Incidental dural tear in spinal surgery complicated by pneumocephalus with abducens (VI) paralysis: a case-report and literature review

Abstract Introduction: Incidental dural tears are a frequent complication of spinal surgery that may lead to various neurologic complications. Case presentation: Here is describe the case of an 83 years-old female, that underwent a lumbar decompression revision surgery, complicated by an incidental dural. The patient presented in post-operative care an acute onset monocular horizontal diplopia with homolateral ptosis and multiple extra-axial bi-frontal signal voids on the cerebral CT-scan, evoking pneumencephalus. The symptomatology resolved with conservative treatment (dorsal decubitus, monocular external occlusion, and close monitoring). The initial presentation with predominant ophthalmologic clinical signs is at our knowledge the first one to be described after lumbar laminectomy. Conclusion: Diplopia in a context of post-operative spinal surgery must evoke pneumencephalus and might require an urgent cerebral imaging to assess diagnosis.