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Case report
peer-reviewed

Spontaneous Intracranial Hypotension after Vestibular Schwannoma Resection Due to an Unexpected Pathology: Tarlov Cysts



Abstract

While infrequent, cerebrospinal fluid (CSF) leaks are known to occur after surgical resection of vestibular schwannomas. Early signs of CSF leak often include headache and altered mental status. If untreated, life-threatening complications can occur, including brainstem herniation and meningitis. The appropriate surgical treatment for a CSF leak requires accurate localization of the source. While the most likely location of a CSF leak after lateral skull base surgery is through the aerated portions of the temporal bone, we present a unique case of a man with a prolonged CSF leak after an acoustic tumor removal who was ultimately found to have an occult spinal perineural (Tarlov) cyst as the source. Accurate localization was ultimately achieved with CT myelogram after empirically obliterating his mastoid failed to restore intracranial CSF volume. Tarlov cysts are the most common cause of idiopathic intracranial hypotension, and this case highlights the importance of considering this entity in the differential diagnosis of postoperative CSF leaks.



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Case report
peer-reviewed

Spontaneous Intracranial Hypotension after Vestibular Schwannoma Resection Due to an Unexpected Pathology: Tarlov Cysts


Author Information

Seth E. Pross Corresponding Author

Otolaryngology Head and Neck Surgery, The Johns Hopkins University School of Medicine

Jeffrey D. Sharon

Otolaryngology Head and Neck Surgery, University of California San Francisco

Michael Lim

Neurosurgery, The Johns Hopkins University School of Medicine

Abhay Moghekar

Neurology, The Johns Hopkins University School of Medicine

Aruna Rao

Neurology, The Johns Hopkins University School of Medicine

John P. Carey

Otolaryngology Head and Neck Surgery, The Johns Hopkins University School of Medicine


Ethics Statement and Conflict of Interest Disclosures

Human subjects: Consent was obtained by all participants in this study. Signed informed consent was obtained from the patient for this case report. Because this is a single retrospective case report, it is exempt from requiring IRB approval. . Conflicts of interest: The authors have declared that no conflicts of interest exist.


Case report
peer-reviewed

Spontaneous Intracranial Hypotension after Vestibular Schwannoma Resection Due to an Unexpected Pathology: Tarlov Cysts


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Case report
peer-reviewed

Spontaneous Intracranial Hypotension after Vestibular Schwannoma Resection Due to an Unexpected Pathology: Tarlov Cysts

  • Author Information
    Seth E. Pross Corresponding Author

    Otolaryngology Head and Neck Surgery, The Johns Hopkins University School of Medicine

    Jeffrey D. Sharon

    Otolaryngology Head and Neck Surgery, University of California San Francisco

    Michael Lim

    Neurosurgery, The Johns Hopkins University School of Medicine

    Abhay Moghekar

    Neurology, The Johns Hopkins University School of Medicine

    Aruna Rao

    Neurology, The Johns Hopkins University School of Medicine

    John P. Carey

    Otolaryngology Head and Neck Surgery, The Johns Hopkins University School of Medicine


    Ethics Statement and Conflict of Interest Disclosures

    Human subjects: Consent was obtained by all participants in this study. Signed informed consent was obtained from the patient for this case report. Because this is a single retrospective case report, it is exempt from requiring IRB approval. . Conflicts of interest: The authors have declared that no conflicts of interest exist.

    Acknowledgements


    Article Information

    Published: May 19, 2017

    DOI

    10.7759/cureus.1261

    Cite this article as:

    Pross S E, Sharon J D, Lim M, et al. (May 19, 2017) Spontaneous Intracranial Hypotension after Vestibular Schwannoma Resection Due to an Unexpected Pathology: Tarlov Cysts. Cureus 9(5): e1261. doi:10.7759/cureus.1261

    Publication history

    Received by Cureus: March 29, 2017
    Peer review began: May 11, 2017
    Peer review concluded: May 15, 2017
    Published: May 19, 2017

    Copyright

    © Copyright 2017
    Pross et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 3.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    License

    This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

While infrequent, cerebrospinal fluid (CSF) leaks are known to occur after surgical resection of vestibular schwannomas. Early signs of CSF leak often include headache and altered mental status. If untreated, life-threatening complications can occur, including brainstem herniation and meningitis. The appropriate surgical treatment for a CSF leak requires accurate localization of the source. While the most likely location of a CSF leak after lateral skull base surgery is through the aerated portions of the temporal bone, we present a unique case of a man with a prolonged CSF leak after an acoustic tumor removal who was ultimately found to have an occult spinal perineural (Tarlov) cyst as the source. Accurate localization was ultimately achieved with CT myelogram after empirically obliterating his mastoid failed to restore intracranial CSF volume. Tarlov cysts are the most common cause of idiopathic intracranial hypotension, and this case highlights the importance of considering this entity in the differential diagnosis of postoperative CSF leaks.



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Create a free account to continue reading this article.

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Seth E. Pross

Otolaryngology Head and Neck Surgery, The Johns Hopkins University School of Medicine

For correspondence:
spross1@jhmi.edu

Jeffrey D. Sharon

Otolaryngology Head and Neck Surgery, University of California San Francisco

Michael Lim, M.D.

Neurosurgery, The Johns Hopkins University School of Medicine

Abhay Moghekar

Neurology, The Johns Hopkins University School of Medicine

Aruna Rao

Neurology, The Johns Hopkins University School of Medicine

John P. Carey

Otolaryngology Head and Neck Surgery, The Johns Hopkins University School of Medicine

Seth E. Pross

Otolaryngology Head and Neck Surgery, The Johns Hopkins University School of Medicine

For correspondence:
spross1@jhmi.edu

Jeffrey D. Sharon

Otolaryngology Head and Neck Surgery, University of California San Francisco

Michael Lim, M.D.

Neurosurgery, The Johns Hopkins University School of Medicine

Abhay Moghekar

Neurology, The Johns Hopkins University School of Medicine

Aruna Rao

Neurology, The Johns Hopkins University School of Medicine

John P. Carey

Otolaryngology Head and Neck Surgery, The Johns Hopkins University School of Medicine