Coexisting protruding osteocyte and arachnoid cyst mimicking spinal cord herniation in a patient with Brown Sequard syndrome

Abstract This 68-year-old man presented with progressive spastic paraparesis of 2-month duration. The diagnosis was Brown-Sequard syndrome(BSS). Magnetic resonance imaging (MRI) revealed ventral displacement of the spinal cord at Th 7–8. The spinal cord deformity was dominant on the left side. He underwent surgery under the preoperative diagnosis of spinal cord herniation at Th 7–8. Intraoperatively we detected an arachnoid cyst and an osteophyte that compressed the spinal cord at Th 7–8 dorsally and ventrally rather than spinal cord herniation. Postoperative MRI showed successful spinal cord decompression. His neurological findings improved remarkably just after surgery. Although the misdiagnosis of spinal hernia in the actual presence of arachnoid cysts has been reported, ours is the first case of both, a lateralized osteophyte and an arachnoid cysts mimicking spinal cord herniation.

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Minimally Invasive Approach for Dorsal Arachnoid Web: 2-Dimensional Operative Video

Operative Neurosurgery ◽

10.1093/ons/opab297 ◽

2021 ◽

Author(s):

Corentin Dauleac ◽

Henri-Arthur Leroy ◽

Richard Assaker

Keyword(s):

Spinal Cord ◽

Minimally Invasive ◽

Skin Incision ◽

Minimally Invasive Approach ◽

Tubular Retractor ◽

Invasive Approach ◽

Spinal Cord Herniation ◽

Muscle Sparing ◽

Magnetic Resonance Imaging Mri ◽

Spinal Cord Decompression

Abstract A 67-yr-old patient presented with severe paraparesis and lower limb spasticity. The spinal cord magnetic resonance imaging (MRI) revealed the “scalpel sign” 1,2 at the T7 level, suggesting a diagnosis of a dorsal arachnoid web. This video demonstrates a microsurgical technique for the excision of a dorsal arachnoid web with a minimally invasive approach. A paramedian skin incision, understanding the muscular aponeurosis, was performed from T7 to T8. Then, we inserted the tubular dilators until the lamina, to perform a muscle-sparing approach. An expandable tubular retractor of adequate length was passed over the widest dilator and docked into place along the subperiosteal plane. The T7 lamina was drilled, and the resection of the superior and inferior adjacent spine levels was completed with a rongeur. Additional contralateral bone resection was performed after tubular retractor tilt to the midline.3 After dura mater opening, it was carefully suspended and the dorsal arachnoid leaflet was cut to drain the dorsolateral and lateral spinal cisterns.4 The dorsal arachnoid web was, first, disconnected from its lateral anchorages. It was then gently removed with microsurgical forceps, to help its microdissection from the spinal cord surface. At this step, peculiar attention was paid to limit the traction or displacements of the spinal cord and surrounding vessels. Once the dorsal arachnoid web was removed, the quality of the spinal cord decompression was confirmed by its re-expansion. In conclusion, the minimally invasive approach is a safe and appropriate technique for dorsal arachnoid web excision.2,5,6-7 The patient gave her informed and signed consent for the writing and publication of this article. Image at 1:00 reused with permission from Castelnovo G et al, Spontaneous transdural spinal cord herniation, Neurology, 2014;82(14):1290.

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Thoracic idiopathic spinal cord herniation in a young patient: a diagnostic and therapeutic challenge

BMJ Case Reports ◽

10.1136/bcr-2018-227847 ◽

2019 ◽

Vol 12 (5) ◽

pp. e227847 ◽

Cited By ~ 1

Author(s):

D Gomez-Amarillo ◽

C Garcia-Baena ◽

D Volcinschi-Moros ◽

F Hakim

Keyword(s):

Spinal Cord ◽

Posterior Approach ◽

Dural Defect ◽

Thoracic Myelopathy ◽

Postoperative Mri ◽

Younger Age ◽

Spinal Cord Herniation ◽

Idiopathic Spinal Cord Herniation ◽

Brown Sequard Syndrome

Idiopathic Spinal Cord Herniation (ISCH) is considered to be a rare cause of Thoracic Myelopathy. It is secondary to the gliding of the Spinal Cord through an anterior dural defect, without a completely defined cause. We present a case of ISCH which, even though was in its usual location, developed in a woman at a younger age than expected. The patient was 20 years old when diagnosed with Brown-Séquard Syndrome. MRI showed herniation at T4-T5 level, which was corrected using a posterior approach to expose the dural defect, reduce the herniation and place a heterologous graft. Postoperatively, neurological function improved, and adequate reduction was seen on imaging. Given the reports of recurrence and deterioration that have been seen after 18 months, follow-up was prolonged for a total of 2 years. We consider postoperative MRI performance important to establish the degree of reduction and alignment of the Spinal Cord.

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Spinal cord herniation into a congenital extradural arachnoid cyst causing Brown-Séquard syndrome

Journal of Neurosurgery ◽

10.3171/jns.1981.55.6.0983 ◽

1981 ◽

Vol 55 (6) ◽

pp. 983-986 ◽

Cited By ~ 87

Author(s):

Hideaki Masuzawa ◽

Hitoshi Nakayama ◽

Nobuyuki Shitara ◽

Takeyo Suzuki

Keyword(s):

Spinal Cord ◽

Arachnoid Cyst ◽

Vertebral Level ◽

Content Type ◽

Congenital Origin ◽

Spinal Cord Herniation ◽

Intercostal Pain ◽

Brown Sequard Syndrome ◽

Extradural Arachnoid Cyst ◽

Fine Print

✓ This is a report of a patient who developed sharp intercostal pain and Brown-Séquard syndrome. Displacement of the spinal cord toward an extradural mass was noted at the T4–5 vertebral level on iophendylate myelography and metrizamide computerized tomography myelography. Multiple meningeal diverticular lesions of congenital origin were also found. Surgical correction of the spinal cord, which had herniated into a laterally located extradural arachnoid cyst and become incarcerated, resulted in a complete neurological recovery.

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A sacral arachnoid cyst causing holocord syringomyelia

Journal of Neurosurgery Pediatrics ◽

10.3171/2011.6.peds11219 ◽

2011 ◽

Vol 8 (3) ◽

pp. 299-302 ◽

Cited By ~ 3

Author(s):

Sumit Thakar ◽

Narayanam Anantha Sai Kiran ◽

Alangar S. Hegde

Keyword(s):

Mr Imaging ◽

Arachnoid Cyst ◽

Complete Resolution ◽

Spastic Paraparesis ◽

Arachnoid Cysts ◽

Sensory Loss ◽

Low Back ◽

Filum Terminale ◽

Sensory Deficits

Spinal extradural arachnoid cysts (ACs) have an infrequent predilection for the sacrum. As with their counterparts in other regions of the spine, cysts in this location are mostly asymptomatic. Common presentations in symptomatic cases include pain in the low back or perineum, radiculopathy, and sphincteric dysfunction. The authors report a hitherto undescribed presentation in which the predominant symptoms are those related to an associated holocord syrinx. This 15-year-old boy presented with fluctuating, spastic paraparesis and a dissociated sensory loss in the trunk. Admission MR imaging of the spine showed an extradural AC from S-2 to S-4 and a holocord, nonenhancing syrinx. The patient underwent S-2 laminectomy, fenestration of the cyst, and partial excision of its wall. Intradural exploration revealed a normal-looking filum terminale and the absence of any dural communication with the cyst. At a follow-up visit 6 months after surgery, his motor and sensory deficits had resolved. Follow-up MR imaging showed complete resolution of the syrinx in the absence of the sacral AC. This is the first report of a sacral extradural AC causing holocord syringomyelia. Because conventional theories of syrinx formation were not helpful in elucidating this case, a hypothesis is postulated to explain the clinicoradiological oddity.

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Posterior spinal cord herniation into an extradural thoracic arachnoid cyst: surgical treatment

Journal of Neurosurgery Pediatrics ◽

10.3171/ped.2006.104.3.210 ◽

2006 ◽

Vol 104 (3) ◽

pp. 210-211 ◽

Cited By ~ 4

Author(s):

Farideh Nejat ◽

Samira Zabihyan Cigarchi ◽

Syed Shuja Kazmi

Keyword(s):

Spinal Cord ◽

Surgical Treatment ◽

Arachnoid Cyst ◽

Spinal Cord Herniation

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Thoracic Spinal Cord Herniation presenting with Brown-Sequard Syndrome

Japanese Journal of Neurosurgery ◽

10.7887/jcns.10.389 ◽

2001 ◽

Vol 10 (6) ◽

pp. 389-393

Author(s):

Motohiro Kajiwara ◽

Junya Hanakita ◽

Hideyuki Suwa ◽

Kazuhiko Shiokawa ◽

Masaaki Saiki ◽

...

Keyword(s):

Spinal Cord ◽

Thoracic Spinal Cord ◽

Thoracic Spinal ◽

Spinal Cord Herniation ◽

Brown Sequard Syndrome

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Upper thoracic spinal cord herniation after traumatic nerve root avulsion

Neurosurgical FOCUS ◽

10.3171/foc.2004.16.5.20 ◽

2004 ◽

Vol 16 (5) ◽

pp. 306-309

Author(s):

Victor R. DaSilva ◽

Mubarak Al-Gahtany ◽

Rajiv Midha ◽

Dipanka Sarma ◽

Perry Cooper

Keyword(s):

Spinal Cord ◽

Nerve Root ◽

Signs And Symptoms ◽

Root Avulsion ◽

Thoracic Spinal Cord ◽

First Case ◽

Thoracic Spinal ◽

Spinal Cord Herniation ◽

Nerve Root Avulsion ◽

Upper Thoracic

✓ Transdural herniation of the spinal cord, a rare but well-documented entity, has been reported sporadically for more than 25 years as a possible cause for various neurological signs and symptoms ranging from isolated sensory or motor findings to myelopathy and Brown–Séquard syndrome. The authors report, to the best of their knowledge, the first case of upper thoracic spinal cord herniation occurring after traumatic nerve root avulsion.

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Rehabilitation of a patient with spinal cord decompression sickness: First case report from Saudi Arabia

Clinical Case Reports ◽

10.1002/ccr3.2453 ◽

2019 ◽

Vol 7 (11) ◽

pp. 2231-2234

Author(s):

Sami Ullah ◽

Ahmad Zaheer Qureshi ◽

Kholoud Kedowah ◽

Afnan AlHargan ◽

Asim Niaz

Keyword(s):

Spinal Cord ◽

Saudi Arabia ◽

Case Report ◽

Decompression Sickness ◽

First Case ◽

Spinal Cord Decompression

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Operative Treatment of Anterior Thoracic Spinal Cord Herniation: Three New Cases and an Individual Patient Data Meta-analysis of 126 Case Reports

Operative Neurosurgery ◽

10.1227/01.neu.0000327686.99072.e7 ◽

2009 ◽

Vol 64 (suppl_1) ◽

pp. ONS145-ONS160 ◽

Cited By ~ 12

Author(s):

Rob J.M. Groen ◽

Berrie Middel ◽

Jan F. Meilof ◽

J.B. Margot de Vos-van de Biezenbos ◽

Roelien H. Enting ◽

...

Keyword(s):

Spinal Cord ◽

Motor Function ◽

Operative Treatment ◽

Meta Analysis ◽

Postoperative Outcome ◽

Thoracic Spinal Cord ◽

Thoracic Spinal ◽

Spinal Cord Herniation ◽

Dura Defect ◽

Brown Sequard Syndrome

Abstract Objective: Anterior thoracic spinal cord herniation is a rare cause of progressive myelopathy. Much has been speculated about the best operative treatment. However, no evidence in favor of any of the promoted techniques is available to date. Therefore, we decided to analyze treatment procedures and treatment outcomes of anterior thoracic spinal cord herniation to identify those factors that determine postoperative outcome. Methods: An individual patient data meta-analysis was conducted, focusing on age, gender, vertebral segment of herniation, preoperative neurological status, operative interval, operative findings, operative techniques, intraoperative neurophysiological monitoring, postoperative imaging, neurological outcome and follow-up. Three cases from our own institution were added to the material collected. Bivariate analysis tests and multivariate logistic regression tests were used so as to define which variables were associated with outcome after surgical treatment of anterior thoracic spinal cord herniation. Results: Brown-Séquard syndrome and release of the herniated spinal cord appeared to be strong independent factors, associated with favorable postoperative outcome. Widening of the dura defect is associated with the highest prevalence of postoperative motor function improvement when compared with the application of an anterior dura patch (P < 0.036). Conclusion: Most patients with anterior thoracic spinal cord herniation require operative treatment because of progressive myelopathy. Patients with Brown-Séquard syndrome have a better prognosis with respect to postoperative motor function improvement. In this review, spinal cord release and subsequent widening of the dura defect were associated with the highest prevalence of motor function improvement. D-wave recording can be a very useful tool for the surgeon during operative treatment of this disorder.

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