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Intracranial hypotension without postural headache after minimally invasive lumbar endoscopic surgery: A case report

  陳怡君(Yi-Chun Chen);林峯盛(Feng-Sheng Lin);楊琳煦(Lin-Hsue Yang)

We report a patient presenting with chronic pain after artificial disk placement performed five years ago for herniation of the lumbar vertebral disk. He had recently undergone endoscopic minimally invasive transforaminal adhesiolysis for progressive radiculopathy. There were no symptoms, including headache, of postoperative complications until discharge except a complaint of general malaise. He presented with diplopia without classic postural headache to the emergency department on the ninth postoperative day after the transforaminal percutaneous endoscopic lumbar surgery. Emergent brain magnetic resonance imaging (MRI) revealed features of low intracranial cerebral pressure. Complete spine MRI revealed a left ventral dural defect and cerebrospinal fluid leakage over the lumbar region. He recovered after revision neurosurgery performed to repair the dural tear over the ventral sac using the Biodesign dural graft and fibrin glue. It is interesting to note that the patient did not present with typical postural pain, only non-specific fatigue, which cannot be diagnosed to a specific etiology during hospitalization and return visits. The dural tear manifested as intracranial hypotension and diplopia on the ninth day after the surgery. Hence, pain physicians should be aware of the potential risk and treatment of dural tears during lumbar transforaminal endoscopic surgery.