Devastating Neurological Outcome Following a Subarachnoid-Pleural Fistula During Thoracic Surgery.

Pneumocephalus due to a subarachnoid-pleural fistula (SPF) has previously been described in the literature and is a rare complication following thoracic surgery. In this report, we discuss a patient who developed profound neurologic sequelae following right-sided pneumonectomy which was complicated by T2 nerve root avulsion and SPF development. The patient returned to the OR on postoperative day 21 in the setting of significant neurologic deterioration secondary to intracranial hypotension and pneumocephalus for SPF closure via thoracic laminectomy in the prone position. We present a rare cause of pneumocephalus and CSF leak, resulting in complications and sequelae and its management.