A Case of Generalized Tonic Seizure after Total En Bloc Spondylectomy under General Anesthesia

Abstract

We report a case of generalized tonic seizures following a total en bloc spondylectomy. The case was that of a 61-year-old man with no history of seizures and no major problems noted under previous general anesthesia. Preoperative examination, including blood tests, showed only atrial fibrillation. A total en bloc spondylectomy（TES）was planned. The operation time was 5 hours and 14 minutes, during which no problem with bleeding and circulatory and respiratory dynamics was observed. After the operation, the patient was admitted to the ICU after extubation for postoperative management. Generalized tonic seizure suddenly developed 20 minutes after entering the ICU. The seizure disappeared after intravenous diazepam injection. Head CT showed high absorption in the right Sylvian fissure and cerebellar tent margin. The MRI excluded cerebral infarction and thrombosis. The patient was extubated two days after the operation, and no other notable findings such as seizures were observed. The most probable cause of the seizures, in this case, was thought to be intracranial hemorrhage due to low CSF pressure, which is one of the complications of spinal surgery.