Pneumocephalus leading to the diagnosis of cerebrospinal fluid leak and esophageal perforation after cervical spine surgery

C. Rory Goodwin, Christine E. Boone, James Pendleton, Benjamin D. Elder, Zhikui Wei, Wesley Hsu, Daniel Sciubba, Timothy F Witham

Research output: Contribution to journalArticle

Abstract

Pneumocephalus is a collection of air within in the intracranial cavity, most commonly seen following traumatic injury or cranial surgeries. Esophageal injury and cerebrospinal fluid (CSF) leak are rare complications that may occur following anterior cervical discectomy and fusion (ACDF). We present a novel case of pneumocephalus arising from unrestricted leakage of CSF via coincident esophageal injury and durotomy in a patient who underwent an ACDF after trauma. A 21-year-old man presented to an outside hospital with C5/C6 subluxation, complete spinal cord injury, and quadriplegia from a motor vehicle accident. He underwent an ACDF, during which a CSF leak was observed. He was then transferred to our institution for rehabilitation and tracheostomy placement 1. week after the ACDF surgery. Following the tracheostomy, the patient developed intractable fevers and nonspecific symptoms. A CT scan demonstrated frontal pneumocephalus without mass effect. Air was found in the retropharyngeal space. There were no accumulations of CSF in the neck. Extravasation of contrast around instrumentation at C5/C6 on a cine esophagogram demonstrated an esophageal perforation at that level. Pneumocephalus may form when large volumes of CSF escape from the intracranial space and air is drawn into the space by the negative pressure. In this unusual case, the esophageal perforation promoted the formation of the pneumocephalus. Treatment included closure of both defects, disrupting the suspected communication between the intracranial space and the esophagus.

Original languageEnglish (US)
JournalJournal of Clinical Neuroscience
DOIs
StateAccepted/In press - Sep 28 2015

Fingerprint

Pneumocephalus
Esophageal Perforation
Diskectomy
Spine
Tracheostomy
Air
Wounds and Injuries
Cerebrospinal Fluid
Quadriplegia
Motor Vehicles
Spinal Cord Injuries
Esophagus
Accidents
Fever
Neck
Rehabilitation
Communication
Cerebrospinal Fluid Leak
Pressure

Keywords

  • Anterior cervical discectomy and fusion
  • CSF leak
  • Esophageal perforation
  • Pneumocephalus
  • Spine
  • Trauma

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology
  • Physiology (medical)

Cite this

Pneumocephalus leading to the diagnosis of cerebrospinal fluid leak and esophageal perforation after cervical spine surgery. / Goodwin, C. Rory; Boone, Christine E.; Pendleton, James; Elder, Benjamin D.; Wei, Zhikui; Hsu, Wesley; Sciubba, Daniel; Witham, Timothy F.

In: Journal of Clinical Neuroscience, 28.09.2015.

Research output: Contribution to journalArticle

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