Burr Hole Drainage : Could Be Another Treatment Option for Cerebrospinal Fluid Leakage after Unidentified Dural Tear during Spinal Surgery?
A 69-year-old female with a history of previous spinal surgery was diagnosed with progressively worsening neurogenic claudication. The patient had no history of head injury and had not taken antiplatelet or anticoagulant medications. Spinal magnetic resonance imaging showed severe spinal stenosis and degenerative spondylolisthesis from level L2 to S1.\nThe patient underwent decompressive laminectomies and lumbosacral arthrodesis at the corresponding levels. During the operation, dural injury and CSF leakage in the surgical field were not evident.\nThe patient was transferred to the surgical intensive care unit for hemodynamic monitoring after surgery. On the first postoperative day, approximately 940 cc of serosanguineous fluid was collected from two subfascial wound drains. She complained of severe headache and had one episode of generalized tonic clonic convulsion. An emergent brain computed tomography (CT) scan showed acute and chronic subdural hemorrhages along the right frontal, temporal and parietal lobes, with a maximal width of 1.5 cm, 5 mm right-to-left midline shift, and intraventricular hemorrhage in both lateral ventricles (). After the CT scan, her mental status recovered, and she presented no focal neurological deficits.\nIntracranial hypotension caused by CSF leakage through an unidentified dural injury site unlikely resulted in acute subdural hemorrhage and intraventricular hemorrhage at the preexisting asymptomatic chronic subdural hemorrhage. On the third postoperative day, one burr hole was made over the right parietal skull under local anesthesia. The brown colored chronic subdural hemorrhage was gushed out and a catheter was positioned in the subdural space. A daily average of approximately 228 cc of blood-containing CSF was drained for 7 days. Serosanguineous fluid from the spinal subfascial wound drains markedly decreased, and the drain was removed 2 days after cranial CSF drainage. The catheter was maintained for 5 more days, and the patient recovered without further complications.