A Rare Case of Post-lumbar Discectomy Pneumocephalus: An Anatomically Informed Case Report

TL;DR

A rare case of pneumocephalus after lumbar discectomy highlights the importance of advanced imaging and timely intervention to manage complications.

Contribution

Demonstrates the utility of high-resolution MRI in identifying subtle dural defects missed during surgery.

Findings

Postoperative pneumocephalus was diagnosed using CT and high-resolution MRI.

An epidural blood patch resolved CSF leakage and pneumocephalus despite no visible dural tear.

Early symptom recognition and imaging are critical for effective management.

Abstract

Pneumocephalus is an uncommon yet significant complication that can arise after lumbar discectomy and requires rapid diagnosis and intervention. Although cerebrospinal fluid (CSF) leakage is not frequently observed during these procedures, it can result from small, often inconspicuous dural defects that may be missed during surgery. This scenario underscores the importance of careful intraoperative inspection and vigilant postoperative monitoring to ensure timely recognition and management, thereby mitigating potential adverse outcomes.

A 36-year-old male patient underwent an L5-S1 lumbar discectomy for disc herniation. Eight days postoperatively, he developed severe headache, neck pain, and nausea, accompanied by CSF leakage confirmed through beta-2 transferrin testing. Computed tomography revealed significant pneumocephalus, while high-resolution MRI demonstrated a subtle dural defect. Despite no macroscopically visible dural tear during re-exploration, applying an epidural blood patch successfully resolved both the CSF leak and pneumocephalus.

This case underscores the value of advanced imaging, specifically high‐resolution MRI, in identifying subtle dural defects that may not be apparent during surgery. Detecting the minor CSF leakage was essential for directing subsequent management and avoiding further complications.

Early recognition of postoperative symptoms combined with comprehensive imaging assessment is crucial in the management of post-discectomy pneumocephalus. The rapid resolution observed after applying an epidural blood patch supports its role as a primary intervention strategy, even in cases where dural tears are not macroscopically evident.

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