Lourenço Costa Bruno, Shamasna Motasem, Nunes Joana, Magalhães Florbela, Peliz António Júdice
Department of Neurosurgery, Centro Hospitalar e Universitário de Coimbra, Praceta Mota Pinto, 3000-075, Coimbra, Portugal,
Eur Spine J. 2014 May;23 Suppl 2:253-6. doi: 10.1007/s00586-013-3147-0. Epub 2013 Dec 28.
To provide new insights into the pathophysiology, prevention and diagnosis of cerebral venous thrombosis (CVT) associated with iatrogenic cerebrospinal fluid (CSF) leaks and/or external CSF drainage.
Case report and literature review.
We describe the case of a 30-year-old woman who developed a CSF fistula after lumbar spinal surgery. The treatment included rest, hydration, caffeine, and continuous lumbar CSF drainage. After closure of the fistula, the patient complained of severe orthostatic headache. Thrombosis involving the superior sagittal sinus, the right transverse sinus, the right sigmoid sinus, and the right jugular vein was diagnosed after neurological deterioration.
A few reports have associated CVT with various forms of spinal meningeal injury. However, it has been rarely documented following spinal surgery complicated by accidental durotomy and/or external lumbar CSF drainage. CSF hypovolemia may precipitate CVT in patients having prothrombotic risk factors. Patients who have or had CSF leaks and/or lumbar CSF drains who present with symptoms of intracranial CSF hypotension should remain in the horizontal position to prevent CVT. In that context, the diagnosis of CVT depends on a high degree of suspicion.
为与医源性脑脊液（CSF）漏和/或外部CSF引流相关的脑静脉血栓形成（CVT）的病理生理学、预防和诊断提供新的见解。
病例报告和文献综述。
我们描述了一名30岁女性在腰椎手术后发生CSF瘘的病例。治疗包括休息、补液、咖啡因和持续腰椎CSF引流。瘘口闭合后，患者抱怨严重的直立性头痛。在神经功能恶化后，诊断出涉及上矢状窦、右侧横窦、右侧乙状窦和右侧颈静脉的血栓形成。
少数报告将CVT与各种形式的脊髓脑膜损伤相关联。然而，在脊柱手术并发意外硬脊膜切开和/或外部腰椎CSF引流后，这种情况很少有记录。CSF血容量不足可能在具有血栓形成危险因素的患者中引发CVT。有或曾有CSF漏和/或腰椎CSF引流且出现颅内CSF低压症状的患者应保持水平卧位以预防CVT。在这种情况下，CVT的诊断取决于高度的怀疑。
