Tonic-clonic seizures as a possible complication for cerebrospinal fluid leakage after intradural spinal surgery, a case report

P. Pisano, F. Guerrini, V. Custodi, M. Del Maestro, R. Galzio, S. Luzzi

Research output: Contribution to journalArticle

Abstract

Background: Cerebrospinal fluid leakage is a well-known spinal surgery complication, especially in adults population. Pseudomeningocele is its most common manifestation and it can bring to some conditions, such as intracranial hypotension, infections and wound healing complication. Epilepsy is not classically associated to CSF leakage. We described a case of a female patient who developed tonic-clonic seizures associated with a pseudomeningocele after a detethering surgery. Case description: A 16 year old female was admitted to our department for surgical treatment of a tethered cord for a sacral lipoma. Her medical history was remarkable mental retardation with psychiatric disturbs and hypothyroidism. She underwent a surgical intervention for the detethering of conus and dura was closed by a suture and fibrin glue. During third postoperative day she started to suffer a severe occipital headache, followed by tonic-clonic seizures. During suture removal, a collection suspected for a pseudomeningocele was found and chemical and radiological exams confirmed the dubious. Despite a continuous bed rest, collection continued to form. So, we decided to perform a surgical revision and to close dural defect. After intervention, patient did not suffer postural headache anymore and after 3 and 6 months she was found in good health. Conclusion: We described the importance of significant morbidity, i.e. that of tonic clonic seizures as a sign of an occult CSF leakage after spinal surgery. Here, hydrocephalus as a condition was present, the change in pressure of CSF can determine seizures as well as promote this complication. A pseudomeningocele is not a trivial complication.

Original languageEnglish
Article number100576
JournalInterdisciplinary Neurosurgery: Advanced Techniques and Case Management
Volume19
DOIs
Publication statusPublished - Mar 2020

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Seizures
Sutures
Headache
Intracranial Hypotension
Fibrin Tissue Adhesive
Bed Rest
Lipoma
Hydrocephalus
Hypothyroidism
Reoperation
Intellectual Disability
Wound Healing
Psychiatry
Epilepsy
Spinal Cord
Morbidity
Pressure
Cerebrospinal Fluid Leak
Health
Infection

Keywords

  • Pseudomeningocele
  • Seizures
  • Spinal
  • Tethered cord

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

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title = "Tonic-clonic seizures as a possible complication for cerebrospinal fluid leakage after intradural spinal surgery, a case report",
abstract = "Background: Cerebrospinal fluid leakage is a well-known spinal surgery complication, especially in adults population. Pseudomeningocele is its most common manifestation and it can bring to some conditions, such as intracranial hypotension, infections and wound healing complication. Epilepsy is not classically associated to CSF leakage. We described a case of a female patient who developed tonic-clonic seizures associated with a pseudomeningocele after a detethering surgery. Case description: A 16 year old female was admitted to our department for surgical treatment of a tethered cord for a sacral lipoma. Her medical history was remarkable mental retardation with psychiatric disturbs and hypothyroidism. She underwent a surgical intervention for the detethering of conus and dura was closed by a suture and fibrin glue. During third postoperative day she started to suffer a severe occipital headache, followed by tonic-clonic seizures. During suture removal, a collection suspected for a pseudomeningocele was found and chemical and radiological exams confirmed the dubious. Despite a continuous bed rest, collection continued to form. So, we decided to perform a surgical revision and to close dural defect. After intervention, patient did not suffer postural headache anymore and after 3 and 6 months she was found in good health. Conclusion: We described the importance of significant morbidity, i.e. that of tonic clonic seizures as a sign of an occult CSF leakage after spinal surgery. Here, hydrocephalus as a condition was present, the change in pressure of CSF can determine seizures as well as promote this complication. A pseudomeningocele is not a trivial complication.",
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AU - Pisano, P.

AU - Guerrini, F.

AU - Custodi, V.

AU - Del Maestro, M.

AU - Galzio, R.

AU - Luzzi, S.

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N2 - Background: Cerebrospinal fluid leakage is a well-known spinal surgery complication, especially in adults population. Pseudomeningocele is its most common manifestation and it can bring to some conditions, such as intracranial hypotension, infections and wound healing complication. Epilepsy is not classically associated to CSF leakage. We described a case of a female patient who developed tonic-clonic seizures associated with a pseudomeningocele after a detethering surgery. Case description: A 16 year old female was admitted to our department for surgical treatment of a tethered cord for a sacral lipoma. Her medical history was remarkable mental retardation with psychiatric disturbs and hypothyroidism. She underwent a surgical intervention for the detethering of conus and dura was closed by a suture and fibrin glue. During third postoperative day she started to suffer a severe occipital headache, followed by tonic-clonic seizures. During suture removal, a collection suspected for a pseudomeningocele was found and chemical and radiological exams confirmed the dubious. Despite a continuous bed rest, collection continued to form. So, we decided to perform a surgical revision and to close dural defect. After intervention, patient did not suffer postural headache anymore and after 3 and 6 months she was found in good health. Conclusion: We described the importance of significant morbidity, i.e. that of tonic clonic seizures as a sign of an occult CSF leakage after spinal surgery. Here, hydrocephalus as a condition was present, the change in pressure of CSF can determine seizures as well as promote this complication. A pseudomeningocele is not a trivial complication.

AB - Background: Cerebrospinal fluid leakage is a well-known spinal surgery complication, especially in adults population. Pseudomeningocele is its most common manifestation and it can bring to some conditions, such as intracranial hypotension, infections and wound healing complication. Epilepsy is not classically associated to CSF leakage. We described a case of a female patient who developed tonic-clonic seizures associated with a pseudomeningocele after a detethering surgery. Case description: A 16 year old female was admitted to our department for surgical treatment of a tethered cord for a sacral lipoma. Her medical history was remarkable mental retardation with psychiatric disturbs and hypothyroidism. She underwent a surgical intervention for the detethering of conus and dura was closed by a suture and fibrin glue. During third postoperative day she started to suffer a severe occipital headache, followed by tonic-clonic seizures. During suture removal, a collection suspected for a pseudomeningocele was found and chemical and radiological exams confirmed the dubious. Despite a continuous bed rest, collection continued to form. So, we decided to perform a surgical revision and to close dural defect. After intervention, patient did not suffer postural headache anymore and after 3 and 6 months she was found in good health. Conclusion: We described the importance of significant morbidity, i.e. that of tonic clonic seizures as a sign of an occult CSF leakage after spinal surgery. Here, hydrocephalus as a condition was present, the change in pressure of CSF can determine seizures as well as promote this complication. A pseudomeningocele is not a trivial complication.

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