Massive Delayed Cerebrospinal Fluid Leakage After Cervical Spinal Tumor Resection: A Case Report.

Background

Cervical dumbbell-shaped neurogenic tumors occurring at two noncontiguous levels are rare, and postoperative cerebrospinal fluid (CSF) collection causing cord compression is an uncommon but serious complication after intradural tumor resection. Case Presentation: A 30-year-old man presented with a 3-month history of progressive gait disturbance. Neurological examination revealed grade 3 paraparesis with upper motor neuron signs. Magnetic resonance imaging (MRI) demonstrated two discrete dumbbell-shaped neurogenic tumors located at the C1-2 and C7-T1 levels. The lesions were simultaneously resected. Complete removal of the C1-2 tumor required total sacrifice of the left C2 nerve root, while the C7-T1 lesion was excised through a T-shaped dural incision. The dura was closed primarily with watertight sutures reinforced with dural sealant, and no CSF leakage was observed during intraoperative Valsalva testing. Two months postoperatively, the patient developed worsening upper back and trapezial pain with severe scapular swelling. MRI revealed a large CSF collection extending from C6 to T5, causing moderate cord compression. Urgent revision surgery was performed. Controlled drainage was attempted to prevent intracranial hypotension, but significant CSF egress occurred. The dural defect was repaired using an autologous muscle plug reinforced with fibrin glue. The patient recovered uneventfully after revision surgery and was discharged without recurrence or complications.

Conclusions

This case highlights that delayed, extensive postoperative CSF collection can occur despite apparently watertight primary closure and negative intraoperative Valsalva testing. Clinical vigilance for this complication is essential when patients present with new axial pain or localized swelling following cervical intradural surgery, even in the absence of classic low-pressure headaches.