Acute Intracranial Subdural Hematoma Following a Lumbar CSF Leak Caused by Spine Surgery

In Brief Study Design. Case report. Objective. To report a case of an acute intracranial subdural hematoma that formed due to cerebrospinal fluid (CSF) leak following lumbar surgery. Summary of Background Data. Intracranial hypotension may occur when CSF is removed from the subarachnoid space. Intracranial subdural hematoma formation has been observed following significant CSF drainage during lumbar puncture or ventricular shunt placement. However, formation has been described only twice in the literature following spine surgery. Methods. Retrospective review of the patient’s medical record and head CT imaging. Results. A 55-year-old woman underwent lumbar surgery for failed back syndrome. Intraoperatively, a dural tear was noted and repaired. One week later, she developed expressive aphasia, and CSF drainage from her lumbar wound was noted. A head CT revealed an acute intracranial subdural hematoma with mass effect. Evacuation of the hematoma occurred via craniotomy, and the lumbar dura was repaired intraoperatively. Conclusions. We report the rare case of an acute intracranial subdural hematoma caused by a CSF leak following lumbar surgery. This report illustrates the potential morbidity associated with CSF leaks occurring after spinal surgery. Intracranial hypotension occurs when CSF volume is decreased significantly, for example, during lumbar puncture or ventricular shunt placement. Occasionally, an intracranial subdural hematoma can form because of iatrogenic CSF depletion; however, this is rare following spine surgery. In this case report, we describe an acute subdural hematoma following lumbar surgery.