Table of Contents
ISRN Surgery
Volume 2011, Article ID 168959, 8 pages
Review Article

Subarachnoid-Pleural Fistula: Applied Anatomy of the Thoracic Spinal Nerve Root

1Division of Neurosurgery, The Ottawa Hospital, Ottawa, ON, Canada K1Y 4E9
2Division of Thoracic Surgery, The Ottawa Hospital, Ottawa, ON, Canada K1H 8L6
3Department of Radiological Sciences, The Ottawa Hospital, Ottawa, ON, Canada K1H 8L6

Received 8 June 2011; Accepted 3 July 2011

Academic Editors: D. Galetta and Y. Tsunezuka

Copyright © 2011 Mohammed F. Shamji et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Subarachnoid-pleural fistula (SPF) is a rare complication of chest or spine operations for neoplastic disease. Concomitant dural and parietal pleural defects permit flow of cerebrospinal fluid into the pleural cavity or intrapleural air into the subarachnoid space. Dural injury recognized intraoperatively permits immediate repair, but unnoticed damage may cause postoperative pleural effusion, intracranial hypotension, meningitis, or pneumocephalus. We review two cases of SPF following surgical intervention for chest wall metastatic disease to motivate a detailed review of the anatomy of neural, osseous, and ligamentous structures at the intervertebral foramen. We further provide recommendations for avoidance and detection of such complication.