Subarachnoid-pleural fistula treated with noninvasive positive-pressure ventilation - Case report

The authors describe the case of a 24-year-old man who underwent an L-1 cor pectomy for spinal decompression and stabilization following an injury that caused an L-1 burst fracture. Postoperatively, an accumulation of spinal f luid developed in the pleural space, which was refractory to 1 week of thor acostomy tube drainage and lumbar cerebrospinal fluid (CSF) diversion. The authors then initiated a regimen of positive-pressure ventilation in which a bilevel positive airway pressure (PAP) mask was used. After 5 days, the C SF collection in the pleural space resolved. Use of a bilevel PAP mask repr esents a safe, noninvasive method of reducing the negative intrathoracic pr essure that promotes CSF leakage into the pleural cavity and may be a usefu l adjunct in the treatment of subarachnoid-pleural fistula.