Dramatic Resolution of Symptomatic Thoracolumbar Traumatic Spinal Subdural Hygroma with Lumbar Puncture: A Literature Review and Case Illustration

Background: Subdural hygromas are excess fluid accumulations in the subdural compartment, likely occurring via tears in the arachnoid membrane causing cerebrospinal fluid (CSF) leakage into the subdural space. Treatment recommendations for spinal subdural hygromas are lacking.

Case description: We report a case of a 30-year-old man who developed delayed-onset cauda equina syndrome after a motor vehicle accident. Magnetic resonance imaging of the thoracic and lumbar spine revealed a CSF intensity collection involving most of the thoracic spine and extending toward the distal end of the thecal sac with ventral displacement of the spinal cord and nerve roots. The patient was successfully treated using interventional radiology-guided lumbar puncture.

Conclusions: Posttraumatic spinal subdural hygromas are rare complications, as evidenced by the lack of literature and treatment guidelines. Using lumbar puncture, we demonstrate clinical and radiographic resolution of a traumatic subdural hygroma. This outcome suggests lumbar puncture may be an effective treatment modality for similar patients, and can potentially be used to avoid a more invasive surgical decompression.