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CC BY 4.0 · J Neuroanaesth Crit Care 2023; 10(03): 202-205
DOI: 10.1055/s-0043-1770781
Case Report

Importance of Multimodal Spinal Cord Monitoring and Hemodynamic Augmentation during High Thoracic Ventral Dural Tear Repair Using the Posterior Approach

Ramamani Mariappan 
1   Department of Neuroanesthesia, Christian Medical College, Vellore, Tamil Nadu, India
,
Sajo Thomas 
2   Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India
,
Krishnaprabhu Raju 
2   Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India
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Abstract

Cerebrospinal fluid (CSF) leakage due to large ventral dural tears (VDT) often requires surgical intervention. Surgical closure of a high thoracic VDT is challenging and associated with high morbidity, especially if it is performed after multiple epidural blood patch (EBP)/fibrin glue injections. A 44-year-old woman was diagnosed with spontaneous intracranial hypotension due to VDT at T1-T2, causing CSF leakage. Multiple EBP and fibrin glue injections failed to treat her symptoms; hence, the patient underwent surgical closure using the posterior approach. The patient was anesthetized using standard anesthetic drugs and was maintained under total intravenous anesthesia to facilitate continuous motor-evoked potential (MEP) monitoring. The surgical course was complicated by bleeding, hypotension, and MEP loss. Continuous MEP monitoring, effective team communication, quick restoration of blood pressure(BP) and BP augmentation with fluid, blood, and vasopressor helped to restore the MEP back to baseline. Hence, the patient recovered without neurological morbidity. This case report highlights the importance of adequate vascular access, multimodal spinal cord monitoring, and BP augmentation during a high thoracic VDT repair.

Keywords

cerebrospinal fluid leakage - hemodynamic management - intracranial hypotension - multimodal spinal cord monitoring - ventral dural tear


Publication History

Article published online:
19 February 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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