Direct pressure on a pseudomeningocele resulting in intraoperative cerebral ischemia |
| |
Authors: | John C. Drummond MD Joseph D. Ciacci MD Roland R. Lee MD |
| |
Affiliation: | 1. VA Medical Center, Anesthesia Service – 125, University of California, 3350 La Jolla Village Drive, San Diego, CA, 92161, USA 2. VA Medical Center, Neurosurgery Service, Division of Neurosurgery, University of California, San Diego, CA, USA 3. VA Medical Center, Radiology Service, Department of Radiology, University of California, San Diego, CA, USA
|
| |
Abstract: | Purpose When positioning patients with meningocele and meningomyelocele, it is standard practice to avoid direct pressure on the lesions. That caution is intended to prevent injury to neural elements within the lesion and violation of the cerebrospinal fluid space. We herein report an additional hazard of direct intraoperative pressure on such lesions. An adult patient with a lumbosacral pseudomeningocele sustained a cerebral ischemic injury as a consequence of direct pressure on the lesion during general anesthesia. Clinical features A 32-yr-old male with spina bifida and a pseudomeningocele related to recent lumbar surgery underwent a urologic procedure in the lithotomy position. Because the lesion was recognized to lie to the left of the midline, cushioning was placed under the patient’s left hip and buttock. The patient was slow to awaken and has sustained significant long-term cognitive deficits. Imaging is consistent with a diffuse cerebral ischemic insult. Conclusion In retrospect, the size and leftward extent of the pseudomeningocele were not appreciated preoperatively, and in spite of the care taken, intraoperative pressure was placed on the lesion. This report cautions that intraoperative pressure related to positioning patients with extra-axial lesions containing cerebrospinal fluid (CSF), e.g., meningoceles and pseudomeningoceles, can result in increases in CSF pressure and thereby a reduction in cerebral perfusion pressure sufficient to result in cerebral ischemia. |
| |
Keywords: | |
本文献已被 SpringerLink 等数据库收录! |
|