1/59. Idiopathic spinal cord herniation: case report and review of the literature.OBJECTIVE AND IMPORTANCE: Idiopathic spinal cord herniation (ISCH) is a rare condition, reported in only 25 patients thus far, in which the thoracic cord is prolapsed through an anterior dural defect. It typically presents in middle age as either brown-sequard syndrome or spastic paraparesis. CLINICAL PRESENTATION: A 55-year-old woman initially presented at the age of 41 years with brown-sequard syndrome at the T8 disc space level on the left side. Investigations, including primitive magnetic resonance imaging, were deemed negative at that time. After a stepwise deterioration over 14 years, she presented again with spastic paraparesis and double incontinence, in addition to her previous spinothalamic dysfunction. magnetic resonance imaging at this stage suggested either ISCH or a dorsal arachnoid cyst. INTERVENTION: Through a T7-T8 laminectomy, a left-of-midline ISCH was identified and easily reduced by gentle cord traction. No dorsal arachnoid cyst was identified. The anterior dural defect was repaired with a XenoDerm patch (LifeCell Corp., Woodlands, TX). After surgery, there was improved motor and sphincter function. However, there was continued sensory disturbance. CONCLUSION: ISCH is rare cause of thoracic cord dysfunction. Despite prolonged diagnostic delay, significant clinical improvement may be obtained with ISCH reduction and anterior dural repair.- - - - - - - - - - ranking = 1keywords = dura (Clic here for more details about this article) |
2/59. Nerve root herniation secondary to lumbar puncture in the patient with lumbar canal stenosis. A case report.STUDY DESIGN: A very rare case of nerve root herniation secondary to lumbar puncture is reported. OBJECTIVE: To describe the characteristic clinical features of this case and to discuss a mechanism of the nerve root herniation. SUMMARY OF BACKGROUND DATA: There has been no previous report of nerve root herniation secondary to lumbar puncture. methods: A 66-year-old woman who experienced intermittent claudication as a result of sciatic pain on her right side was evaluated by radiography and magnetic resonance imaging, the results of which demonstrated central-type canal stenosis at L4-L5. The right sciatic pain was exacerbated after lumbar puncture. myelography and subsequent computed tomography showed marked stenosis of the thecal sac that was eccentric to the left, unlike the previous magnetic resonance imaging finding. RESULTS: At surgery, a herniated nerve root was found through a small rent of the dorsocentral portion of the thecal sac at L4-L5, presenting a loop with epineural bleeding. The herniated nerve root was put back into the intrathecal space, and the dural tear was repaired. CONCLUSION: Lumbar puncture can be a cause of nerve root herniation in cases of lumbar canal stenosis. The puncture should not be carried out at an area of stenosis.- - - - - - - - - - ranking = 0.33333333333333keywords = dura (Clic here for more details about this article) |
3/59. Idiopathic spinal cord herniation: value of MR phase-contrast imaging.We report two patients with an idiopathic transdural spinal cord herniation at the thoracic level. Phase-contrast MR imaging was helpful in showing an absence of CSF flow ventral to the herniated cord and a normal CSF flow pattern dorsal to the cord, which excluded a compressive posterior arachnoid cyst.- - - - - - - - - - ranking = 0.33333333333333keywords = dura (Clic here for more details about this article) |
4/59. Congenital lumbar hernia.Congenital lumbar hernia (CLH) is a rare anomaly with only 45 cases reported in the English-language literature. This paper describes nine patients with CLH treated in our unit. Unusual features included the relatively high incidence of inferior lumbar hernia, presentation at the age of 6 years in one case, and an association with hydrometrocolpos and anorectal malformation, which is hitherto unreported. In seven patients the hernia could be repaired successfully. One patients' parents refused surgery for the CLH after treatment of a hydrometrocolpos and another died of fulminant pneumonia before the operation. Early operation is the treatment of choice, and repair with local tissues is preferable. The need for prosthetic material arises when the size of the defect is large. A successful operation offers a good quality of life.- - - - - - - - - - ranking = 0.41771799453359keywords = mater (Clic here for more details about this article) |
5/59. spinal cord herniation into an extensive extradural meningeal cyst: postoperative analysis of intracystic flow by phase-contrast cine MRI.We report a patient with idiopathic spinal cord herniation who underwent postoperative myelography and phase-contrast cine magnetic resonance imaging (MRI) to clarify the condition of the ventral cystic lesion into which the spinal cord had been herniated. This 58-year-old man showed symptoms and signs compatible with brown-sequard syndrome. A myelogram and MRI showed that the spinal cord was incarcerated in a small space, and this finding led to the diagnosis of spinal cord herniation. In the operation, the herniated spinal cord was returned to the initial intradural space, and the dural defect was enlarged to prevent recurrence of the herniation. After the operation, leg muscle strength improved and bladder and bowel dysfunction resolved, but analgesia was unchanged. Postoperative myelography revealed a very large extradural cystic lesion, which extended from C2 to L1 vertebral level. A cerebrospinal fluid (CSF) flow study of the intradural space disclosed a near-normal pattern, but the intracystic CSF dynamics were abnormal. In the intracystic space at just the upper level of the lesion, cranial flow (reverse directional flow in comparison with the intradural flow) was seen in the systolic cycle after momentary fast caudal flow, and these CSF dynamics may have been related to the spinal cord herniation.- - - - - - - - - - ranking = 3keywords = dura (Clic here for more details about this article) |
6/59. Spontaneous spinal cord herniation: case report and review of the literature.OBJECTIVE AND IMPORTANCE: Spontaneous herniation of the spinal cord substance through a previously uninjured and/or untouched dura is a very exceptional occurrence. Spontaneous spinal cord herniation, which was first reported 25 years ago, is a cause of myelopathy that is treatable but difficult to diagnose. CLINICAL PRESENTATION: A 49-year-old female patient who presented with a 3-year history of a burning sensation and hyperesthesia in her right leg and a 3-month history of left leg stiffness was diagnosed as exhibiting signs of Brown-Sequard syndrome. magnetic resonance imaging of the thoracic spinal canal demonstrated S-shaped anterior kinking and transdural herniation of the spinal cord at the T3-T4 levels. INTERVENTION: The patient underwent surgery via a three-level laminectomy. The herniated part of the spinal cord was microsurgically reduced, and the dural defect was repaired with Gore-Tex membrane (WL Gore & Associates, Flagstaff, AZ). The outcome of surgery was excellent. CONCLUSION: review of the world literature revealed 29 reported cases, with 27 of these cases being published since 1990. The clinical features, radiological diagnosis, and treatment options for this unique entity are summarized, with a synopsis of numerous misconceptions that appeared in the literature. With more familiarity with and increased awareness of this entity, more cases will be diagnosed.- - - - - - - - - - ranking = 1keywords = dura (Clic here for more details about this article) |
7/59. Progressive spontaneous herniation of the thoracic spinal cord: case report.OBJECTIVE AND IMPORTANCE: We report one case of spontaneous thoracic spinal cord herniation. To our knowledge, this is the first case involving radiological documentation of the development of herniation. Clinical features and surgical techniques are also presented. CLINICAL PRESENTATION: We describe the case of a 51-year-old female patient who experienced progressive brown-sequard syndrome for 2 years. Three magnetic resonance imaging examinations were performed; they revealed the progressive development of anterolateral spinal cord herniation at the level of T6 during those 2 years. INTERVENTION: After laminectomy at T6, the herniated myelon was microsurgically removed and the neurological symptoms improved. CONCLUSION: We present the possible causes, the proposed pathophysiological mechanisms, and the clinical and radiological development of this rare entity, with a review of the literature published to date. We propose that a preexisting weakness of the ventral dural fibers, combined with abnormal adhesion of the spinal cord to the anterior dural sleeve, leads to progressive herniation throughout life. Microsurgical treatment may halt the exacerbation of the neurological symptoms.- - - - - - - - - - ranking = 0.66666666666667keywords = dura (Clic here for more details about this article) |
8/59. Transdural cauda equina incarceration after microsurgical lumbar discectomy: case report.OBJECTIVE AND IMPORTANCE: Complications usually occur when they are least expected. We present an unusual case of nerve entrapment after microsurgical discectomy. CLINICAL PRESENTATION: A patient undergoing uneventful first lumbar microsurgical discectomy developed severe back and leg pain and a progressive neurological deficit during the first postoperative night. Herniation of cauda equina nerve roots had occurred through an unnoticed minimal defect in the dura, which had not caused cerebrospinal fluid leakage. The roots were incarcerated and swollen, and they filled the space of the resected nucleus pulposus. It was presumed that elevation of intra-abdominal pressure and consequent increased intraspinal pressure during extubation led to the herniation of arachnoid and cauda equina roots. The nerve roots were then trapped and incarcerated in the manner of bowel loops in an abdominal wall hernia. INTERVENTION: During reoperation, the nerve roots were repositioned into the dural sac. The patient recovered without further complications and without long-term sequelae. CONCLUSION: All dural tears that occur during intraspinal surgery, even if they are small and the arachnoid is intact, should be closed with stitches or at a minimum with a patch of muscle or gelatin sponge with fibrin glue. Care should be taken to avoid increased intra-abdominal pressure during extubation. Excessive pain and progressive neurological dysfunction occurring shortly after microsurgical lumbar discectomy or any intraspinal procedure is indicative of possible hemorrhage with subsequent compression of nerve roots. The case reported here provides anecdotal evidence that this situation can also be caused by a herniation of cauda equina nerve roots through a small dural defect that was not evident during the initial operation.- - - - - - - - - - ranking = 2.6666666666667keywords = dura (Clic here for more details about this article) |
9/59. Idiopathic spinal cord herniation.spinal cord herniation is a rare condition that has become increasingly recognised in the last few years. The authors report a case of idiopathic spinal cord herniation in a 33 year old woman who presented with progressive brown-sequard syndrome. The diagnosis was made on MR imaging. After repairing the herniation the patient made a gradual improvement. Potential causes are discussed, including the possible role of dural tethering. In conclusion, idiopathic spinal cord herniation is a potentially treat able condition that should be more readily diagnosed with increased awareness and newer imaging techniques such as high resolution MRI.- - - - - - - - - - ranking = 0.33333333333333keywords = dura (Clic here for more details about this article) |
10/59. Acute posttraumatic spinal cord herniation. Case report and review of the literature.Transdural herniations of the spinal cord are rare, and those occurring acutely after a spinal cord injury (SCI) are particularly unusual. In this report, the authors present the case of acute posttraumatic spinal cord herniation in a patient who sustained severe polytraumatic injuries. The clinical manifestations were acute flaccid paralysis of the right leg and rapidly progressive sensorimotor deficits of the contralateral leg. The herniation was surgically reduced. Postoperatively left leg paralysis was completely resolved. The authors review the pertinent literature, and suggest that, with regard to another underlying pathophysiological mechanism, cases of acute posttraumatic spinal cord herniation should be differentiated from those "posttraumatic" cases in which herniation of the spinal cord occurs years or even decades after the traumatic event. To the best of the authors' knowledge, only one similar case has been previously reported. They conclude that acute posttraumatic spinal cord herniation should be included in the differential diagnosis of acute neurological deterioration after SCI.- - - - - - - - - - ranking = 0.33333333333333keywords = dura (Clic here for more details about this article) |
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