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Subarachnoid-Pleural Fistula As a Complication of the Lateral-Extracavitary Approach to Thoracic Intraspinal Neurinoma

Diaz, P., MD; Maillo, A., MD; Hemández, J., MD; Morales, F., MD; Jiménez, M. F., MD*; Moreta, J. A., MD; Martin, J. A., MD

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Study Design This report describes an infrequent but major complication resulting from a lateral extracavitary approach to the spinal cord. The diagnosis was made via myelography-computed tomography.

Objectives The authors emphasize the importance of a proper approach in diagnosing a subarachnoid-pleural fistula and treating this clinical condition correctly.

Summary of Background Data Myelography-computed tomography was used to diagnose the subarachnoid-pleural fistula. It was necessary to re-open the thoracotomy to seal the dura mater because the pleuroperitoneal shunting was not effective.

Methods The patient presented with an intradural and extramedullary thoracic neurinoma located on the anterior part of the spinal canal that was causing anterior spinal cord compression. A lateral extracavitary approach was taken with a thoracotomy, with the tumor being completely removed. During the postoperative period, the patient had a persistent pleural effusion. The diagnosis of a cerebrospinal fluid fistula was made via myelography-computed tomography, Implantation of a pleuroperitoneal shunt was unsuccessful, and it was necessary to re-open the thoracotomy to seal the dura mater.

Results Myelography-computed tomography successfully helped diagnose the subarachnoid-pleural fistula and identify the precise anatomic location of the leakage. Pleuroperitoneal shunting was not effective in dealing with the pleural effusion.

Conclusions This complication should be taken into account when this kind of surgical approach is performed. Myelography-computed tomography is the most reliable test for diagnosing this clinical condition and pinpointing the exact location of the leakage.

Department of Neurosurgery, Virgen de la Vega Hospital, Salamance, Spain, and *Service of Thoracic Surgery, University Hospital, Salamanca.

© Lippincott-Raven Publishers.