Intracerebral haematoma after lumbar cerebrospinal fluid drainage

Cerebrospinal fluid [CSF] leak is a well recognized complication of basilar skull fracture, skull base surgery and neurootological procedures. Continuous CSF drainage has been a widely accepted procedure to prevent and treat such leaks. Though generally the procedure is innocuous, it can cause complications like headache, nausea, vomiting, subdural bleeding, infection and tension pneumocephalus. Though the development of intracranial subdural haematomas have been reported in a number of cases after deliberate lumbar CSF drainage or inadvertent CSF leak following spine surgery; lumbar CSF drain causing an intracerebral haemorrhage has not been reported previously as per the authors' review of literature. We report a rare case of intracerebral haematoma following lumbar CSF drainage which was managed by timely diagnosis and early evacuation. The authors recommend close neurological monitoring of patients who require continuous lumbar drainage to detect any life-threatening complications

Surgery in adult spinal dysraphism: a series of 51 patients

To study the various clinical presentation of spinal dysraphism in adults and analyse the risks and benefits of surgical treatment for spinal dysraphism in adults. Patients of spinal dysraphism who were operated after 16 years of age were included in this study and the clinical-radiological details, operative finding and histopathological findings of these patients were analysed. Age of the patients ranged from 16 - 58 years, with the mean age at surgery being 24.5 years. Lipomatous malformation was the commonest associated anomaly [53%] followed by split cord malformations [23.6%]. Sensory [62.7%], motor [60%] and bladder disturbances [49%] were the most common presentations. Detethering led to resolution of pain in 68%, healing of trophic ulcers in 100% and improvement in motor and sensory symptoms in 29% and 37.5% of the patients respectively. The results for sphincter dysfunction were particularly disappointing and none of these patients had improved during the follow-up period. There was no deaths or major postoperative complication in this study. This study clearly shows that a substantial number of patients benefit by surgery with the surgical outcome being excellent for healing of trophic ulcers and relieving pain. However, as none of the patients with established sphincter disturbances improved following surgery, prophylactic surgery early in childhood may be required in this group of patients to prevent the development of autonomic disturbances