Positive-pressure ventilation attenuates subarachnoid-pleural fistula after thoracic spinal surgery: A report of two cases
Background: Dural tear and cerebrospinal fluid (CSF) leakage is known to be a complication of anterior thoracic spine surgery. If dural tear occurs on the ventral side of dura in combination with a pleural injury, it potentially becomes a subarachnoid-pleural fistula. The pressure gradient permits c...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
SAGE Publishing
2019-08-01
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| Series: | Journal of Orthopaedic Surgery |
| Online Access: | https://doi.org/10.1177/2309499019865470 |
| _version_ | 1818212206615986176 |
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| author | Mamoru Kono Masao Koda Tetsuya Abe Kousei Miura Katsuya Nagashima Kengo Fujii Hiroshi Kumagai Hiroshi Noguchi Toru Funayama Takeo Furuya Masashi Yamazaki |
| author_facet | Mamoru Kono Masao Koda Tetsuya Abe Kousei Miura Katsuya Nagashima Kengo Fujii Hiroshi Kumagai Hiroshi Noguchi Toru Funayama Takeo Furuya Masashi Yamazaki |
| author_sort | Mamoru Kono |
| collection | DOAJ |
| description | Background: Dural tear and cerebrospinal fluid (CSF) leakage is known to be a complication of anterior thoracic spine surgery. If dural tear occurs on the ventral side of dura in combination with a pleural injury, it potentially becomes a subarachnoid-pleural fistula. The pressure gradient permits continuous flow of CSF from the subarachnoid space into the cavum thorax, resulting in an intractable subarachnoid-pleural fistula. We report two cases of successfully treated subarachnoid-pleural fistula using noninvasive positive-pressure ventilation (NPPV). Methods: Two patients, a 52-year-old man and a 54-year-old woman, underwent anterior thoracic spine surgery to treat thoracic myelopathy caused by spinal tumor and ossification of the posterior longitudinal ligament. During surgery, dural tear and CSF leakage to the cavum thorax due to perforation of the dura was observed. We treated with polyglycolic acid sheet (Neovel ® ) in combination with fibrin glue; a suction drainage tube was placed at the subfascial level and the wound was drained with negative pressure. However, after removal of the drainage tube, subarachnoid-pleural fistula was proven. We applied NPPV to the patients. Results: We used the application of NPPV for 2 weeks in the first patient and 1 week in the second patient. In both of them, subarachnoid-pleural fistula was attenuated without apparent adverse events. Conclusion: NPPV is noninvasive and potentially useful therapy to attenuate subarachnoid-pleural fistula after thoracic spinal surgery. |
| first_indexed | 2024-12-12T05:44:43Z |
| format | Article |
| id | doaj.art-3c271c99668b4b44bb92ff2fe5818209 |
| institution | Directory Open Access Journal |
| issn | 2309-4990 |
| language | English |
| last_indexed | 2024-12-12T05:44:43Z |
| publishDate | 2019-08-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Journal of Orthopaedic Surgery |
| spelling | doaj.art-3c271c99668b4b44bb92ff2fe58182092022-12-22T00:35:49ZengSAGE PublishingJournal of Orthopaedic Surgery2309-49902019-08-012710.1177/2309499019865470Positive-pressure ventilation attenuates subarachnoid-pleural fistula after thoracic spinal surgery: A report of two casesMamoru Kono0Masao Koda1Tetsuya Abe2Kousei Miura3Katsuya Nagashima4Kengo Fujii5Hiroshi Kumagai6Hiroshi Noguchi7Toru Funayama8Takeo Furuya9Masashi Yamazaki10 Department of Orthopedic Surgery, University of Tsukuba, Ibaraki, Japan Department of Orthopedic Surgery, University of Tsukuba, Ibaraki, Japan Department of Orthopedic Surgery, University of Tsukuba, Ibaraki, Japan Department of Orthopedic Surgery, University of Tsukuba, Ibaraki, Japan Department of Orthopedic Surgery, University of Tsukuba, Ibaraki, Japan Department of Orthopedic Surgery, University of Tsukuba, Ibaraki, Japan Department of Orthopedic Surgery, University of Tsukuba, Ibaraki, Japan Department of Orthopedic Surgery, University of Tsukuba, Ibaraki, Japan Department of Orthopedic Surgery, University of Tsukuba, Ibaraki, Japan Department of Orthopedic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan Department of Orthopedic Surgery, University of Tsukuba, Ibaraki, JapanBackground: Dural tear and cerebrospinal fluid (CSF) leakage is known to be a complication of anterior thoracic spine surgery. If dural tear occurs on the ventral side of dura in combination with a pleural injury, it potentially becomes a subarachnoid-pleural fistula. The pressure gradient permits continuous flow of CSF from the subarachnoid space into the cavum thorax, resulting in an intractable subarachnoid-pleural fistula. We report two cases of successfully treated subarachnoid-pleural fistula using noninvasive positive-pressure ventilation (NPPV). Methods: Two patients, a 52-year-old man and a 54-year-old woman, underwent anterior thoracic spine surgery to treat thoracic myelopathy caused by spinal tumor and ossification of the posterior longitudinal ligament. During surgery, dural tear and CSF leakage to the cavum thorax due to perforation of the dura was observed. We treated with polyglycolic acid sheet (Neovel ® ) in combination with fibrin glue; a suction drainage tube was placed at the subfascial level and the wound was drained with negative pressure. However, after removal of the drainage tube, subarachnoid-pleural fistula was proven. We applied NPPV to the patients. Results: We used the application of NPPV for 2 weeks in the first patient and 1 week in the second patient. In both of them, subarachnoid-pleural fistula was attenuated without apparent adverse events. Conclusion: NPPV is noninvasive and potentially useful therapy to attenuate subarachnoid-pleural fistula after thoracic spinal surgery.https://doi.org/10.1177/2309499019865470 |
| spellingShingle | Mamoru Kono Masao Koda Tetsuya Abe Kousei Miura Katsuya Nagashima Kengo Fujii Hiroshi Kumagai Hiroshi Noguchi Toru Funayama Takeo Furuya Masashi Yamazaki Positive-pressure ventilation attenuates subarachnoid-pleural fistula after thoracic spinal surgery: A report of two cases Journal of Orthopaedic Surgery |
| title | Positive-pressure ventilation attenuates subarachnoid-pleural fistula after thoracic spinal surgery: A report of two cases |
| title_full | Positive-pressure ventilation attenuates subarachnoid-pleural fistula after thoracic spinal surgery: A report of two cases |
| title_fullStr | Positive-pressure ventilation attenuates subarachnoid-pleural fistula after thoracic spinal surgery: A report of two cases |
| title_full_unstemmed | Positive-pressure ventilation attenuates subarachnoid-pleural fistula after thoracic spinal surgery: A report of two cases |
| title_short | Positive-pressure ventilation attenuates subarachnoid-pleural fistula after thoracic spinal surgery: A report of two cases |
| title_sort | positive pressure ventilation attenuates subarachnoid pleural fistula after thoracic spinal surgery a report of two cases |
| url | https://doi.org/10.1177/2309499019865470 |
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