Pseudohypoxic Brain Swelling After Uncomplicated Lumbar Decompression and Fusion for Spondylolisthesis

Swathi Chidambaram, Kevin Swong, Michael Ander, Russel P. Nockels*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Background: Pseudohypoxic brain swelling (PHBS), also known as postoperative intracranial hypotension−associated venous congestion, is a rare complication after neurosurgery characterized by rapid and often severe postoperative deterioration in consciousness and distinct imaging findings on brain magnetic resonance imaging. Imaging findings associated with PHBS include computed tomography and magnetic resonance imaging findings that resemble hypoxic changes and intracranial hypotensive changes in basal ganglia and thalamus, telencephalic, and infratentorial regions without notable changes in intracranial vasculature. Case Description: This report describes the case of an L4-5 microdiskectomy with posterior decompression and fusion complicated by clinical and radiographic findings resembling PHBS without a known intraoperative durotomy. Conclusions: Spine surgeons should be alerted to the possibility that PHBS may occur in patients even after an operation without known durotomy or cerebrospinal fluid leakage and with spontaneous clinical resolution unrelated to suction drainage changes or epidural blood patches.

Original languageEnglish (US)
Pages (from-to)155-158
Number of pages4
JournalWorld neurosurgery
StatePublished - Jan 2020
Externally publishedYes


  • Lumbar decompression and fusion
  • Postoperative complications
  • Postoperative intracranial hypotension−associated venous
  • Pseudohypoxic brain swelling

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology


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