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

1981 ◽  
Vol 55 (6) ◽  
pp. 983-986 ◽  
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.

Thoracic idiopathic spinal cord herniation at the vertebral body level: a subgroup with a poor prognosis?

2002 ◽  
Vol 97 (3) ◽  
pp. 369-374 ◽  
Author(s):  
Giuseppe M. V. Barbagallo ◽  
Laurence A. G. Marshman ◽  
Carl Hardwidge ◽  
Richard W. Gullan
Keyword(s):  
Spinal Cord ◽  
Vertebral Body ◽  
Prosthetic Material ◽  
Dural Defect ◽  
Content Type ◽  
Distinct Subgroup ◽  
Surgical Reduction ◽  
Spinal Cord Herniation ◽  
Idiopathic Spinal Cord Herniation ◽  
Fine Print

✓ The authors present two cases of thoracic idiopathic spinal cord herniation (TISCH) occurring at the vertebral body (VB) level in whom adequate surgical reduction failed to reverse symptoms. In the second case, in which TISCH occurred into a VB cavity, presentation was atypical (subacute spinal cord syndrome) and there was persistent postoperative deterioration. In both cases, adequate surgical reduction was achieved via a posterior midthoracic laminectomy, and reduction was maintained by closure of the anterior dural defect by using prosthetic material. Thoracic idiopathic spinal cord herniation occurring at a VB level may be technically well treated by surgical reduction, but the outcome appears less predictable. Herniation that occurs directly into a VB cavity may form a distinct subgroup in which the presentation is atypical and the prognosis worse.

Spinal Cord Herniation

2005 ◽  
Vol 3 (6) ◽  
pp. 508-509
Author(s):  
Laurence Marshman
Keyword(s):  
Spinal Cord ◽  
Dura Mater ◽  
Posterior Approach ◽  
Direct Manipulation ◽  
Dural Repair ◽  
Content Type ◽  
Novel Approach ◽  
Spinal Cord Herniation ◽  
Thoracic Cord ◽  
Fine Print

Anterior spinal cord herniation is a well-documented condition in which the thoracic cord becomes tethered within a defect in the anterior dura mater. Typical procedures have involved a posterior approach with direct manipulation of the thoracic cord to expose and blindly release its point of tethering. The authors report three cases in which a novel approach for the treatment of anterior thoracic cord herniation was performed, cord manipulation and traction are minimized, and direct dural repair of the defect is performed.

Herniation of the spinal cord

1995 ◽  
Vol 82 (1) ◽  
pp. 131-136 ◽  
Author(s):  
Rakesh Kumar ◽  
Jamal Taha ◽  
Alson Lee Greiner
Keyword(s):  
Spinal Cord ◽  
Rare Condition ◽  
Spinal Curvature ◽  
Sensory Level ◽  
Dural Defect ◽  
Content Type ◽  
Spinal Cord Herniation ◽  
Left Limb ◽  
Meningeal Cysts ◽  
Fine Print

✓ Herniation of the spinal cord, or displacement of the cord outside the dura, is so rare that only 13 cases have been reported in the literature. The authors report a new case of spontaneous herniation of the spinal cord in a 38-year-old man who presented with lower left limb paresis and Brown-Séquard syndrome, with a T-8 sensory level. Displacement of the spinal cord was noted on computerized tomography following myelography and on magnetic resonance imaging. The herniated cord was confirmed at operation and reduced intradurally. Postoperatively, the patient showed complete neurological recovery. Based on a review of the literature, herniation of the spinal cord may be classified as spontaneous, iatrogenic, or traumatic. At cervical levels, the spinal cord has herniated into an iatrogenic pseudomeningocele located dorsally. At thoracic levels, spinal cord herniations were reported to be in a preexisting extradural arachnoid cyst located ventrally. The authors propose a pathogenesis for spinal cord herniation based on abnormal positioning of the spinal cord in the dural sleeve and the known anteroposterior movements of the cord that occur with cardiac and respiratory pulsations. The presence of a dural defect situated on the concavity of the spinal curvature is a prerequisite for this rare condition. As adhesions develop between the cord and the edges of the dural defect, cerebrospinal fluid pulsations push the cord into a preexisting cyst. The authors suggest modifying the classification by Nabors, et al., of spinal meningeal cysts to include this mechanism of spinal cord herniation. This diagnosis should also be considered in the differential diagnosis of myelopathy in the absence of a mass lesion.

Spinal intradural arachnoid cysts located anterior to the cervical spinal cord

1999 ◽  
Vol 91 (2) ◽  
pp. 211-215 ◽  
Author(s):  
Saim Kazan ◽  
Özgür Özdemir ◽  
Mahmut Akyüz ◽  
Recai Tuncer
Keyword(s):  
Spinal Cord ◽  
Arachnoid Cyst ◽  
Cervical Spinal Cord ◽  
Arachnoid Cysts ◽  
Cervical Region ◽  
Diagnostic Tools ◽  
Content Type ◽  
Contrast Enhanced Ct ◽  
Intradural Arachnoid Cysts ◽  
Fine Print

✓ The authors describe two rare occurrences of radiographically, surgically, and pathologically confirmed spinal intradural arachnoid cysts (not associated with additional pathological entities) that were located anterior to the cervical spinal cord. These lesions have been reported previously in only eight patients. The patients described in this report were young adults who presented with progressive spastic tetraparesis shortly after sustaining mild cervical trauma and in whom no neurological deficit or bone fracture was demonstrated. The presence of an intradural arachnoid cyst was detected on postcontrast computerized tomography (CT) myelography and on magnetic resonance imaging; both diagnostic tools correctly characterized the cystic nature of the lesion. Plain radiography, plain tomography, and contrast-enhanced CT scans were not diagnostic. In both cases a laminectomy was performed, and the wall of the cyst was excised and fenestrated with subarachnoid space. Postoperatively, the patients made complete neurological recoveries. Based on a review of the literature, arachnoid cysts of the spinal canal may be classified as either extra- or intradural. Intradural arachnoid cysts usually arise posterior to the spinal cord in the thoracic spine region; however, these cysts very rarely develop in the cervical region. The pathogenesis of arachnoid cysts is unclear, although congenital, traumatic and inflammatory causes have been postulated. The authors believe that the formation of an arachnoid cyst cannot be explained by simply one mechanism because, in some reported cases, there has been accidental or iatrogenic trauma in association with congenital lesions. They also note that an intradural arachnoid cyst located anterior to the cervical spinal cord is an extremely rare disorder that may cause progressive myelopathy; however, the postoperative prognosis is good.

Surgical management of idiopathic spinal cord herniation: a review of nine cases treated by the enlargement of the dural defect

2001 ◽  
Vol 95 (2) ◽  
pp. 169-172 ◽  
Author(s):  
Masahiko Watanabe ◽  
Kazuhiro Chiba ◽  
Morio Matsumoto ◽  
Hirofumi Maruiwa ◽  
Yoshikazu Fujimura ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Neurological Deficits ◽  
Dural Defect ◽  
Normal Position ◽  
Postoperative Results ◽  
Content Type ◽  
Progressive Myelopathy ◽  
Spinal Cord Herniation ◽  
Idiopathic Spinal Cord Herniation ◽  
Fine Print

Object. Spinal cord herniation is a rare cause of progressive myelopathy and can be corrected surgically. In most previous reports, closure of the dural defect was the recommended procedure. The object of this paper is to describe a new procedure in which spinal cord constriction is released by enlarging the hiatus; additionally the postoperative results will be discussed. Methods. In nine patients with spinal cord herniation, enlargement of the dural defect was performed. In eight patients, neurological deficits resolved immediately after surgery. In one patient with a severe preoperative neurological deficit whose spinal cord herniated massively, deterioration occurred postoperatively. To date, no recurrence of herniation has been observed. Conclusions. The goals of surgery are to reduce the herniation, return the spinal cord to the normal position, and prevent the recurrence of herniation. The use of sutures to close the dural defect has been the method of choice to date. The surgical space in front of the spinal cord, however, is insufficient to accommodate this procedure safely. Because symptoms are caused by the constriction of the spinal cord at the hiatus, surgical expansion of the hiatus allows the goals of surgery to be achieved. This procedure, which is technically easier and less invasive with regard to the vulnerable spinal cord than the closure of the dural defect, could be a viable alternative for the treatment of this rare disease.

Low-pressure headaches and spinal cord herniation

2003 ◽  
Vol 98 (1) ◽  
pp. 93-95 ◽  
Author(s):  
Tomohiro Inoue ◽  
Aaron A. Cohen-Gadol ◽  
William E. Krauss
Keyword(s):  
Spinal Cord ◽  
Cerebrospinal Fluid Leak ◽  
Low Pressure ◽  
Dural Defect ◽  
Content Type ◽  
Spinal Cord Herniation ◽  
History Of ◽  
Fluid Leak ◽  
Brown Sequard Syndrome ◽  
Transdural Spinal Cord Herniation

✓ Almost 40 cases of spontaneous transdural spinal cord herniation have been reported in the literature. These patients often present with gait disturbance and sensory changes, and their condition is diagnosed as Brown—Séquard syndrome. The pathogenesis of this condition has remained poorly understood. In particular, there is no agreement whether the dural defect is acquired or congenital. In the reported case, a 21-year-old man presented with a 3-year history of intermittent low-pressure headaches consistent with intracranial hypotension. Eventually, the headaches resolved but he developed myelopathy due to a spinal cord herniation. In this case, the authors hypothesize that the progressive spinal cord herniation through a spontaneous dural tear sealed the site of the cerebrospinal fluid leak, causing the resolution of headaches.

Hemorrhage into an intradiploic arachnoid cyst

1991 ◽  
Vol 75 (6) ◽  
pp. 969-971 ◽  
Author(s):  
Ashok Mahade Hande ◽  
Anil Pandurang Karapurkar
Keyword(s):  
Cerebrospinal Fluid ◽  
Arachnoid Cyst ◽  
Unusual Case ◽  
Arachnoid Cysts ◽  
Arachnoid Membrane ◽  
Content Type ◽  
Intradiploic Arachnoid Cyst ◽  
Extradural Arachnoid Cyst ◽  
Fine Print

✓ Intracranial arachnoid cysts are relatively rare; it is believed that they account for only 1% of all intracranial space-occupying lesions. When they occur in the intracranial cavity, they usually develop in relation to an arachnoid cistern as a pocket of cerebrospinal fluid within two layers of arachnoid membrane. Five cases of intradiploic arachnoid cysts have been reported, but an arachnoid cyst presenting as an extradural mass has not been described before. The authors present an unusual case of hemorrhage into a massive intracranial extradural arachnoid cyst with no intradural communication.

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

2021 ◽  
Author(s):  
jinxing li ◽  
Toru Sasamori ◽  
Kazutoshi Hida
Keyword(s):  
Spinal Cord ◽  
Arachnoid Cyst ◽  
Spastic Paraparesis ◽  
Arachnoid Cysts ◽  
Postoperative Mri ◽  
First Case ◽  
Spinal Cord Herniation ◽  
Magnetic Resonance Imaging Mri ◽  
Spinal Cord Decompression ◽  
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.

Spinal Cord Herniation Associated with an Intradural Spinal Arachnoid Cyst Diagnosed by Magnetic Resonance Imaging

Neurosurgery ◽  
1991 ◽  
Vol 29 (1) ◽  
pp. 137-139 ◽  
Author(s):  
Toyohiko Isu ◽  
Takashi Iizuka ◽  
Yoshinobu Iwasaki ◽  
Masafumi Nagashima ◽  
Minoru Akino ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Spinal Cord ◽  
Magnetic Resonance ◽  
Arachnoid Cyst ◽  
Neurological Dysfunction ◽  
Magnetic Resonance Imaging Scan ◽  
Resonance Imaging ◽  
Spinal Cord Herniation ◽  
Spinal Arachnoid Cyst ◽  
Extradural Arachnoid Cyst

Abstract Two rare cases of spinal cord herniation associated with intradural spinal arachnoid cyst are reported. A preoperative magnetic resonance imaging scan demonstrated the presence of spinal cord herniation, identified as a protrusion continuous with the spinal cord. Surgery upon the intradural spinal arachnoid cyst improved progressive neurological dysfunction. The authors postulate that spinal cord herniation occurred for the following reason: The pressure of the intradural arachnoid cyst on the dorsal aspect of the spinal cord caused thinning of the dura, leading to a tear and, thus, the development of an extradural arachnoid cyst. Along with the enlargement of intradural arachnoid cyst, the spinal cord herniated through the tear in the dura into the extradural arachnoid cyst. (Neurosurgery 29:137-139, 1991)

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