A hypertensive response to irrigation: endoscopic repair of a ventral spinal CSF leak.
Catherine M Garcia, Shane Shahrestani, Sohrab Gollogly et al.
✦ AI-curated · Sources linked
Case in brief
A 36-year-old woman with recurrent spontaneous intracranial hypotension due to a ventral T11-12 CSF leak underwent endoscopic repair. During the procedure, she experienced severe hypertension, with systolic blood pressure reaching 275 mm Hg, linked to continuous irrigation. Cessation of irrigation normalized her hemodynamics, and the procedure was completed successfully with no further complications postoperatively.
What made this case unusual
The case illustrates a significant hypertensive response during endoscopic repair of a CSF leak, attributed to irrigation-induced pressure transmission through a dural defect, which is not commonly reported in standard endoscopic procedures.
Diagnostic / clinical pearl
Clinicians should be aware that continuous irrigation during endoscopic spine surgery in patients with CSF leaks can lead to acute hemodynamic instability due to altered pressure dynamics.
Why it matters
Understanding the potential for irrigation-related complications in patients with CSF leaks is crucial for surgical planning and intraoperative management, ensuring patient safety during endoscopic procedures.