Sphenopalatine Ganglion Block for Headache Treatment After an Incidental Durotomy: A Case Report.

Incidental durotomy is the most common intraoperative complication of spine surgeries. Our main goal is to report a case of a postoperative postdural puncture headache following an incidental durotomy successfully managed with a sphenopalatine ganglion block. A 75-year-old woman, American Society of Anesthesiologists physical status II, proposed for a lumbar interbody fusion. During surgery, an incidental durotomy with cerebrospinal fluid leak occurred, being repaired with muscle and DuraSeal® Dural Sealant System. In the recovery room, 1 hour after the end of the surgery, the patient developed a severe headache associated with nausea and photophobia. A bilateral transnasal sphenopalatine ganglion block with 0.75% ropivacaine was performed. Immediate pain relief was verified. The patient reported only mild headaches on the first postoperative day, feeling progressively better until discharge. The sphenopalatine ganglion block may be an effective alternative treatment for postdural puncture headache following an incidental durotomy during neurosurgeries. Sphenopalatine ganglion block may be a safe, lowrisk alternative in the treatment of postdural puncture headache after an incidental durotomy that can be used in the immediate postoperative period to enable early recovery and return to day-to-day activities, which will hopefully lead to better surgical outcomes and patient satisfaction.

Spontaneous hemorrhage in a lumbar ganglion cyst.

STUDY DESIGN: Case report. OBJECTIVE: To describe a case of a subacute radiculopathy resulting from a spontaneous hemorrhage into a lumbar ganglion cyst. SUMMARY OF BACKGROUND DATA: Ganglion and synovial cysts of the lumbar spine are becoming more frequent, and they are generally associated with degenerative lumbar spinal disease. Few cases of hemorrhage into lumbar juxtafacet cysts after trauma or anticoagulation therapy have been described in the literature. METHODS: A case of a spontaneous hemorrhage in a lumbar ganglion cyst is presented. RESULTS: A 61-year-old man presented with a 2-month history of intermittent bilateral lumbar ache. Eight days before admission he had a sudden exacerbation of the lumbar pain and began to fall frequently and noticed weakness and tingling in his lower members, mainly in the right leg. Magnetic resonance imaging scan revealed a hematic collection associated with a large juxtafacet cyst at the L4-L5 level. He was submitted to surgery and the cyst was totally removed. Microscopic examination was consistent with the diagnosis of a ganglion cyst. Two days after surgery he had already an independent gait. CONCLUSION: Although, there are a few descriptions of hemorrhagic lumbar justafacet cysts after trauma or anticoagulant therapy, this is the first case of a hemorrhagic ganglion cyst with no previous traumatic event or use of medication. Magnetic resonance imaging was essential for making the preoperative diagnosis. Neurosurgical cyst removal proved to be an effective treatment.