Epidural hematoma of the cervical spine after cervical laminectomy in a patient with ventriculo-peritoneal shunt

Cervical laminectomy is one of the most common procedures performed in the sitting position. However in the presence of intracranial hypotension, a negative intradural pressure develops when the patients are in the sitting position. They are therefore at risk of developing cervical spinal epidural hematomas after cervical laminectomy. We report a case of a shunted patient who developed an epidural hematoma 3 days after a cervical laminectomy procedure in a seated position when he began to ambulate. When performing a cervical laminectomy procedure on a shunted patient, an upright position should be avoided during the operation. Intra-operative hypercapnia. as well as intra- and post-operative intravenous hydration should be maintained in order to increase intradural pressure, preventing the formation of cervical spinal epidural hematoma after cervical laminectomy. (C) 2003 Elsevier Ltd. All rights reserved.