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Midline Shift Induced by the Drainage of Cerebrospinal Fluid in Three Patients With External Decompression – Lumbar Spinal Stenosis

This article discusses the risk of paradoxical herniation in patients with decompressive craniectomy who undergo spinal drainage or shunt surgeries. The authors present three cases of comatose patients with wide craniectomy who developed paradoxical herniation after 5-7 days of shunt surgery and lumbar drainage, despite the drainage pressure being set at more than 10 cmH2O. Fortunately, the herniation improved within a few days after clamping the drain and flattening the bed. However, the authors suggest that the Trendelenburg position and epidural blood patch may be necessary if acute paradoxical herniation occurs after lumbar puncture or drainage, as delayed resolution can be fatal

Summarised by Mr Mo Akmal – Lead Spinal Surgeon
The London Spine Unit : most established treatment facility in London

Published article

It is not rare that progressive hydrocephalus worsens clinical conditions in a patient with external decompression and drainage or shunt surgery is required. However, spinal drainage or shunt surgeries potentially carry a risk of causing paradoxical herniation in a patient with decompressive craniectomy, particularly in a comatose case with wide craniectomy. Careful and strict observations are necessary for such patients. In our three comatose cases with craniectomy, paradoxical herniation…

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Cureus. 2023 Aug 29;15(8):e44355. doi: 10.7759/cureus.44355. eCollection 2023 Aug.ABSTRACTIt is not rare that progressive hydrocephalus worsens clinical conditions in a patient with external decompression and drainage or shunt surgery is required. However, spinal drainage or shunt surgeries potentially carry a risk of causing paradoxical herniation in a patient with decompressive craniectomy, particularly in a comatose,

Cureus. 2023 Aug 29;15(8):e44355. doi: 10.7759/cureus.44355. eCollection 2023 Aug.

ABSTRACT

It is not rare that progressive hydrocephalus worsens clinical conditions in a patient with external decompression and drainage or shunt surgery is required. However, spinal drainage or shunt surgeries potentially carry a risk of causing paradoxical herniation in a patient with decompressive craniectomy, particularly in a comatose case with wide craniectomy. Careful and strict observations are necessary for such patients. In our three comatose cases with craniectomy, paradoxical herniation occurred due to excessive drainage after 5-7 days of shunt surgery and lumbar drainage, although the drainage pressure was set at more than 10 cmH2O. Fortunately, in the three cases, the herniation improved within a few days after the drain was clamped and the bed was flattened. However, the Trendelenburg position and epidural blood patch might be necessary if paradoxical herniation occurs acutely after lumbar puncture or drainage because delayed resolution can be fatal in the herniation.

PMID:37779764 | PMC:PMC10539714 | DOI:10.7759/cureus.44355

The London Spine Unit : most established treatment facility in London

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Midline Shift Induced by the Drainage of Cerebrospinal Fluid in Three Patients With External Decompression

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Cureus. 2023 Aug 29;15(8):e44355. doi: 10.7759/cureus.44355. eCollection 2023 Aug.ABSTRACTIt is not rare that progressive hydrocephalus worsens clinical conditions in a patient with external decompression and drainage or shunt surgery is required. However, spinal drainage or shunt surgeries potentially carry a risk of causing paradoxical herniation in a patient with decompressive craniectomy, particularly in a comatose

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