Abstract
Lumbar drainage is commonly used in skull base surgery; however, very few cases of
intracranial hypotension syndrome are reported to be caused by this procedure. We
present a clinical case of lumbar drainage–assisted orbital and optic canal decompression
surgery for a recurrent voluminous spheno-orbital meningioma, together with a literature
review. A 49-year-old woman became confused and drowsy on postoperative day 3, after
initially experiencing neurologic stability. Computed tomography (CT) scan of the
head showed extradural frontotemporal fluid collection with moderate right to left
midline shift. Magnetic resonance imaging (MRI) of the brain showed signs of intracranial
hypotension, such as brain sagging and diffuse dural contrast enhancement. Conservative
treatment with bed rest, aggressive hydration, steroids, and aminophylline led to
progressive neurologic improvement. A systematic literature review was also performed,
and previous reported cases were analyzed. Overall, neurosurgeons must be aware of
the lumbar drainage–induced hypotension syndrome in skull base surgeries, because
immediate diagnosis is essential for therapeutic decision-making. In this setting,
conservative management is the first-line treatment as surgery may lead to severe
complications.
Keywords
intracranial hypotension syndrome - lumbar drainage - skull base surgery - case report
- literature review
