Extensive spinal cord infarction after posterior fossa surgery in the sitting position: case report.

Abstract

Spinal cord injury is a rare complication of neurosurgery performed with the patient in the sitting position. Previous reports showed that the level of injury is usually located at or near the C5 segmental spinal level, and the term midcervical quadriplegia has been proposed. Extensive spinal cord and lower brainstem infarction also can occur after posterior fossa surgery performed with the patient in the sitting position. We describe a 45-year-old woman who was operated on in the sitting position because of a fourth ventricular pilocytic astrocytoma. After surgery, the patient experienced quadriplegia. T2-weighted magnetic resonance imaging scans revealed a long, hyperintense area within the cervicothoracic spinal cord that was extended to the lower pons and was consistent with infarction. There was no evidence of previous spine disease. The patient died 6 weeks later of respiratory failure. We speculate that alteration of spinal cord blood flow by stretching of the cervical spinal cord and spinal epidural venous engorgement might have caused this devastating complication.