Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Aug 6, 2021; 9(22): 6485-6492
Published online Aug 6, 2021. doi: 10.12998/wjcc.v9.i22.6485
Subdural fluid collection rather than meningitis contributes to hydrocephalus after cervical laminoplasty: A case report
Hao-Han Huang, Zhi-Hua Cheng, Bao-Zhi Ding, Jie Zhao, Chang-Qing Zhao
Hao-Han Huang, Bao-Zhi Ding, Jie Zhao, Chang-Qing Zhao, Department of Orthopaedics, Shanghai Key Laboratory of Orthopaedic Implants, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
Zhi-Hua Cheng, Department of Neurosurgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
Author contributions: Huang HH, Cheng ZH, Ding BZ, Zhao J, and Zhao CQ designed the study; Huang HH collected the data; Huang HH, Cheng ZH, Ding BZ, Zhao J, and Zhao CQ analyzed the data and developed the methodology; Huang HH was a major contributor in writing the manuscript; Huang HH, Cheng ZH, and Zhao CQ analyzed and interpreted the patient’s data; Zhao CQ oversaw the study; Huang HH and Cheng ZH contributed equally to this work; all authors read and approved the final manuscript.
Informed consent statement: Written informed consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare no conflicts of interest for this manuscript.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Chang-Qing Zhao, MD, PhD, Chief Doctor, Department of Orthopaedics, Shanghai Key Laboratory of Orthopaedic Implants, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, No. 639 Zhizaoju Road, Shanghai 200011, China. zhaocq9hospital@163.com
Received: March 28, 2021
Peer-review started: March 28, 2021
First decision: April 28, 2021
Revised: May 9, 2021
Accepted: May 27, 2021
Article in press: May 27, 2021
Published online: August 6, 2021
Processing time: 121 Days and 9.2 Hours
Abstract
BACKGROUND

Hydrocephalus following dural tear after spinal surgery is rare. Although a few cases of obstructive hydrocephalus caused by subdural fluid collection and communicating hydrocephalus associated with meningitis have been reported, the mechanism remains uncertain. Herein we describe a patient complicated with hydrocephalus after cervical laminoplasty in whom subdural fluid collection in the cervical spine and posterior cranial fossa rather than chronic meningitis was the main mechanism.

CASE SUMMARY

A 45-year-old man underwent cervical laminoplasty for cervical spondylotic myelopathy at a local hospital. Ten days postoperatively, a high fever occurred and magnetic resonance imaging (MRI) showed cerebrospinal fluid (CSF) leakage. Pseudomeningocele liquid test showed high levels of protein and white blood cell (WBC) count with negative bacterial culture. The patient was treated with short-term intravenous antibiotic and discharged with normal body temperature. The patient was uneventful during the first 8 mo follow-up although repeated MRI showed persistent pseudomeningocele. At the 9th mo postoperatively, the patient gradually presented with dizziness and headache accompanied by recurrent weakness of his left arm. Imaging examinations demonstrated hydrocephalus and a cystic lesion around the cervical spinal cord. CSF test from lumbar puncture indicated chronic meningitis. MRI on 1 d after pseudomeningocele drainage showed a significant decrease in the cystic volume, suggesting that the cystic lesion would be subdural fluid collection rather than adhesive arachnoiditis. After dural defect repair, the patient’s symptoms completely resolved and hydrocephalus gradually disappeared. CSF analysis at the 21-mo follow-up revealed significantly decreased protein level and WBC count.

CONCLUSION

Subdural fluid collection rather than meningitis contributes to the hydrocephalus formation after cervical laminoplasty.

Keywords: Hydrocephalus; Cerebrospinal fluid leakage; Cervical laminoplasty; Subdural fluid collection; Meningitis; Case report

Core Tip: Hydrocephalus following dural tear after spinal surgery is rare, and the mechanism remains uncertain. Although this case is not the first case of subdural fluid collection or chronic meningitis accompanied with hydrocephalus after spinal surgery, it is the first case of hydrocephalus accompanied with both subdural fluid collection and chronic meningitis. It confirmed that subdural fluid collection rather than meningitis mainly contributes to hydrocephalus after cervical laminoplasty for the first time. Combined with this case and literature review, it provided a reliable explanation for the mechanism of hydrocephalus after spinal surgery.