engleski

Nightmare complication after lumbar disc surgery - cranial non-traumatic acute epidural hematoma : case report

The non-traumatic cranial epidural hematoma is extremely rare clinical entity and they commonly occurs in the presence of infectious disease, as complication of sinusitis, coagulopathy, vascular malformation of the dura, hemorrhagic tumor, in patients with sickle cell disease, systemic lupus erythematosus, after open heart surgery, and in patients on hemodialysis. We report a case of spontaneous epidural hematoma that occurred after herniated disc surgery. There was no history of preceding head trauma and patient medical history was unremarkable. Up to date, no report is found of cranial epidural hematoma after lumbar discectomy.Methods. A 58-year old woman was operated due to a herniated disc at lumbar L3-L4 level and spinal stenosis. Bilateral L3-L4 interlaminectomies and L3-L4 discectomy was performed. Hemovac drain was placed in epidural space. Four hours after surgery patient developed left side weakness accompanied with nausea, vomiting and severe headache. Urgent CT of the head showed acute cranial epidural hematoma and the patient underwent emergent surgery. There were no evidence of the trauma of the scalp or any other anatomical abnormality. Control CT 14 hours after evacuation of the hematoma showed new extradural hematoma at site of previous one. Patient underwent second surgery.Results. Nine days after operation of the spine, patient recovered completely with no neurological deficit, but the cerebrospinal fluid (CSF) showed at place of spinal wound. Patient was operated once more and a minor dural tear was revealed which was repaired. The patient was discharged on ninth postoperative and she recovered completely.Conclusion. There have been described rare cases of spontaneous subdural, intracerebral, and intracerebellar hematoma caused by intracranial hypotension, but this is the first described case of spontaneous cranial epidural hematoma after lumbar disc surgery caused by intracranial hypotension.

dural injury; epidural hematoma; spinal surgery

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