Acute Intracranial Subdural Hematoma Following Dural Tear in Spine Surgery: A Rare but Potentially Life-Threatening Complication

Background: Dural tearing on complex spinal surgeries is a well-known complication on literature, however, acute subdural hematoma due to Cerebral Spinal Fluid (CSF) and consequently intracranial hypotension is rare. This is the first case reported in the literature in which the immediately postoperative exam showed anisocoric pupils and acute subdural hematoma was promptly identified. Methods: To report a case of an acute intracranial subdural hematoma following a CSF leak during a post infectious spine deformity correction surgery, leading to cerebral herniation and brain stem compression. Results: A 39 year-old female patient, diagnosed with Pott’s disease on 2014 treated with antibiotics and no prior surgery evolved with progressive thoracic kyphosis and paraparesis grade III. CT scan showed T11 vertebral body involvement with kyphotic deformity and MRI indicated spinal cord compression. A T11 vertebrectomy (VCR) and kyphosis correction was performed and an incidental dural tear was primary treated with direct suture. On immediate post-operative examination anisocoric pupils was noted and an immediate brain CT scan showed a left acute fronto-temporo-parietal subdural hematoma with uncal herniation requiring drainage. After the surgical procedure, patient was discharged from the hospital after 3 weeks with outpatient rehabilitation. Conclusion: Dural tear and intracranial hypotension is usually a benign condition; however, a potentially fatal complication is the formation of an acute intracranial subdural hematoma. This case demonstrates the need for awareness of this potentially fatal complication after spine surgery.