gms | German Medical Science

57. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

11. bis 14.05.2006, Essen

Positional syncope after lumbar disc surgery

Bewusstseinsverlust durch Bandscheibenoperation?

Meeting Abstract

  • corresponding author M. Qweider - Neurochirurgische Klinik, Universitätsklinikum der RWTH Aachen
  • M.F. Oertel - Neurochirurgische Klinik, Universitätsklinikum der RWTH Aachen
  • J.M. Gilsbach - Neurochirurgische Klinik, Universitätsklinikum der RWTH Aachen
  • M.C. Korinth - Neurochirurgische Klinik, Universitätsklinikum der RWTH Aachen

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 57. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie. Essen, 11.-14.05.2006. Düsseldorf, Köln: German Medical Science; 2006. DocP 12.195

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dgnc2006/06dgnc412.shtml

Veröffentlicht: 8. Mai 2006

© 2006 Qweider et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective: Positional fainting caused by a cerebrospinal fluid (CSF) leak associated with spine surgery is an exceptional finding. We describe the unique case of recurrent positional syncope caused by acute intracranial hypertension due to a CSF leak after lumbar disc surgery.

Methods: A 56-year-old male was admitted with sudden onset of headache and recurrent syncopal fainting after lying in the supine position on firm furniture. He had undergone surgery for lumbar disc herniation at level L4/5 3 weeks before. 10 days after operation a swelling of the lower back appeared, which was unsuccessfully treated by repeated punctures. The patient’s history did not reveal any fainting before. Extensive investigations excluded any cardiologic or neurologic pathological findings as an underlying cause. Neuroimaging revealed a large dorsal subcutaneous accumulation of fluid, communicating with the dural sack and projecting at the level L4/5. Provoking syncopal fainting by positioning of the patient on his back was always positive and reproducible. With the presumptive diagnosis of a persistent postoperative CSF fistula a second operation was performed. Intraoperatively, a large subcutaneous sac extending to the dura mater was found and the associated dural leak was occluded, leading to complete resolution of the patient’s symptomatology.

Results: A rare case of syncopal fainting caused by position depending acute intracranial hypertension associated with a large post surgical accumulation of CSF was reported. Diagnostic work-up revealed a secondary pseudomeningocele, which was treated successfully by microsurgery.

Conclusions: Very uncommon is that dural leaks after spine surgery can result in intracranial hypertension. The present case description supports the hypothesis that not only symptomatic intracranial hypotension after opening of the subarachnoid cavity and loss of CSF, but also intracranial hypertension caused by a compression mechanism which forces the cerebrospinal fluid back into the subarachnoid cavity can be found post surgically. Secondary pseudomeningocele should be considered differential diagnostically in all cases of positional fainting after spine surgery.