Brain Herniation Secondary to Cerebrospinal Fluid Leak Following Elective Lumbar Spine Surgery

January 11, 2022

Case Reports

. 2021 Dec 8;13(12):e20266.

doi: 10.7759/cureus.20266.

eCollection 2021 Dec.

Affiliations

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Case Reports

Andrew Zhang et al.

Cureus.

2021.

. 2021 Dec 8;13(12):e20266.

doi: 10.7759/cureus.20266.

eCollection 2021 Dec.

Affiliations

¹ Orthopaedic Surgery, Louisiana State University Health Sciences Center, Shreveport, USA.
² Orthopaedic Surgery, Hospital for Special Surgery, New York, USA.
³ Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, USA.

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Abstract

Lumbar spine surgery can be complicated by perioperative cerebrospinal fluid (CSF) leak. However, development of brain herniation secondary to CSF leak following lumbar spine surgery has not been previously reported in the current literature. This case report describes a 48-year-old woman who, after a revision lumbar decompression and fusion, experienced CSF leak followed by development of brain herniation, which resulted in patient demise. The postoperative period was complicated by patient nonadherence to conservative management of CSF leak.

Keywords:

brain herniation; complication; csf leak; dural leak; elective; lumbar; spine surgery; transtentorial herniation.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

**Figure 1. MRI of Lumbar Spine**

Sagittal (a) and axial (b) MRI of the lumbar spine, illustrating grade 1 anterolisthesis of L4 on L5 and L5 on S1 and bilateral pars defects of L5. Interbody devices from a previous surgery are present at L4-5 and L5-S1 disc spaces. MRI, magnetic resonance imaging.

**Figure 2. CT Brain**

Coronal (a) and axial (b) CT brain, illustrating global cerebral edema with effacement of the basilar and quadrigeminal cisterns concerning for transtentorial herniation. CT, computed tomography.

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