- Department of Experimental Biomedicine and Clinical Neuroscience, Neurosurgical Unit, Paolo Giaccone University Hospital, Palermo, Italy
- Neurosurgical Unit Clinic, Catholic University, Rome, Italy
- Neurosurgical Unit, Medical College of Georgia Hospital, Augusta, GA, USA
Domenico Gerardo Iacopino
Department of Experimental Biomedicine and Clinical Neuroscience, Neurosurgical Unit, Paolo Giaccone University Hospital, Palermo, Italy
DOI:10.4103/2152-7806.173563Copyright: © 2016 Surgical Neurology International This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
How to cite this article: Maugeri R, Giugno A, Graziano F, Visocchi M, Giller C, Iacopino DG. Delayed chronic intracranial subdural hematoma complicating resection of a tanycytic thoracic ependymoma. Surg Neurol Int 07-Jan-2016;7:
How to cite this URL: Maugeri R, Giugno A, Graziano F, Visocchi M, Giller C, Iacopino DG. Delayed chronic intracranial subdural hematoma complicating resection of a tanycytic thoracic ependymoma. Surg Neurol Int 07-Jan-2016;7:. Available from: http://surgicalneurologyint.com/surgicalint_articles/delayed-chronic-intracranial-subdural-hematoma-complicating-resection-of-a-tanycytic-thoracic-ependymoma/
Background:To demonstrate that the diagnosis of an intracranial subdural hematoma should be considered for patients presenting with acute or delayed symptoms of intracranial pathology following resection of a spinal tumor.
Case Description:We present a case of a 57-year-old woman found to have a chronic subdural hematoma 1 month following resection of a thoracic extramedullary ependymoma. Evacuation of the hematoma through a burr hole relieved the presenting symptoms and signs. Resolution of the hematoma was confirmed with a computed tomography (CT) scan.
Conclusion:Headache and other symptoms not referable to spinal pathology should be regarded as a warning sign of an intracranial subdural hematoma, and a CT scan of the head should be obtained. The mechanism of the development of the hematoma may be related to the leakage of cerebrospinal fluid with subsequent intracranial hypotension leading to an expanding subdural space and hemorrhage.
Keywords: Cerebrospinal fluid leakage, chronic subdural hematoma, thoracic ependymoma
Chronic subdural hematoma is a common condition occurring typically in the elderly after a mild head injury.[
Although dural tears occurring during resection of spinal tumors are relatively common, symptomatic intracranial hypotension resulting from CSF loss in this setting is rare. The development of a chronic subdural hematoma after such a dural tear is even more rare and has been reported only 1 time to our knowledge.[
A 57-year-old woman presented with a 1-year history of progressive paraparesis. She reported pain radiating to both legs for several years and had been unable to walk for the previous 3 months. Her examination confirmed a severe paraparesis and a T12 sensory level but no bowel of bladder deficits.
A magnetic resonance (MR) scan revealed an enhancing tumor on the right side of the thoracic spine at the T11–T12 level [Figures
Pathologic examination revealed a tanycytic ependymoma, described only rarely in this location.[
Postoperatively, she experienced a rapid and progressive recovery of lower extremity motor and sensory function. Her walking ability improved, and she was discharged 10 days later.
One month following her resection, the patient complained of a persistent headache and was found to have a mild right hemiparesis. The remainder of her neurologic examination was unremarkable.
She denied any history of recent or remote head trauma or alcohol abuse and had no detectable coagulopathy.
Her thoracic incision was well-healed without evidence of CSF leakage.
A computed tomography (CT) scan showed an 18 mm thick collection of hypodense fluid in the subdural space over the left frontoparietal region with an 8 mm midline shift [
An MR imaging (MRI) of her thoracic spine showed a CSF collection at the resection site. She was felt that CSF leakage at the surgical site had produced intracranial hypotension and a chronic subdural hematoma that accounted for her symptoms and signs [Figure
The subdural space was evacuated through single burr hole, and a follow-up CT scan confirmed the resolution of the fluid and the midline shift [
To the best of our knowledge, this is the second report of a chronic subdural hematoma occurring in a delayed fashion following resection of a thoracic spinal tumor.[
Dural tears during neurosurgical procedures are common, with a prevalence of 1–17%.[
We report a very rare occurrence of a chronic intracranial subdural hematoma occurring in a delayed fashion after resection of a thoracic spinal tumor. The occurrence of this hematoma was likely due to intracranial hypotension due to CSF leakage, which may occur despite meticulous wound closure and the use of fibrin glue. The index of suspicion for an intracranial mass in patients presenting with a headache or other symptoms not explained by spinal pathology should be high, and acute diagnostic and therapeutic measures should be promptly instituted.
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