Subdural fluid collection rather than meningitis contributes to hydrocephalus after cervical laminoplasty: A case report

Table 1 Results of cerebrospinal fluid culture during hospitalization and follow-up

Date	Sample	WBCs	RBCs	Glucose	Protein	Chloride	CSF culture	Implication
1	Cyst puncture	WBCs: 450 × 106/L	0	5.92 mmol/L	1.478 g/L	Normal	Negative	Acute meningitis
2	Lumbar puncture	WBCs: 303 × 106/L; monocytes, 14%	0	Normal	4.24 g/L	117 mmol/L	Negative	Chronic meningitis
3	Lumbar puncture	WBCs: 10 × 106/L	0	5.09 mmol/L	2.02 g/L	130 mmol/L	Negative	Chronic meningitis

1: 13 d after cervical operation at a local hospital; 2: Readmission due to hydrocephalus at our hospital; 3: 21 mo after dural repair. WBCs: White blood cells; RBCs: Red blood cells; CSF: Cerebrospinal fluid.

Table 2 Summary of previously reported cases on hydrocephalus after spinal surgery

Ref.	Age (yr), sex	Spine procedure	Dural tear	Fever	CSF test	Risk factors of hydrocephalus	Intervention	Outcome
Bland and McDonald[14], 1992	58, M	Cervical tumor resection	Yes	None	Elevated CSF protein and red blood cell count	Elevated CSF protein, subarachnoid hemorrhage	VP shunt	Full recovery
Maezawa et al[4], 1996	69, F	Cervical laminoplasty	Yes	None	Elevated protein (64 mg/L)	Systemic hypertension, elevated CSF protein level, subdural hydroma, suboccipital arachnoiditis	VP shunt	Full recovery
Aghi et al[18], 2004	52, F	Cervical myelogram	None	None	Elevated leukocytes and erythrocytes	Hemorrhage in cervical subdural space	EVD, suboccipital craniectomy, and C1–C2 laminectomies	Full recovery
Koerts et al[10], 2008	45, M	Lumbar surgery	Yes	None	Moderate increase of WBCs, elevated protein level (69 mg/L) and lactate	Multiple lumbar surgery, CSF infection, and spinal adhesive arachnoiditis	EVD	Full recovery
Morofuji et al[11], 2009	51, M	Thoracic decompression	Yes	None	None	Remote cerebellar hemorrhage	Suboccipital decompression	Full recovery
Lindley et al[3], 2011	14, M	Oc–C2 fusion + rhBMP	None	None	None	Intense inflammatory response to rhBMP, wound seroma formation, Epidural fluid extending from the surgical site into the epidural space	EVD, wound exploration, and drain	Full recovery
	8,M	Oc–C1–C2 fusion + rhBMP	None	None	None			Full recovery
Stovell et al[6], 2013	63, F	C1-C2 fixation	Yes	None	None	Potential subarachnoid blood, injury of vessel	VP shunt	Full recovery
Cavanilles et al[7], 2013	65, F	Luambar fusion and decompression	Yes	None	None	Caudal sagging of cerebellum, mass effect with compression in the posterior fossa	EVD	Mild motor deficits
Kaloostian et al[9], 2013	77, M	T11–S1 posterior decompression and instrumented fusion	Yes	None	None	Subarachnoid blood in the cerebellar folia	VP shunt	Cognitive defects
	81, M	L4–5 decompression	Yes	None	None	Cerebellar hemorrhage	Ventriculostomy	Died
	64, F	L1~S1 posterior decompression and instrumented fusion	Yes	None	None	Large cerebellar hemorrhage, brainstem compression, and hydrocephalus	-	Died soon
Matsushima et al[5],2016	65, M	Cervical laminoplasty	Yes	None	Elevated protein (75 mg/L)	Increased CSF protein levels, spinal cord subarachnoidal hemorrhage	Dural repair and VP shunt	Full recovery
Endriga et al[8], 2016	62, F	Lumbar decompression	Yes	None	None	Subarachnoid hemorrhage, extensive subdural fluid collection, pseudomeningoceole	VP shunt	Full recovery
Benedetto et al[13], 2016	31, M	Cervical tumor resection	Yes	None	None	Subdurall fluid collections	Dural repair	Full recovery
Esfahani et al[15], 2017	7, M	Cervical neurenteric cyst resection	Yes	High fever	None	Contamination of high cytokeratin content or other debris in the CSF, chemical meningitis	VP shunt	Full recovery
Kobayashi et al[16], 2018	39, M	Cervical tumor resection	Yes	None	None	Aseptic meningitis, microhemorrhage, and fibrinogenic components	VP shunt and dural repair	Full recovery
Prior et al[17], 2018	6, F	Lumbar tumor resection	Yes	None	None	Possible dissemination of fat droplets in the subarachnoid spaces, aseptic	VP shunt and dural repair	Full recovery
Tan et al[12], 2018	76, F	L3-S1 laminectomies and fusion	Yes	None	None	Intraventricular hemorrhage	EVD	Full recovery

VP: Ventriculoperitoneal; EVD: External ventricular drainage; CSF: Cerebrospinal fluid.