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57th Annual Meeting of the German Society of Neurosurgery
Joint Meeting with the Japanese Neurosurgical Society

German Society of Neurosurgery (DGNC)

11 - 14 May, Essen

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Positional syncope after lumbar disc surgery

Bewusstseinsverlust durch Bandscheibenoperation?

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  • 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

The electronic version of this article is the complete one and can be found online at: http://www.egms.de/en/meetings/dgnc2006/06dgnc412.shtml

Published: May 8, 2006

© 2006 Qweider et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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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.