CASE REPORT article
Front. Med.
Sec. Intensive Care Medicine and Anesthesiology
Dural tear with severe irrigation-related complications during unilateral biportal endoscopy under general anesthesia: a case series and and literature review
Jian Guo
Feng Zhou
Yitao Qian
Yuting Qiu
Shuangjian Han
Jianhong Xu
Fourth Affiliated Hospital, School of Medicine, Zhejiang University, Yiwu, China
Select one of your emails
You have multiple emails registered with Frontiers:
Notify me on publication
Please enter your email address:
If you already have an account, please login
You don't have a Frontiers account ? You can register here
Abstract
Background: Unilateral biportal endoscopy (UBE) has been widely adopted in clinical practice owing to its advantages of providing a clearer surgical field, reducing estimated blood loss, and shortening hospitalization duration. Dural tear represents a common complication of UBE; when combined with the unique dual-channel continuous high-pressure irrigation system, it may trigger severe irrigation-related complications (IRC) that jeopardize patient safety. Case presentation: We retrospectively reviewed UBE procedures performed at the Fourth Affiliated Hospital of Zhejiang University School of Medicine from August 2024 to July 2025. A total of 5 cases of severe IRC following incidental dural tear of UBE were identified. Key clinical manifestations during the anesthesia emergence phase included refractory hypertension, tachycardia, postoperative emergence agitation, headache, and back pain. All patients achieved successful outcomes following comprehensive treatment. Conclusions: Incidental dural tear during UBE can result in severe IRC, which pose a considerable threat to patient safety. Comprehensive interventions—including sedation, analgesia, targeted management of hypertension and tachycardia, as well as administration of mannitol, furosemide, or methylprednisolone—are crucial. Anesthesiologists should maintain vigilance for these clinical features and proactively manage IRC associated with dural tear during UBE. Keywords: Unilateral biportal endoscopy; Dural tear; Irrigation-related complications; Hypertension; Tachycardia; Emergence agitation
Summary
Keywords
Dural Tear, Emergence agitation, Hypertension, Irrigation-related complications, Tachycardia, Unilateral biportal endoscopy
Received
28 December 2025
Accepted
04 February 2026
Copyright
© 2026 Guo, Zhou, Qian, Qiu, Han and Xu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Jianhong Xu
Disclaimer
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.