Iatrogenic intradiploic cerebrospinal fluid collection

Area of Science:

• Neurosurgery
• Cerebrospinal Fluid Dynamics
• Skull Base Surgery

Background:

• Intradiploic cerebrospinal fluid (CSF) collections are rare neurosurgical complications.
• Previous reports detail various causes, but iatrogenic origins are specifically examined here.
• Understanding pathophysiological mechanisms and management strategies for these collections is crucial.

Observation:

• A 14-year-old boy with Chiari malformation type I presented with headache and attention deficits.
• Imaging revealed persistent cerebellar tonsillar descent, a cervical syrinx, and an intradiploic fluid collection in the occipital bone.
• The patient underwent occipital bone decompression and resection of the intradiploic cavity with duraplasty.

Findings:

• Iatrogenic intradiploic focal fluid accumulation results from combined dural and inner table calvarial/vertebral bone defects.
• Postoperative imaging confirmed successful removal of the iatrogenic bone alteration.
• This complication, though rare, necessitates consideration in postoperative imaging findings.

Implications:

• Early recognition and surgical intervention are vital for managing iatrogenic intradiploic CSF collections.
• Defects in the dura and inner bone table are key factors in the development of these collections.
• Awareness of this potential complication aids in accurate diagnosis and effective patient management.