Obstructive Hydrocephalus Due to Intraventricular Hemorrhage After Incidental Durotomy During Lumbar Spine Surgery

Study Design. Case report and review of literature. Objective. To present an exceedingly rare occurrence of obstructive hydrocephalus secondary to intraventricular hemorrhage after incidental durotomy during lumbar spine surgery. Summary of Background Data. Incidental durotomies are uncommon but well recognized complications associated with spine surgery. Whereas mostly considered benign with no untoward clinical sequele, it can be symptomatic and present with spinal headaches, pseudomeningoceles, wound infection, meningitis and rarely intracerebral hemorrhage. Methods. A 76-year-old woman underwent L3-S1 laminectomies and fusion for lumbar spondylosis and stenosis. Intraoperatively, a small incidental durotomy was encountered and primarily repaired. Results. The patient developed altered mental status on postoperative day 2. Computed tomography of the brain revealed obstructive hydrocephalus and intraventricular hemorrhage. The patient was immediately transferred to the neurosurgery intensive care unit and an external ventricular drain was placed emergently with high opening pressure. Her mental status improved immediately after cerebral spinal fluid diversion. The external ventricular drain was successfully removed after 8 days. The patient made a full recovery and was discharged in stable condition. Conclusion. Obstructive hydrocephalus after intraventricular hemorrhage is an exceptionally rare but potentially life-threatening complication of incidental durotomies. Spine surgeons should be aware of this rare but serious complication.