scholarly journals Symptomatic interdural cerebrospinal fluid collections after surgery for idiopathic spinal cord herniation: illustrative case

2021 ◽  
Vol 2 (14) ◽  
Author(s):  
Yasufumi Ohtake ◽  
Makoto Senoo ◽  
Mamoru Fukuda ◽  
Yuuki Ishida ◽  
Ryunosuke Yoshihara ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Cerebrospinal Fluid ◽  
Epidural Space ◽  
Illustrative Case ◽  
Direct Closure ◽  
Csf Pressure ◽  
Arm Pain ◽  
Spinal Cord Herniation ◽  
Blood Patch ◽  
Idiopathic Spinal Cord Herniation

BACKGROUND Idiopathic spinal cord herniation (ISCH) is very rare. Some reports have described postoperative ventral cerebrospinal fluid (CSF) collections in patients with ISCH; however, such collections are asymptomatic in most patients, and there is no consensus regarding whether they are part of the natural history or a complication. OBSERVATIONS A 30-year-old man with ISCH underwent direct closure of a duplicated dura mater. Eight months postoperatively, he developed reworsening of right lower limb paresis and new severe right arm pain and paresis. Three-dimensional magnetic resonance imaging revealed ventral CSF collections, which the authors judged as the responsible lesions. The authors initially considered these collections to be present in the epidural space, extradurally compressing the dural sac and resulting in myelopathy. An epidural blood patch failed; however, a CSF drainage test resulted in dramatic improvement. The authors therefore determined that the CSF collections were located in the interdural space, not the epidural space. A lumboperitoneal (LP) shunt was performed to reduce the CSF pressure. The patient’s symptoms improved immediately postoperatively. He had developed no recurrence of symptoms 6 months after surgery. LESSONS Ventral interdural CSF collections after ISCH surgery can cause reworsening of myelopathy and may be cured by a LP shunt to control CSF pressure.

CT-Guided Autologous Blood Patch for High-Level Cervical Cerebrospinal Fluid Leakage: Imaging Characteristics and Treatment Safety and Efficiency

2021 ◽  
pp. 1-7
Author(s):  
Xiaofeng He ◽  
Yueyong Xiao ◽  
Xiao Zhang ◽  
Xiaobo Zhang ◽  
Xin Zhang ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Epidural Space ◽  
Autologous Blood ◽  
Cerebrospinal Fluid Leakage ◽  
Imaging Features ◽  
Ct Guided ◽  
Iodinated Contrast ◽  
Blood Patch ◽  
Csf Leakage ◽  
High Level

<b><i>Introduction:</i></b> Epidural blood patches (EBPs) are rarely performed at the high-level cervical levels. The aim of the study was to investigate the imaging features, safety, and effectiveness of CT-guided percutaneous EBPs for high-level cervical cerebrospinal fluid (CSF) leakage. <b><i>Methods:</i></b> Twenty-five patients with spontaneous high-level (C1–C3) CSF leakage on MRI and CT imaging, including 2 patients with intracranial epidural hematoma caused by CSF, were treated with EBP. Two needles were inserted into the C1–3 bilateral epidural space. The needle location was confirmed by injection of both 3–5mL sterile air and a diluted iodinated contrast agent to delineate its spatial diffusion. The patient’s blood 11.1 ± 3.1 mL was slowly injected to make a patch; the distribution in epidural space was monitored with intermittent CT scanning. <b><i>Results:</i></b> The typical manifestation of CSF leakage was the high signal outside the C1–3 cervical dura on MR T2W fat inhibition images and low density in cervical muscle space on CT images. Twenty patients suffered from headaches and were able to sit and walk 24 h after the operation. Four patients, with partial relief of headache and a small but persistent CSF leakage, were re-treated with EBS. One patient underwent a third operation because of a persistent CSF leakage on MRI. <b><i>Conclusions:</i></b> Imaging of water at the surrounding epidural space of high cervical level is a typical feature of dural rupture on both MRI and CT. CT-guided EBP is safe and efficient for the high-level cervical CSF leakage, especially for cases in which conservative treatments failed.

Idiopathic spinal cord herniation: an imaging diagnosis with a significant delay

2015 ◽  
Vol 15 (9) ◽  
pp. 1943-1948 ◽  
Author(s):  
Britton J. Carter ◽  
Brent D. Griffith ◽  
Lonni R. Schultz ◽  
Muwaffak M. Abdulhak ◽  
Daniel S. Newman ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Imaging Diagnosis ◽  
Significant Delay ◽  
Spinal Cord Herniation ◽  
Idiopathic Spinal Cord Herniation

Idiopathic Spinal Cord Herniation: Case Report and Literature Review

2001 ◽  
Vol 143 (4) ◽  
pp. 401-406 ◽  
Author(s):  
P. Pereira ◽  
F. Duarte ◽  
R. Lamas ◽  
R. Vaz
Keyword(s):  
Spinal Cord ◽  
Case Report ◽  
Literature Review ◽  
Spinal Cord Herniation ◽  
Idiopathic Spinal Cord Herniation

Idiopathic Spinal Cord Herniation: Case Report and Review of the Literature

Neurosurgery ◽  
1999 ◽  
Vol 44 (5) ◽  
pp. 1129-1133 ◽  
Author(s):  
Laurence A.G. Marshman ◽  
Carl Hardwidge ◽  
Suzanne C. Ford-Dunn ◽  
John S. Olney
Keyword(s):  
Spinal Cord ◽  
Case Report ◽  
Review Of The Literature ◽  
Spinal Cord Herniation ◽  
Idiopathic Spinal Cord Herniation

scholarly journals Idiopathic Spinal Cord Herniation Associated With Calcified Thoracic Disc Extrusion-Case Report-

2003 ◽  
Vol 43 (7) ◽  
pp. 364-368 ◽  
Author(s):  
Takao SAGIUCHI ◽  
Hideo IIDA ◽  
Shigekuni TACHIBANA ◽  
Satoshi UTSUKI ◽  
Ryusui TANAKA ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Case Report ◽  
Spinal Cord Herniation ◽  
Idiopathic Spinal Cord Herniation ◽  
Thoracic Disc ◽  
Disc Extrusion

Post–Dural Puncture Headache

2017 ◽  
Author(s):  
Philip Rubin
Keyword(s):  
Cerebrospinal Fluid ◽  
Epidural Space ◽  
Gold Standard ◽  
Dural Puncture ◽  
Epidural Blood Patch ◽  
Autologous Blood ◽  
Caffeine Intake ◽  
Recumbent Position ◽  
Post Dural Puncture Headache ◽  
Blood Patch

Post–dural puncture headache (PDPH) is a benign but debilitating condition that may occur as a consequence of any dural puncture, whether intentional (as with spinal anesthesia or lumbar puncture) or inadvertent (as with epidural anesthesia). The headache is characteristically unique, as it is postural in nature—worsened when sitting or standing, and markedly improved in the recumbent position. After the puncture, passage of cerebrospinal fluid (CSF) across the dura mater from a pressurized environment (subarachnoid space) to the epidural space, is the initial culprit behind the headache. Noninvasive conservative measures including hydration, analgesics, and caffeine intake are typically offered as initial treatments, but if those measures fail, the “gold standard” epidural blood patch is commonly offered. This procedure entails injection of autologous blood into the epidural space to both halt continued CSF “loss,” and to increase CSF pressure, both of which aid in headache resolution.

Idiopathic Spinal Cord Herniation

Spine ◽  
1993 ◽  
Vol 18 (Supplement) ◽  
pp. 2138-2141 ◽  
Author(s):  
Hideo Nakazawa ◽  
Yoshiaki Toyama ◽  
Kazuhiko Satomi ◽  
Yoshikazu Fujimura ◽  
Kiyoshi Hirabayashi
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Herniation ◽  
Idiopathic Spinal Cord Herniation

Changes in Cerebrospinal Fluid Pressure and Lactate Concentrations during Thoracoabdominal Aortic Aneurysm Surgery

1997 ◽  
Vol 86 (1) ◽  
pp. 41-47 ◽  
Author(s):  
Benjamin Drenger ◽  
Stephen D. Parker ◽  
Steven M. Frank ◽  
Charles Beattie
Keyword(s):  
Spinal Cord ◽  
Cerebrospinal Fluid ◽  
Aortic Aneurysm ◽  
Aortic Surgery ◽  
Thoracoabdominal Aortic Aneurysm ◽  
Aortic Occlusion ◽  
Aneurysm Surgery ◽  
Csf Pressure ◽  
Csf Lactate ◽  
Aortic Aneurysm Surgery

Background Although ischemic injury to the spinal cord is a well-known complication of aortic surgery, no metabolic markers have been identified as predictors of an adverse outcome. This study evaluated the effect of cerebrospinal fluid (CSF) drainage, with and without distal femoral perfusion or moderate hypothermia on blood and CSF lactate concentrations and CSF pressure during thoracoabdominal aortic aneurysm surgery. Methods Three nonconcurrent groups of patients were studied prospectively: patients with normal body temperature (35 degrees C) but without distal femoral bypass (n = 6), patients with normal body temperature with bypass (n = 7), and patients with hypothermia (30 degrees C) and bypass (n = 8). In all patients, CSF pressure was recorded before, during, and after aortic cross-clamping. During the surgical repair, CSF drainage was performed using a 4-Fr intrathecal silicone catheter. Blood and CSF lactate concentrations were measured throughout the operation. Results Significant increases in blood (490%) and CSF (173%) lactate concentrations were observed during and after thoracic aortic occlusion in patients with normothermia and no bypass (P &lt; 0.02 and 0.05, respectively). Distal perfusion attenuated the increase in both blood and CSF lactate (P &lt; 0.01), and a further reduction was achieved with hypothermia of 30 degrees C (P &lt; 0.001). Patients who became paraplegic showed a greater increase in CSF lactate concentrations after aortic clamp release compared with those who suffered no neurological damage (275% vs. 123% of baseline; P &lt; 0.05). Increased CSF pressure of 42-60% (P &lt; 0.005) was noted soon after thoracic aortic occlusion, both with and without distal femoral bypass. Conclusions Incremental reductions in CSF lactate concentrations were achieved using distal femoral bypass and hypothermia. The reduction in CSF lactate correlated with the methods used to protect the spinal cord during thoracoabdominal aortic aneurysm surgery and was associated with better outcome. Decompression by distal bypass of the hemodynamic overload caused by aortic occlusion was insufficient to eliminate the acute increase in CSF pressure. Cerebrospinal fluid lactate measurements during high aortic surgery may accurately represent the spinal cord metabolic balance.

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