Early post‑operative cerebrospinal fluid hypovolemia: Report of 7 cases

Hou,Kun; Zhu,Xiaobo; Zhang,Yang; Gao,Xianfeng; Suo,Shihuan; Zhao,Jinchuan; Li,Guichen

doi:10.3892/etm.2018.6018

June-2018 Volume 15 Issue 6

Full Size Image

Journals

International Journal of Molecular Medicine

International Journal of Molecular Medicine is an international journal devoted to molecular mechanisms of human disease.

International Journal of Oncology

International Journal of Oncology is an international journal devoted to oncology research and cancer treatment.

Molecular Medicine Reports

Covers molecular medicine topics such as pharmacology, pathology, genetics, neuroscience, infectious diseases, molecular cardiology, and molecular surgery.

Oncology Reports

Oncology Reports is an international journal devoted to fundamental and applied research in Oncology.

Experimental and Therapeutic Medicine

Experimental and Therapeutic Medicine is an international journal devoted to laboratory and clinical medicine.

Oncology Letters

Oncology Letters is an international journal devoted to Experimental and Clinical Oncology.

Biomedical Reports

Explores a wide range of biological and medical fields, including pharmacology, genetics, microbiology, neuroscience, and molecular cardiology.

Molecular and Clinical Oncology

International journal addressing all aspects of oncology research, from tumorigenesis and oncogenes to chemotherapy and metastasis.

World Academy of Sciences Journal

Multidisciplinary open-access journal spanning biochemistry, genetics, neuroscience, environmental health, and synthetic biology.

International Journal of Functional Nutrition

Open-access journal combining biochemistry, pharmacology, immunology, and genetics to advance health through functional nutrition.

International Journal of Epigenetics

Publishes open-access research on using epigenetics to advance understanding and treatment of human disease.

Medicine International

An International Open Access Journal Devoted to General Medicine.

June-2018 Volume 15 Issue 6

Full Size Image

Article

Early post‑operative cerebrospinal fluid hypovolemia: Report of 7 cases

Authors:
- Kun Hou
- Xiaobo Zhu
- Yang Zhang
- Xianfeng Gao
- Shihuan Suo
- Jinchuan Zhao
- Guichen Li
View Affiliations / Copyright

Affiliations: Department of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China, Department of Neurology, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
Pages: 5119-5124
|
Published online on: April 2, 2018

https://doi.org/10.3892/etm.2018.6018
Expand metrics +

Abstract

Cerebrospinal fluid (CSF) hypovolemia is a common neurosurgical condition, which may be spontaneous or iatrogenic. At our institution, a substantial number of the reported cases of early post‑operative CSF hypovolemia were identified to have unintentional or unrecognized post‑operative continuous excessive CSF leakage. Cases who presented with post‑operative CSF hypovolemia several days after uneventful intracranial surgeries without continuous CSF leakage were rarely reported. A retrospective review of the medical records of these patients was performed to identify those patients who developed early post‑operative CSF hypovolemia without the presence of post‑operative continuous CSF leakage. A total of 7 patients, 5 of which were males, were identified in this retrospective study. They experienced CSF hypovolemia between days 1 and 7 after emergency or scheduled intracranial surgeries. Ventricular collapse, cisternal effacement and midline shift are the most common radiological observations. With early diagnosis and management, 4 of the patients achieved a Glasgow Outcome Scale (GOS) score of 5, 1 achieved a GOS score of 4 and the remaining 2 had a GOS score of 3. No mortality was noted in this series. Although rare in incidence, early post‑operative CSF hypovolemia may occur without the existence of post‑operative continuous CSF leakage. When the diagnosis of CSF hypovolemia is reached, factors that may exacerbate CSF compensation should be promptly terminated. Trendelenburg position and sufficient intravenous hydration are practical and effective managements, and CSF hypovolemia may thereby be reversed in a substantial number of patients.

View Figures

View References

1	Kawahara I, Tsutsumi K, Matsunaga Y, Takahata H, Ono T, Toda K and Baba H: Early awareness of cerebrospinal fluid hypovolemia after craniotomy for microsurgical aneurysmal clipping. Acta Neurochir (Wien). 155:1543–1548. 2013. View Article : Google Scholar : PubMed/NCBI
2	Li G, Zhu X, Zhang Y, Zhao J, Han Z and Hou K: Cranial nerve palsy secondary to cerebrospinal fluid diversion. Clin Neurol Neurosurg. 143:19–26. 2016. View Article : Google Scholar : PubMed/NCBI
3	Van Roost D, Thees C, Brenke C, Oppel F, Winkler PA and Schramm J: Pseudohypoxic brain swelling: A newly defined complication after uneventful brain surgery, probably related to suction drainage. Neurosurgery. 53:1315–1326. 2003. View Article : Google Scholar : PubMed/NCBI
4	Sugrue PA, Hsieh PC, Getch CC and Batjer HH: Acute symptomatic cerebellartonsillar herniation following intraoperative lumbar drainage. J Neurosurg. 110:800–803. 2009. View Article : Google Scholar : PubMed/NCBI
5	Miyazawa K, Shiga Y, Hasegawa T, Endoh M, Okita N, Higano S, Takahashi S and Itoyama Y: CSF hypovolemia vs intracranial hypotension in ‘spontaneous intracranial hypotension syndrome’. Neurology. 60:941–947. 2003. View Article : Google Scholar : PubMed/NCBI
6	Parpaley Y, Urbach H, Kovacs A, Klehr M and Kristof RA: Pseudohypoxic brain swelling (postoperative intracranial hypotension-associated venous congestion) after spinal surgery: Report of 2 cases. Neurosurgery. 68:E277–E283. 2011. View Article : Google Scholar : PubMed/NCBI
7	Yokota H, Yokoyama K, Miyamoto K and Nishioka T: Pseudohypoxic brain swelling after elective clipping of an unruptured anterior communicating artery aneurysm. Clin Neurol Neurosurg. 111:900–903. 2009. View Article : Google Scholar : PubMed/NCBI
8	Evins AI, Boeris D, Burrell JC and Ducati A: Postoperative intracranial hypotension-associated venous congestion: Case report and literature review. Clin Neurol Neurosurg. 115:2243–2246. 2013. View Article : Google Scholar : PubMed/NCBI
9	Snyder KA, Clarke MJ, Gilbertson JR and Hocker SE: Prompt recognition and management of postoperative intracranial hypotension-associated venous congestion: A case report. Neurocrit Care. 24:448–453. 2016. View Article : Google Scholar : PubMed/NCBI
10	Teasdale G and Jennett B: Assessment of coma and impaired consciousness. A practical scale. Lancet. 2:81–84. 1974. View Article : Google Scholar : PubMed/NCBI
11	Oyelese AA, Steinberg GK, Huhn SL and Wijman CA: Paradoxical cerebral herniation secondary to lumbar puncture after decompressive craniectomy for a large space-occupying hemispheric stroke: Case report. Neurosurgery. 57:E5942005. View Article : Google Scholar : PubMed/NCBI
12	Jung HJ, Kim DM and Kim SW: Paradoxical transtentorial herniation caused by lumbar puncture after decompressive craniectomy. J Korean Neurosurg Soc. 51:102–104. 2012. View Article : Google Scholar : PubMed/NCBI
13	Creutzfeldt CJ, Vilela MD and Longstreth WT Jr: Paradoxical herniation after decompressive craniectomy provoked by lumbar puncture or ventriculoperitoneal shunting. J Neurosurg. 123:1170–1175. 2015. View Article : Google Scholar : PubMed/NCBI
14	Komotar RJ, Mocco J, Ransom ER, Mack WJ, Zacharia BE, Wilson DA, Naidech AM, McKhann GM 2nd, Mayer SA, Fitzsimmons BF and Connolly ES Jr: Herniation secondary to critical postcraniotomy cerebrospinal fluid hypovolemia. Neurosurgery. 57:286–292. 2005. View Article : Google Scholar : PubMed/NCBI
15	Lundberg N: The saga of the Monro-Kellie doctrine in intracranial pressure VIshii S, Nagai H and Brock M: Proceedings of the fifth international symposium on intracranial pressure. Springer; Tokyo: pp. 68–76. 1983, View Article : Google Scholar
16	Hadizadeh DR, Kovács A, Tschampa H, Kristof R, Schramm J and Urbach H: Postsurgical intracranial hypotension: Diagnostic and prognostic imaging findings. AJNR Am J Neuroradiol. 31:100–105. 2010. View Article : Google Scholar : PubMed/NCBI
17	Dagnew E, van Loveren HR and Tew JM Jr: Acute foramen magnum syndrome caused by an acquired Chiari malformation after lumbar drainage of cerebrospinal fluid: Report of three cases. Neurosurgery. 51:823–828. 2002. View Article : Google Scholar : PubMed/NCBI
18	Zhao J, Li G, Zhang Y, Zhu X and Hou K: Sinking skin flap syndrome and paradoxical herniation secondary to lumbar drainage. Clin Neurol Neurosurg. 133:6–10. 2015. View Article : Google Scholar : PubMed/NCBI

Journals

International Journal of Molecular Medicine

International Journal of Oncology

Molecular Medicine Reports

Oncology Reports

Experimental and Therapeutic Medicine

Oncology Letters

Biomedical Reports

Molecular and Clinical Oncology

World Academy of Sciences Journal

International Journal of Functional Nutrition

International Journal of Epigenetics

Medicine International

Early post‑operative cerebrospinal fluid hypovolemia: Report of 7 cases

This article is mentioned in:

Abstract

Figure 1

Figure 2

Figure 3

Related Articles