinal surgery. Pol J Radiol 2016;81:34–5. https://doi.org/10.12659/PJR.895570.

  3. 3.

    Menon SK, Onyia CU. A short review on a complication of lumbar spine surgery: CSF leak. Clin Neurol Neurosurg 2015;139:248–51. https://doi.org/10.1016/j.clineuro.2015.10.013.

  4. 4.

    Cammisa FP Jr, Girardi FP, Sangani PK, Parvataneni HK, Cadag S, Sandhu HS. Incidental durotomy in spine surgery. Spine 2000;25:2663–7.

  5. 5.

    Chaichana KL, Pradilla G, Witham TF, Gokaslan ZL, Bydon A. The clinical significance of pneumorachis: a case report and review of the literature. J Trauma 2010;68:736–44. https://doi.org/10.1097/TA.0b013e3181c46dd3.

  6. 6.

    M Das J, Bajaj J. Pneumocephalus. StatPearls. Treasure Island (FL): StatPearls Publishing. 2019.

  7. 7.

    Ozturk E, Kantarci M, Karaman K, Basekim CC, Kizilkaya E. Diffuse pneumocephalus associated with infratentorial and supratentorial hemorrhages as a complication of spinal surgery. Acta Radiol 2006;47:497–500.

  8. 8.

    Turgut M, Akyüz O. Symptomatic tension pneumocephalus: an unusual post-operative complication of posterior spinal surgery. J Clin Neurosci 2007;14:666–8.

Download references

Acknowledgements

The authors would like to thank the patient and his family to give consent for reporting of this case.

Author information

Correspondence to Mayank Gupta.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Gupta, M., Kumar Varma, K.K. & Singh Chhabra, H. A rare case of concomitant pneumocephalus and pneumorachis after lumbar spine surgery with late presenting dural leak. Spinal Cord Ser Cases 5, 86 (2019) doi:10.1038/s41394-019-0235-3

Download citation