Surgical treatment of post-lumbar puncture dural CSF leak causing chronic headache

1982 ◽  
Vol 57 (5) ◽  
pp. 703-707 ◽  
Author(s):  
Hugh Harrington ◽  
H. Richard Tyler ◽  
Keasley Welch
Keyword(s):  
Surgical Treatment ◽  
Lumbar Puncture ◽  
Subarachnoid Space ◽  
Contrast Material ◽  
Csf Leak ◽  
Lumbar Region ◽  
Dural Defect ◽  
Duration Of Symptoms ◽  
Content Type ◽  
Radiographic Technique

✓ A-58-year-old woman experienced incapacitating headache and occipital paresthesiae for 5 years after lumbar myelography. Conservative methods of treatment failed. Successive investigations for a suspected cerebrospinal fluid (CSF) leak were unrevealing. Leakage of CSF from the subarachnoid space into the epidural space in the lumbar region was finally confirmed when oil-soluble contrast material (Pantopaque), injected into the cervical subarachnoid space, was revealed by a specific technical modification to be escaping from the lumbar sac. Repair of the dural defect with dorsolumbar fascia resulted in almost complete alleviation of symptoms. This case is unusual because of the radiographic technique used, the duration of symptoms, and the rarity of reports of successful surgical treatment for this serious complication of lumbar puncture.

Surgical Treatment of Spinal Extradural Arachnoid Cysts in the Thoracolumbar Spine

Neurosurgery ◽  
2012 ◽  
Vol 71 (2) ◽  
pp. 278-284 ◽  
Author(s):  
Haruki Funao ◽  
Masaya Nakamura ◽  
Naobumi Hosogane ◽  
Kota Watanabe ◽  
Takashi Tsuji ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Surgical Procedure ◽  
Thoracolumbar Spine ◽  
Neurological Recovery ◽  
Dural Defect ◽  
Total Resection ◽  
Duration Of Symptoms ◽  
Significant Difference ◽  
The Mean ◽  
Poor Outcomes

Abstract BACKGROUND: Because an idiopathic spinal extradural arachnoid cyst (SEAC) is rare, its optimal surgical treatment remains controversial. OBJECTIVE: To evaluate the results of surgical treatments for SEACs and to clarify features of the disease associated with poor outcomes. METHODS: Twelve patients with SEACs who underwent surgery at our hospital between 1988 and 2008 were examined retrospectively. The mean follow-up period was 4.7 years. Total resection of the cyst was performed in 7 patients and closure of the dural defect without cyst resection in 5 patients. Surgical outcomes were evaluated with regard to the duration of symptoms, the size of the cyst, and the surgical procedure used. RESULTS: Neurological recovery was observed in all patients, and there was no recurrence. Poor outcomes were observed in patients with a long duration of symptoms (>1 year, P < .01) and large cyst size (>5 vertebrae, P < .05). The surgical procedure had no significant association with the postoperative neurological recovery. However, there was a significant difference in the degree of the mean postoperative kyphotic angle between the patients treated by total resection of the cyst (9.7 degrees) and those treated by closure of the dural defect without cyst resection through selective laminectomy (2.2 degrees) (P < .01). CONCLUSION: There was no significant difference in postoperative neurological recovery between the 2 surgical procedures. However, closure of the dural defect without cyst resection was less invasive, preventing postoperative kyphotic deformity of the thoracolumbar spine.

Surgical treatment of spontaneous spinal cerebrospinal fluid leaks

1998 ◽  
Vol 88 (2) ◽  
pp. 243-246 ◽  
Author(s):  
Wouter I. Schievink ◽  
Vittorio M. Morreale ◽  
John L. D. Atkinson ◽  
Fredric B. Meyer ◽  
David G. Piepgras ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Surgical Treatment ◽  
Intracranial Hypotension ◽  
Csf Leak ◽  
Preoperative Imaging ◽  
Content Type ◽  
Surgical Exploration ◽  
Fine Print ◽  
Csf Leaks

Object. Spontaneous spinal cerebrospinal fluid (CSF) leaks are an increasingly recognized cause of intracranial hypotension and may require neurosurgical intervention. In the present report the authors review their experience with the surgical management of spontaneous spinal CSF leaks. Methods. Between 1992 and 1997, 10 patients with spontaneous spinal CSF leaks and intracranial hypotension were treated surgically. The mean age of the seven women and three men was 42.3 years (range 22–61 years). Preoperative imaging showed a single meningeal diverticulum in two patients, a complex of diverticula in one patient, and a focal CSF leak alone in seven patients. Surgical exploration in these seven patients demonstrated meningeal diverticula in one patient; no clear source of CSF leakage could be identified in the remaining six patients. Treatment consisted of ligation of the diverticula or packing of the epidural space with muscle or Gelfoam. Multiple simultaneous spinal CSF leaks were identified in three patients. Conclusions. All patients experienced complete relief of their headaches postoperatively. There has been no recurrence of symptoms in any of the patients during a mean follow-up period of 19 months (range 3–58 months; 16 person-years of cumulative follow up). Complications consisted of transient intracranial hypertension in one patient and leg numbness in another patient. Although the disease is often self-limiting, surgical treatment has an important role in the management of spontaneous spinal CSF leaks. Surgery is effective in eliminating the headaches and the morbidity is generally low. Surgical exploration for a focal CSF leak, as demonstrated on radiographic studies, usually does not reveal a clear source of the leak. Some patients may have multiple simultaneous CSF leaks.

Progressive spasticity and scoliosis in children with myelomeningocele

1985 ◽  
Vol 62 (3) ◽  
pp. 367-375 ◽  
Author(s):  
T. S. Park ◽  
Wayne S. Cail ◽  
William M. Maggio ◽  
Diane C. Mitchell
Keyword(s):  
Surgical Treatment ◽  
Posterior Fossa ◽  
Clinical Presentation ◽  
Contrast Material ◽  
Posterior Fossa Decompression ◽  
Content Type ◽  
Motor Strength ◽  
Favorable Neurological Outcome ◽  
The Brain ◽  
Tomography Scanning

✓ Seventeen myelodysplastic patients with progressive extremity spasticity and scoliosis underwent radiological evaluation and surgical treatment. All but one were under 18 years of age at the time of surgical treatment. Duration of the clinical presentation ranged from 1½ to 7 years. Metrizamide was instilled into the subarachnoid space in 12 patients, the lateral ventricle in two, and the hydromyelic cavity in three. Sequential computerized tomography scanning after intrathecal instillation of the contrast material clearly demonstrated hydromyelia in nine patients and compression of the brain stem in five. Posterior fossa decompression with plugging of the obex was performed in 12 patients, posterior fossa decompression alone in three, and ventriculoperitoneal (VP) shunting procedures in two. Of the 12 patients who underwent the obex plugging procedures, eight have shown partial or complete resolution of spasticity and an increase in motor strength with no significant postoperative complications. In contrast, posterior fossa decompression or VP shunting procedures alone have not led to a favorable neurological outcome. Hydromyelia may occur more commonly among myelodysplastic patients than previously recognized and may be treated most effectively by the obex plugging procedure.

Nontraumatic acute spinal subdural hematoma

1999 ◽  
Vol 91 (1) ◽  
pp. 65-73 ◽  
Author(s):  
Maurizio Domenicucci ◽  
Alessandro Ramieri ◽  
Pasquale Ciappetta ◽  
Roberto Delfini
Keyword(s):  
Surgical Treatment ◽  
Subarachnoid Space ◽  
Thoracolumbar Spine ◽  
Neurological Status ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Content Type ◽  
Spinal Hematoma ◽  
Spinal Puncture ◽  
Fine Print

✓ Acute subdural spinal hematoma occurs rarely; however, when it does occur, it may have disastrous consequences. The authors assessed the outcome of surgery for this lesion in relation to causative factors and diagnostic imaging (computerized tomography [CT], CT myelography), as well as eventual preservation of the subarachnoid space. The authors reviewed 106 cases of nontraumatic acute subdural spinal hematoma (101 published cases and five of their own) in terms of cause, diagnosis, treatment, and long-term outcome. Fifty-one patients (49%) were men and 55 (51%) were women. In 70% of patients the spinal segment involved was in the lumbar or thoracolumbar spine. In 57 cases (54%) there was a defect in the hemostatic mechanism. Spinal puncture was performed in 50 patients (47%). Late surgical treatment was performed in 59 cases (56%): outcome was good in 25 cases (42%) (in 20 of these patients preoperative neurological evaluation had shown mild deficits or paraparesis, and three patients had presented with subarachnoid hemorrhage [SAH]). The outcome was poor in 34 cases (58%; 23 patients with paraplegia and 11 with SAH). The formation of nontraumatic acute spinal subdural hematomas may result from coagulation abnormalities and iatrogenic causes such as spinal puncture. Their effect on the spinal cord and/or nerve roots may be limited to a mere compressive mechanism when the subarachnoid space is preserved and the hematoma is confined between the dura and the arachnoid. It seems likely that the theory regarding the opening of the dural compartment, verified at the cerebral level, is applicable to the spinal level too. Early surgical treatment is always indicated when the patient's neurological status progressively deteriorates. The best results can be obtained in patients who do not experience SAH. In a few selected patients in whom neurological impairment is minimal, conservative treatment is possible.

Cervical bone spur presenting with spontaneous intracranial hypotension

1998 ◽  
Vol 89 (3) ◽  
pp. 483-484 ◽  
Author(s):  
A. Giancarlo Vishteh ◽  
Wouter I. Schievink ◽  
Jonathan J. Baskin ◽  
Volker K. H. Sonntag
Keyword(s):  
Mr Imaging ◽  
Intracranial Hypotension ◽  
Cervical Spinal Cord ◽  
Contrast Material ◽  
Spontaneous Intracranial Hypotension ◽  
Csf Leak ◽  
Presumptive Diagnosis ◽  
Content Type ◽  
Hindbrain Herniation

✓ Spontaneous intracranial hypotension due to a spinal cerebrospinal fluid (CSF) leak is a rare but increasingly recognized cause of postural headaches. The exact cause of these CSF leaks often remains unknown. The authors treated a 32-year-old man with a unique cause of spontaneous intracranial hypotension. He suffered an excruciating headache that was exacerbated by his being in an upright position. The results of four-vessel cerebral angiography were negative; however, magnetic resonance (MR) imaging of the brain revealed pachymeningeal enhancement and hindbrain herniation. A presumptive diagnosis of spontaneous intracranial hypotension was made. Myelography revealed extrathecal contrast material ventral to the cervical spinal cord as well as an unusual midline bone spur at C5–6. The patient's symptoms did not resolve with the application of epidural blood patches, and he subsequently underwent an anterior approach to the C5–6 spur. After discectomy, a slender bone spur that had pierced the thecal sac was found. After its removal, the dural rent was closed using two interrupted prolene sutures. The patient was discharged home 2 days later. On follow up his symptoms had resolved, and on MR imaging the pachymeningeal enhancement had resolved and the cerebellar herniation had improved slightly.

Posterior epidural migration of herniated lumbar disc fragment

2011 ◽  
Vol 14 (3) ◽  
pp. 313-317 ◽  
Author(s):  
Ahmet Sengoz ◽  
Kadir Kotil ◽  
Erol Tasdemiroglu
Keyword(s):  
Surgical Treatment ◽  
Cauda Equina Syndrome ◽  
Lumbar Disc ◽  
Cauda Equina ◽  
Case Series ◽  
Rare Condition ◽  
Neurological Deficits ◽  
Lumbar Region ◽  
Duration Of Symptoms ◽  
First Choice

Object Posterior epidural migration of a free disc fragment in the lumbar region is a very rare condition that has only been reported in isolated cases to date. Patients with this condition present with radiculopathy or major neurological deficits. Difficulties in diagnosis and the choice and timing of surgical treatment are important in these cases. In this clinical case series, features of cases with posterior epidural migration of free lumbar disc fragments accompanied by cauda equina syndrome are discussed. Methods Eight cases (0.27%) of posterior epidural migration of disc fragments were detected among 2880 patients surgically treated for lumbar disc herniation between 1995 and 2008. Seven of these patients had cauda equina syndrome. The mean duration of symptoms in the 8 cases was 4.2 days (range 1–10 days). The group included 6 men and 2 women, with a mean age of 48 years (range 34–72 years). The sequestered disc fragments were at the L3–4 level in 6 patients (75%) and the L4–5 level in 2 (25%). Magnetic resonance imaging showed tumor-like ring contrast enhancement around sequestered fragments in 5 patients. The patients' motor, sensory, sexual, and urological functions were evaluated postoperatively, and modified Odom criteria and a visual analog scale were used in the assessment of postoperative outcomes. Results A microsurgical approach was used in all cases. Sequestrectomy with minimal hemilaminotomy and removal of the free segments were performed. The patients were followed up for a mean period of 28.5 months. Three patients (37.5%) had excellent results, 3 (37.5%) had good results, 1 patient (12.5%) had fair results, and only 1 patient had poor results according to the Odom criteria. The main factors affecting the long-term outcomes were the presence of cauda equina syndrome and the time period between onset of symptoms and surgery. Conclusions Patients with posterior migration of a disc fragment present with severe neurological deficits such as cauda equina syndrome. Because the radiological images of disc fragments may mimic those of other more common posterior epidural space–occupying lesions, definite diagnosis of posteriorly located disc fragments is difficult. All of these lesions can be completely removed with hemilaminotomy and sequestrectomy, and early surgical treatment is important as a first choice to prevent severe neurological deficits.

Computerized tomography and surgical treatment in intracranial suppuration

1977 ◽  
Vol 47 (1) ◽  
pp. 73-78 ◽  
Author(s):  
Mauritius J. Joubert ◽  
Stephan Stephanov
Keyword(s):  
Surgical Treatment ◽  
Brain Abscess ◽  
Computerized Tomography ◽  
Contrast Material ◽  
Intravenous Contrast ◽  
Content Type ◽  
Burr Holes ◽  
Intracranial Suppuration ◽  
Repeated Aspiration ◽  
Fine Print

✓ The authors report their experience with 30 cases of intracranial suppuration: 23 with brain abscess and seven with subdural empyema. All of the cases were diagnosed by means of computerized tomography and enhancement with intravenous contrast material. Most of the patients were treated by single or repeated aspiration through burr holes.

Posttraumatic syringomyelia

1973 ◽  
Vol 39 (4) ◽  
pp. 485-492 ◽  
Author(s):  
Donald R. McLean ◽  
Jack D. R. Miller ◽  
Peter B. R. Allen ◽  
S. Ali Ezzeddin
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Subarachnoid Space ◽  
Fourth Ventricle ◽  
Contrast Material ◽  
Positive Contrast ◽  
Content Type ◽  
Cord Injury ◽  
Posttraumatic Syringomyelia ◽  
Fine Print

✓ A detailed study of posttraumatic syringomyelia is reported. The interior of the syrinx was outlined by positive contrast and gas myelography. The contrast material entered the syrinx via a communication between the cavity and the subarachnoid space at the site of spinal cord injury. The syrinx also communicated with the fourth ventricle. It is postulated that posttraumatic syringomyelia results from the dissection of cystic remnants of hematomyelia known to be present at the site of serious spinal cord injury. Dissection occurs when pressure within the cyst is increased by elongation of the spinal cord during neck movements, principally flexion. Posttraumatic syringomyelia should be treated by a surgical procedure, which allows permanent drainage of the syrinx into the subarachnoid space.

Spinal subarachnoid hematoma after lumbar puncture causing reversible paraplegia in acute leukemia

1983 ◽  
Vol 58 (3) ◽  
pp. 438-439 ◽  
Author(s):  
Joan Bladé ◽  
Félix Gastón ◽  
Emili Montserrat ◽  
Pedro Marín ◽  
Albert Grañena ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Acute Leukemia ◽  
Lumbar Puncture ◽  
Bleeding Disorders ◽  
Content Type ◽  
Thrombocytopenic Patient ◽  
Fine Print

✓ Subarachnoid hematoma after lumbar puncture is extremely rare, even in patients with thrombocytopenia or other bleeding disorders. The authors report the case of a patient with acute leukemia and thrombocytopenia who developed paraplegia due to a subarachnoid hematoma following lumbar puncture. He recovered after an emergency laminectomy. If a subarachnoid hematoma occurs in a thrombocytopenic patient, prompt surgical treatment, in addition to intensive platelet support, can reverse the severe neurological consequences.

Surgical treatment of tentorial arteriovenous malformations draining into the subarachnoid space

1984 ◽  
Vol 60 (5) ◽  
pp. 1059-1066 ◽  
Author(s):  
François Grisoli ◽  
François Vincentelli ◽  
Sylvaine Fuchs ◽  
Mario Baldini ◽  
Charles Raybaud ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Subarachnoid Space ◽  
Arteriovenous Malformations ◽  
Content Type ◽  
Complete Cure ◽  
First Case ◽  
Operative Findings ◽  
Fine Print

✓ Four patients with tentorial arteriovenous malformations (AVM's) were treated surgically. The operative findings in the first case suggested that clipping of the draining vein close to the AVM may result in complete cure. The three subsequent cases were treated with this technique. The clinical and radiological implications are discussed.

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