Formation of subdural hygroma after surgery for degenerative spinal disease: observation from practice

AIM. To describe the clinical observation of a rare complication in the form of the formation of a decompensated form of subdural hygroma in a patient after decompressive stabilizing intervention at the L4-L5 level. CLINICAL CASE. Patient N., 63 years old, complained of pain in the posterolateral surface of the right lower limb. History of endoscopic decompression of the spinal canal at the place of residence for spinal canal stenosis at the L4-L5 level in 2021 and 2022. According to the Lumbosacral Spine MRI: multifactorial stenosis of the spinal canal at the L4-L5 level with compression of the L5 root by the discosteophyte complex.Intraoperatively, a defect of the dura mater was obtained without damage to the arachnoid membrane and there was no leakage of cerebrospinal fluid.On the 3rd day after surgery, the patient began to complain of an intense headache, on the 5th day during verticalization, an episode of loss of consciousness was noted. A CT scan of the brain was performed, according to the results of which pneumocephaly is determined subdurally and along the sickle of the brain. On the 14th day, the patient showed decreased alertness to moderate stupor, and hypertensive dislocation symptoms. According to CT of the brain, a subdural hygroma of the left frontal region with a volume of 150 cm3 and a transverse dislocation to the right by 13 mm was detected. The following surgical intervention was performed: microsurgical removal of the subdural hygroma in the left frontal region with a volume of 1, Stuckey ventriculocisternostomy 1. After 1 day, negative dynamics were noted: according to CT of the brain, an increase in the subdural hygroma to 120 cm3 with a transverse dislocation of up to 16 mm. A repeated surgical intervention was performed in the volume of subdural-peritoneal shunting. The postoperative period was satisfactory. On the control CT of the brain the volume of subdural contents decreased to 10 cm3, transverse dislocation to the right to 3 mm. The patient was discharged in satisfactory condition on the 21st day. CONCLUSION. The present clinical observation is of great interest due to rare formation of this complication during decompressive-stabilizing interventions on the spinal column. When clinical symptoms of intracranial hypotension appear, it is necessary to stay alert and conduct clinical and instrumental diagnostics to exclude the formation of this complication.