Idiopathic Ventral Spinal Cord Herniation: Video Report and Systematic Review

Background: Idiopathic spinal cord herniation (ISCH) is a rare, underrecognized, and often misdiagnosed entity of unclear pathogenesis that typically presents as a slowly progressive thoracic myelopathy. There are less than 200 such cases reported in the literature. ISCH diagnosis and treatment are often delayed contributing to greater fixed neurological deficits, often leading to costly, unnecessary imaging studies, and inappropriate surgery. Case Description: Here, a 48-year-old female presented with trauma-induced ISCH characterized by gradually worsening lower extremity myelopathy. Conclusion: Idiopathic spinal cord herniation (ISCH) is rare, often underdiagnosed posttraumatic myelopathy that, when accurately diagnosed and treated, can result in good outcomes.

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Dorsal arachnoid web

Neurosurgical FOCUS ◽

10.3171/2014.v3.focus14273 ◽

2014 ◽

Vol 37 (v2supplement) ◽

pp. Video8

Author(s):

Paul C. McCormick

Keyword(s):

Spinal Cord ◽

Arachnoid Cyst ◽

Progressive Myelopathy ◽

Link Type ◽

Spinal Cord Herniation ◽

Ventral Spinal Cord

Dorsal thoracic arachnoid web is a rare but often overlooked cause of progressive myelopathy. Syringomyelia, either above or below the compressive arachnoid band, may also be present. Dorsal arachnoid cyst and ventral spinal cord herniation may be mistaken for this condition. This video demonstrates the microsurgical identification and techniques of resection of a dorsal arachnoid band producing a progressive myelopathy in a 63-year-old man.The video can be found here: http://youtu.be/KDNTqiyW6yo.

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Spinal Cord Suspension Using Dentate Ligament Hitch Stitches: A Novel Technique for the Repair of Ventral Spinal Cord Herniation

Operative Neurosurgery ◽

10.1093/ons/opx108 ◽

2017 ◽

Vol 14 (3) ◽

pp. 252-258 ◽

Cited By ~ 4

Author(s):

Jonathan Lui ◽

Parag Sayal ◽

David Choi

Keyword(s):

Spinal Cord ◽

Standard Technique ◽

Resonance Imaging ◽

Novel Technique ◽

Early Results ◽

Spinal Cord Herniation ◽

Idiopathic Spinal Cord Herniation ◽

Dural Patch ◽

Dentate Ligament ◽

Ventral Spinal Cord

Abstract BACKGROUND Idiopathic spinal cord herniation is usually repaired by releasing the spinal cord and inserting a dural patch to close the herniated segment of dura. However, reherniation is a potential limitation of this standard technique. OBJECTIVE To describe early results of a novel technique that utilizes the dentate ligament to hitch the spinal cord and prevent reherniation. METHODS Two patients underwent dural hernia repair and the dentate hitch technique was performed. RESULTS Restored lower limb power and mobility, and satisfactory reduction of spinal cord herniation on magnetic resonance imaging in 2 patients at 6- and 24-mo follow-ups, respectively. CONCLUSION The dentate hitch technique can achieve repair of spinal cord herniation, with satisfactory postoperative results and minimizes the risk of reherniation.

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Idiopathic ventral spinal cord herniation: a rare presentation of tethered cord

Neurosurgical FOCUS ◽

10.3171/2010.3.focus1089 ◽

2010 ◽

Vol 29 (1) ◽

pp. E10 ◽

Cited By ~ 18

Author(s):

John H. Shin ◽

Ajit A. Krishnaney

Keyword(s):

Spinal Cord ◽

Natural History ◽

Surgical Techniques ◽

Tethered Cord ◽

Rare Condition ◽

Review Article ◽

Optimal Management ◽

Rare Presentation ◽

Spinal Cord Herniation ◽

Ventral Spinal Cord

Idiopathic ventral spinal cord herniation is a rare condition that has been increasingly reported in the last decade. The natural history and optimal management have yet to be defined. Therefore, debate exists regarding the pathogenesis and surgical management of this condition. The purpose of this review article is to further educate neurosurgeons about the surgical techniques and outcomes associated with treating this rare and often misdiagnosed condition.

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Clipping of an anterior spinal artery aneurysm using an endoscopic fluorescence imaging system for craniocervical junction epidural arteriovenous fistula: technical note

Journal of Neurosurgery Spine ◽

10.3171/2019.1.spine18983 ◽

2019 ◽

Vol 31 (2) ◽

pp. 279-284 ◽

Cited By ~ 2

Author(s):

Ahmed Mansour ◽

Toshiki Endo ◽

Tomoo Inoue ◽

Kenichi Sato ◽

Hidenori Endo ◽

...

Keyword(s):

Spinal Cord ◽

Arteriovenous Fistula ◽

Fluorescence Imaging ◽

Imaging System ◽

Artery Aneurysm ◽

Craniocervical Junction ◽

Anterior Spinal Artery ◽

Posterolateral Approach ◽

Fluorescence Imaging System ◽

Ventral Spinal Cord

The authors report the case of a 78-year-old man with a craniocervical junction epidural arteriovenous fistula who presented with subarachnoid hemorrhage from a ruptured anterior spinal artery (ASA) aneurysm. Because endovascular embolization was difficult, a posterolateral approach was chosen and a novel endoscopic fluorescence imaging system was utilized to clip the aneurysm. The fluorescence imaging system provided clear and magnified views of the ventral spinal cord simultaneously with the endoscope-integrated indocyanine green videoangiography, which helped safely obliterate the ASA aneurysm. With the aid of this novel imaging system, surgeons can appreciate and manipulate complex vascular pathologies of the ventral spinal cord through a posterolateral approach, even when the lesion is closely related to the ASA.

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