Subarachnoid-pleural and subarachnoid-mediastinal fistulae
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I I Pollack1, D Pang, W A Hall
1Department of Neurosurgery, University of Pittsburgh School of Medicine, Pennsylvania.
Insights
Rare cerebrospinal fluid fistulas, subarachnoid-pleural and subarachnoid-mediastinal, can occur after severe chest trauma in children. Diagnosis involves identifying spinal cord rupture and cerebrospinal fluid leakage, even without vertebral injury.
Area of Science:
- Neurology
- Thoracic Surgery
- Pediatric Traumatology
Background:
- Subarachnoid-pleural and subarachnoid-mediastinal fistulas are rare but serious complications following chest trauma.
- These fistulas involve the abnormal communication between the subarachnoid space and the pleural or mediastinal cavities.
- They are often associated with severe spinal cord injuries.
Observation:
- The study describes one case each of subarachnoid-mediastinal fistula and subarachnoid-pleural fistula.
- Both affected patients were young children who sustained severe longitudinal distraction injuries to the thoracic spine.
- Complete spinal cord transection was present without initial radiographic evidence of vertebral column injury.
Findings:
- Progressive mediastinal widening and enlarging pleural effusion, in the absence of aortic injury, raised suspicion for intrathoracic cerebrospinal fluid fistulas.
- Myelography was crucial in pinpointing the exact site of spinal cord rupture and subsequent cerebrospinal fluid leakage.
- These findings highlight a diagnostic challenge in cases of severe spinal trauma with intrathoracic complications.
Implications:
- Early recognition and diagnosis of these rare fistulas are critical for appropriate management.
- Understanding the mechanism of injury and diagnostic modalities like myelography can improve patient outcomes.
- This study contributes to the limited literature on cerebrospinal fluid fistulas secondary to pediatric spinal trauma.
Abstract:
Subarachnoid-pleural fistula and subarachnoid-mediastinal fistula are rare complications of chest trauma. One case each of subarachnoid-mediastinal fistula and subarachnoid-pleural fistula is described. Both patients were young children who suffered severe longitudinal distraction injuries to their thoracic spine and exhibited complete cord transection without radiographic evidence of vertebral column injury. Progressive mediastinal widening and enlarging pleural effusion in the absence of angiographic evidence of aortic injury suggested the diagnosis of an intrathoracic cerebrospinal fluid fistula. Myelograms identified the site of spinal cord rupture and cerebrospinal fluid leakage. The diagnosis, management, and outcome of these rare fistulae are discussed.