TRAUMATIC SUBARACHNOID-PLEURAL FISTULA

Background. Traumatic subarachnoid-pleural fistula is a very uncommon but important condition. Only 21 cases have been reported so far in th e world Literature. Methods. We encountered 2 cases of subarachnoid-pl eural fistula, both in pediatric patients presenting without any neuro logic deficit. Whereas our first patient presented with recurrent, rap idly filling clear pleural effusions with an obscure cause, posing a d iagnostic problem for the pediatricians, the second patient had trauma to the pleura and dura mater by the sharp edge of Kirschner wire, wit h impending risk of injury to spinal cord and infection. Results. Surg ical intervention was undertaken after we had a strong suspicion of su barachnoid-pleural fistula in both cases. A subarachnoid-pleural fistu la was found at the level of the eleventh thoracic vertebra in the fir st patient and at the level of the eighth thoracic vertebra in the sec ond patient. Autogenous tissues (mediastinal pleural nap and hammered intercostal muscle covered with methylcellulose) were used to repair t he fistula. The subarachnoid space was decompressed with a lumbar drai n in the second patient. Conclusions. The diagnosis of subarachnoid-pl eural fistula is difficult when it is not associated with any neurolog ic deficit. We found that a high degree of suspicion and early surgica l intervention to repair the fistula are rewarding.