Department of Orthopaedic Surgery, Shinshu University School of Medicine, Nagano, Japan.
Department of Orthopaedic Surgery, Marunouchi Hospital, Nagano, Japan.
Br J Neurosurg. 2024 Jun;38(3):706-711. doi: 10.1080/02688697.2021.1958157. Epub 2021 Sep 23.
Postoperative intracranial complications are rare in spine surgery not including cranial procedures. We describe an uncommon case of pseudohypoxic brain swelling (PHBS) and secondary hydrocephalus after transforaminal lumbar interbody fusion (TLIF) presenting as impaired consciousness and repeated seizures.
A 65-year-old man underwent L4-5 TLIF for lumbar spondylolisthesis and began experiencing generalized seizures immediately postoperatively. Computed tomography (CT) revealed diffuse cerebral edema-like hypoxic ischemic encephalopathy. He was transported to our hospital, at which time epidural drainage was halted and anti-edema therapy was commenced. His impaired consciousness improved. However, he suffered secondary hydrocephalus due to continuous bleeding from a dural defect and spinal epidural fluid collection 3 months later. Following the completion of dural repair and insertion of a ventriculoperitoneal shunt, his neurologic symptoms and neuroimaging findings improved significantly.
PHBS can be considered in patients with unexpected neurological deterioration following lumbar spine surgery even with the absence of documented durotomy. This might be due to postoperative intracranial hypotension-associated venous congestion, and to be distinguished from the more common postoperative cerebral ischemic events-caused by arterial or venous occlusions-or anesthetics complications.
脊柱手术（不包括颅部手术）后颅内并发症罕见。我们描述了一例罕见的术后颅低压性脑肿胀（PHBS）和继发性脑积水病例，该患者在经椎间孔腰椎体间融合术（TLIF）后表现为意识障碍和反复癫痫发作。
一名 65 岁男性因腰椎滑脱症接受 L4-5 TLIF 治疗，术后即刻出现全身癫痫发作。计算机断层扫描（CT）显示弥漫性类似缺氧缺血性脑病的脑水肿。他被转运至我院，此时停止硬膜外引流并开始进行抗水肿治疗。他的意识障碍有所改善。然而，3 个月后，由于硬脑膜缺损持续出血和硬脊膜外积液，他继发了脑积水。完成硬脑膜修补和脑室-腹腔分流术后，他的神经症状和神经影像学表现显著改善。
即使没有记录到硬脊膜切开术，腰椎手术后出现意外神经功能恶化的患者也可以考虑 PHBS。这可能是由于术后颅内低血压相关的静脉充血引起的，与更常见的术后由动脉或静脉阻塞引起的脑缺血事件或麻醉并发症不同。
