Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2020 Aug 6:6:27.
doi: 10.1186/s41016-020-00204-2. eCollection 2020.

Diagnose and treatment of traumatic pleural-subarachnoid fistula in children: A case report and systematic review

Wei Yang  1 , Ming Ge #  1 , Chenghao Chen  2 , Qi Zeng #  2
Affiliations
Case Reports

Diagnose and treatment of traumatic pleural-subarachnoid fistula in children: A case report and systematic review

Wei Yang et al. Chin Neurosurg J. .

Abstract

Background: Pleural-subarachnoid fistula (PSF) is a rare disease that is difficult to diagnose and treat. Secondary intracranial hypertension and the treatment are seldom mentioned previously among PSF.

Case presentation: A 1-year-old boy diagnosed PSF developed into secondary intracranial hypertension after conservative treatment. He was finally cured by down-step treatment of mannitol, avoiding form ventricle-peritoneal shunt. Then, we reviewed the literature of pleural-subarachnoid fistula. Fifty-six cases have been reported so far. Most of the cases (51.8%) were caused by surgery; only 17.9% were caused by car accidents. Regarding the treatment, half of the cases cured by surgery and the other by conservative measures. Our case is the first one involving secondary intracranial hypertension and cured by down-step treatment of mannitol.

Conclusions: A comprehensive examination should be performed before the treatment to avoid any inappropriate medical strategies. Secondary acute intracranial hypertension may be cured by down step treatment of mannitol, evading from the long-term ventriculoperitoneal shunt.

Keywords: Complications; Intracranial hypertension; Pleural-subarachnoid fistula; Treatment.

PubMed Disclaimer

Conflict of interest statement

Competing interestsThe authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
a–c Brain CT and heavily T2 spine MR. a No abnormal signs on brain CT. b, c The arrow in heavily spine MR shows the suspected fistula signal between at T11 level
Fig. 2
Fig. 2
d–e Myelography. d–e The arrows show the contrast agents leaking from the subarachnoid space to the thorax
Fig. 3
Fig. 3
f–i Chest X-ray and brain MRI. f, g The MRIs show no ventriculomegaly or paraventricular edema after removal of cisternal drainage. h, i The chest X-ray show the no effusion in the thorax
See this image and copyright information in PMC

References

    1. Heller JG, Kim HS, Carlson GW. Subarachnoid--pleural fistulae--management with a transdiaphragmatic pedicled greater omental flap: report of two cases. Spine. 2001;26:1809–1813. doi: 10.1097/00007632-200108150-00018. - DOI - PubMed
    1. Moss MS, Wingate JP. Case of the month: that’s torn it! Br J Radiol. 1996;69:479–480. doi: 10.1259/0007-1285-69-821-479. - DOI - PubMed
    1. Asner S, Chapuis-Taillard C, Ris HB, et al. Pneumocephalus and pneumococcal meningitis after thoracic surgery. Asian Cardiovasc Thoracic Ann. 2011;19:346–348. doi: 10.1177/0218492311407796. - DOI - PubMed
    1. Brown WM, 3rd, Symbas PN. Pneumocephalus complicating routine thoracotomy: symptoms, diagnosis and management. Ann Thorac Surg. 1995;59:234–236. doi: 10.1016/0003-4975(94)00434-9. - DOI - PubMed
    1. de Olaiz NB, Leon Atance P, Alix TA. Pneumocephalus and cerebrospinal fluid fistula following removal of a superior sulcus tumor (pancoast tumor) Arch Bronconeumol. 2004;40:422–425. - PubMed

Publication types

LinkOut - more resources