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  • Title: Subarachnoid-pleural fistula treated with noninvasive positive-pressure ventilation. Case report.
    Author: Yoshor D, Gentry JB, LeMaire SA, Dickerson J, Saul J, Valadka AB, Robertson CS.
    Journal: J Neurosurg; 2001 Apr; 94(2 Suppl):319-22. PubMed ID: 11302641.
    Abstract:
    The authors describe the case of a 24-year-old man who underwent an L-1 corpectomy for spinal decompression and stabilization following an injury that caused an L-1 burst fracture. Postoperatively, an accumulation of spinal fluid developed in the pleural space, which was refractory to 1 week of thoracostomy tube drainage and lumbar cerebrospinal fluid (CSF) diversion. The authors then initiated a regimen of positive-pressure ventilation in which a bi-level positive airway pressure (PAP) mask was used. After 5 days, the CSF collection in the pleural space resolved. Use of a bi-level PAP mask represents a safe, noninvasive method of reducing the negative intrathoracic pressure that promotes CSF leakage into the pleural cavity and may be a useful adjunct in the treatment of subarachnoid-pleural fistula.
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