Postoperative cauda equina syndrome in patients undergoing single-level lumbar microdiscectomy

2005 ◽  
Vol 19 (2) ◽  
pp. 1-5 ◽  
Author(s):  
Vassilios Dimopoulos ◽  
Kostas N. Fountas ◽  
Theofilos G. Machinis ◽  
Carlos Feltes ◽  
Induk Chung ◽  
...  
Keyword(s):  
Cauda Equina Syndrome ◽  
De Novo ◽  
Cauda Equina ◽  
Conus Medullaris ◽  
Clinical Findings ◽  
Magnetic Resonance Images ◽  
Single Level ◽  
Lumbar Microdiscectomy ◽  
First Case ◽  
Intraoperative Electrophysiological Monitoring

Cauda equina syndrome is a well-documented complication of uneventful lumbar microdiscectomy. In the vast majority of cases, no radiological explanation can be obtained. In this paper, the authors report two cases of postoperative cauda equina syndrome in patients undergoing single-level de novo lumbar microdiscectomy in which intraoperative electrophysiological monitoring was used. In both patients, the amplitudes of cortical and subcortical intraoperative somatosensory evoked potentials (SSEPs) abruptly decreased during discectomy and foraminotomy. In the first patient, a slow, partial improvement of SSEPs was observed before the end of the operation, whereas no improvement was observed in the second patient. In the first case, clinical findings consistent with cauda equina syndrome were seen immediately postoperatively, whereas in the second one the symptoms developed within 1.5 hours after the procedure. Postoperative magnetic resonance images obtained in both patients, and a lumbar myelogram obtained in the second one revealed no signs of conus medullaris or nerve root compression. Both patients showed marked improvement after an intense course of rehabilitation. The authors' findings support the proposition that intraoperative SSEP monitoring may be useful in predicting the development of cauda equina syndrome in patients undergoing lumbar microdiscectomy. Nevertheless, further prospective clinical studies are necessary for validation of these findings.

scholarly journals Arteriovenous Fistula in a Nerve Root of the Cauda Equina Fed by a Proximal Radiculo-Medullary Artery

2011 ◽  
Vol 17 (2) ◽  
pp. 217-223 ◽  
Author(s):  
T. Ohtonari ◽  
S. Ota ◽  
N. Nishihara ◽  
K. Suwa ◽  
T. Ota ◽  
...  
Keyword(s):  
Arteriovenous Fistula ◽  
Nerve Root ◽  
Cauda Equina ◽  
Conus Medullaris ◽  
Magnetic Resonance Images ◽  
Digital Subtraction ◽  
Feeding Artery ◽  
Spinal Arteriovenous Fistula ◽  
First Case ◽  
Flow Void

While there have been a few reports on cases of intradural spinal arteriovenous fistula located on the filum terminale, no cases of its location in a nerve root of the cauda equina have been reported to date. We describe two such cases and describe the intraoperative findings. A 40-year-old man presented weakness of his left leg. Another 62-year-old man presented paraparesis dominantly in his left leg with urinary hesitation. In both cases, spinal T2-weighted magnetic resonance images showed edema of the spinal cord, indicating a flow void around it. Digital subtraction angiography disclosed an anterior radicular artery branching from the anterior spinal artery on the surface of the conus medullaris and a turnaround vein running in the opposite direction within the cauda equina. In the first patient, while the feeding artery running along a nerve root was detected, the draining vein and the fistula were not identified at first sight. An incision into the respective nerve root exposed their location within it. In the second patient, unlike the first case, the feeding artery and the fistula were buried in a nerve root, while the draining vein was running along the nerve's surface. In both cases, permanent clips were applied to the draining vein closest to the fistula. The recognition of a hidden fistulous point in a nerve root of the cauda equina is essential for successful obliteration of the fistula.

scholarly journals Anaplastic pilocytic astrocytoma of the cerebellum presenting with conus medullaris drop metastasis

2021 ◽  
Vol 8 (1) ◽  
pp. 10
Author(s):  
Jared F. Sweeney ◽  
Vaibhav Chumbalkar ◽  
Michael D. Staudt ◽  
Pouya Entezami ◽  
Jiang Qian ◽  
...  
Keyword(s):  
Pilocytic Astrocytoma ◽  
Cauda Equina ◽  
Conus Medullaris ◽  
Complete Understanding ◽  
First Case ◽  
Spine Imaging ◽  
Drop Metastasis ◽  
Cerebellar Mass ◽  
Definition Of ◽  
Staged Operations

Due to its rarity, a complete understanding of the clinical behavior, pathogenesis, and diagnostic definition of anaplastic pilocytic astrocytoma (APA) is currently lacking. The optimal clinical management and use of adjuvant therapies has yet to be defined. We present a 64 year-old-female with progressive headaches, dysarthria, and ataxia, who was found to have right cerebellar mass. A gross total resection was achieved through two staged operations. Pathology demonstrated focal areas of necrosis, tumor infiltration, and increased mitotic activity most consistent with APA. Adjuvant chemotherapy and stereotactic radiosurgery were administered. Approximately two years later, the patient presented with symptoms of cauda equina syndrome, and lumbar spine imaging demonstrated a large intradural mass at the conus medullaris with diffuse leptomeningeal enhancement. A biopsy was performed and was consistent with metastatic APA. APA may rarely progress to metastatic disease, most frequently involving the leptomeninges of the posterior fossa and cervical spine. This report represents the first case of metastases distal to the cervicomedullary junction.

scholarly journals Cauda Equina Syndrome Secondary to Leptomeningeal Carcinomatosis of Gastroesophageal Junction Cancer

2016 ◽  
Vol 8 (1) ◽  
pp. 87-91 ◽  
Author(s):  
Amal Alkhotani ◽  
Nouf Alrishi ◽  
M. Salem Alhalabi ◽  
Tahira Hamid
Keyword(s):  
Cauda Equina Syndrome ◽  
Gastroesophageal Junction ◽  
Cauda Equina ◽  
Leptomeningeal Carcinomatosis ◽  
Leg Pain ◽  
Urine Retention ◽  
Gastroesophageal Junction Cancer ◽  
First Case ◽  
Facial Diplegia ◽  
Leg Weakness

Leptomeningeal carcinomatosis (LMC) is a diffuse or multifocal malignant infiltration of the pia matter and arachnoid membrane. The most commonly reported cancers associated with LMC are breast, lung, and hematological malignancies. Patients with LMC commonly present with multifocal neurological symptoms. We report a case of LMC secondary to gastroesophageal junction cancer present initially with cauda equina syndrome. A 51-year-old male patient with treated adenocarcinoma of the gastroesophageal junction presented with left leg pain, mild weakness, and saddle area numbness. Initial radiological examinations were unremarkable. Subsequently, he had worsening of his leg weakness, fecal incontinence, and urine retention. Two days later, he developed rapidly progressive cranial neuropathies including facial diplegia, sensorineural hearing loss, dysarthria, and dysphagia. MRI with and without contrast showed diffuse enhancement of leptomeninges surrounding the brain, spinal cord, and cauda equina extending to the nerve roots. Cerebrospinal fluid cytology was positive for malignant cells. The patient died within 10 days from the second presentation. In cancer patients with cauda equina syndrome and absence of structural lesion on imaging, LMC should be considered. To our knowledge, this is the first case of LMC secondary to gastroesophageal cancer presenting with cauda equina syndrome.

Symptomatic pneumorachis associated with incidental durotomy during microscopic lumbar disc surgery

2006 ◽  
Vol 5 (2) ◽  
pp. 165-167 ◽  
Author(s):  
Aristedis Rovlias ◽  
Emmanuel Pavlakis ◽  
Serafim Kotsou
Keyword(s):  
Rare Complication ◽  
Lumbar Disc ◽  
Cauda Equina ◽  
Valve Mechanism ◽  
Reconstruction Process ◽  
Lumbar Microdiscectomy ◽  
First Case ◽  
Incidental Durotomy ◽  
Tomography Scan

✓ Unintended incidental durotomy is not a rare complication of lumbar microsurgery and is usually recognized and treated immediately. The reconstruction process can be complicated further by unpredictable factors. To their knowledge, the authors report the first case of a symptomatic pneumorachis associated with the accidental awakening of a patient during reconstruction of an incidental durotomy following lumbar microdiscectomy. Incomplete cauda equina syndrome developed in the patient on awakening from surgery after reconstruction of an unintended incidental dural tear that occurred during lumbar microdiscectomy. Symptomatic pneumorachis was revealed on an emergency computed tomography scan, and the patient underwent immediate repeated operation to remove air and decompress the spinal canal. The increasing number and complexity of surgical procedures in the lumbar spine contribute to the growing incidence of unintended durotomy. The surgeon should be aware of rare complications that may arise. Development of a vacuum phenomenon in conjunction with a ball–valve mechanism may lead to pneumorachis during durotomy repair. If this rare complication is promptly recognized and confronted, the outcome will not be associated with long-term sequelae.

Cauda Equina Syndrome Due To Dural Sac Shift with Engorgement of the Epidural Venous Plexus: Rare Complication After Lumbar Microdiscectomy

2017 ◽  
Vol 104 ◽  
pp. 1048.e15-1048.e18 ◽  
Author(s):  
Yoshinori Maki ◽  
Motohiro Takayama ◽  
Hideki Hayashi ◽  
Yohei Yokoyama ◽  
Yuji Agawa
Keyword(s):  
Cauda Equina Syndrome ◽  
Rare Complication ◽  
Cauda Equina ◽  
Venous Plexus ◽  
Lumbar Microdiscectomy ◽  
Dural Sac

scholarly journals Conus medullaris and cauda equina syndrome as a result of traumatic injuries: management principles

2004 ◽  
Vol 16 (6) ◽  
pp. 1-23 ◽  
Author(s):  
James S. Harrop ◽  
Gabriel E. Hunt ◽  
Alexander R. Vaccaro
Keyword(s):  
Neurological Disorders ◽  
Cauda Equina Syndrome ◽  
Treatment Options ◽  
Cauda Equina ◽  
Conus Medullaris ◽  
Leg Pain ◽  
Terminal Portion ◽  
Traumatic Injuries ◽  
Precise Understanding ◽  
Disc Herniations

Conus medullaris syndrome (CMS) and cauda equina syndrome (CES) are complex neurological disorders that can be manifested through a variety of symptoms. Patients may present with back pain, unilateral or bilateral leg pain, paresthesias and weakness, perineum or saddle anesthesia, and rectal and/or urinary incontinence or dysfunction. Although patients typically present with acute disc herniations, traumatic injuries at the thoracolumbar junction at the terminal portion of the spinal cord and cauda equina are also common. Unfortunately, a precise understanding of the pathophysiology and optimal treatments, including the best timing of surgery, has yet to be elucidated for either traumatic CES or CMS. In this paper the authors review the current literature on traumatic conus medullaris and cauda equina injuries and available treatment options.

Extramedullary Ependymoma Near the Conus Medullaris With Lumbar Nerve Root Attachment: Case Report

Neurosurgery ◽  
2011 ◽  
Vol 68 (3) ◽  
pp. E831-E834 ◽  
Author(s):  
Christopher M Bonfield ◽  
Devin Amin ◽  
Ronald L Hamilton ◽  
Peter C Gerszten
Keyword(s):  
Nerve Root ◽  
Spinal Cord Tumor ◽  
Cauda Equina ◽  
Compression Fracture ◽  
Conus Medullaris ◽  
Magnetic Resonance Images ◽  
World Health ◽  
Low Grade ◽  
Lumbar Nerve Root ◽  
Intradural Extramedullary

Abstract BACKGROUND AND IMPORTANCE: Ependymomas are the most common primary spinal cord tumor, most frequently located near the cauda equina and conus medullaris. We believe that this is the first reported case of a low-grade, nonmyxopapillary (World Health Organization grade 2), intradural, extramedullary ependymoma involving a spinal nerve root. CLINICAL PRESENTATION: An 87-year-old woman presented with a chief complaint of acute onset of severe right hip and lateral thigh pain without midline back pain. She had baseline chronic bladder dysfunction, which remained unchanged. Her physical examination was significant for 4/5 strength in her right hip flexion (possibly related to pain), and 5 beats of clonus bilaterally. She had no point tenderness at the level of her compression fracture. Computed tomography of the patient's lumbar spine revealed a well-corticated, chronic compression fracture of the L3 vertebral body. Magnetic resonance images demonstrated an ovoid-shaped, 1.5 × 1-cm, well-circumscribed, intradural, extramedullary lesion at the conus medullaris. The patient underwent an L1-3 laminectomy with intradural resection of the mass, which was found to be intricately involved with a single nerve root. The nerve root was coagulated and sectioned, and a gross total resection of the tumor was achieved. CONCLUSION: The patient tolerated the procedure well, with no complications or any postoperative neurological deficit. Her right-sided pain immediately resolved after surgery. Her strength and ambulation were normal after surgery. No adjuvant radiotherapy was offered to the patient. This case illustrates a unique tumor presentation and the successful surgical treatment of the condition.

Sign in / Sign up

Export Citation Format

Share Document