Low-pressure headaches and 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.

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

Journal of Neurosurgery Spine ◽

10.3171/spi.2002.97.3.0369 ◽

2002 ◽

Vol 97 (3) ◽

pp. 369-374 ◽

Cited By ~ 7

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.

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Biologically inert synthetic dural substitutes

Journal of Neurosurgery ◽

10.3171/jns.1990.73.6.0936 ◽

1990 ◽

Vol 73 (6) ◽

pp. 936-941 ◽

Cited By ~ 28

Author(s):

Damianos E. Sakas ◽

Komporn Charnvises ◽

Lawrence F. Borges ◽

Nicholas T. Zervas

Keyword(s):

Foreign Body ◽

Cerebrospinal Fluid Leak ◽

Dural Defect ◽

Artificial Membranes ◽

Content Type ◽

Dural Graft ◽

Polyurethane Film ◽

Foreign Body Reactions ◽

Fluid Leak ◽

Carbonate Film

✓ Two types of artificial membranes, a medical-grade aliphatic polyurethane and a polysiloxane-carbonate block copolymer, were tested as substitutes for dura in 24 and 12 rabbits, respectively. The films were placed either epidurally, subdurally, or as dural grafts in equal subgroups of animals. The postoperative course was uneventful with no manifestations of convulsive disorder or cerebrospinal fluid leak. The animals were sacrificed 3, 6, or 9 months after implantation of the artificial membranes. Both types of artificial membranes were easily removed from the underlying nervous and the other surrounding tissues. The histological examination failed to reveal adhesions, neomembrane formations, or any type of foreign body reactions to the polyurethane film. The implantation of the polysiloxane-carbonate film caused no reaction when it was applied epidurally. As a dural graft, the polysiloxane-carbonate copolymer induced the formation of a thin neomembrane of one to two layers of fibroblasts which formed a watertight seal of the dural defect. A similar thin neomembrane was found to encase this artificial membrane in the group of animals in which it was implanted subdurally. There was no foreign body reaction to the polysiloxane-carbonate film. The authors conclude that these materials hold promise as dural substitutes or in the prevention of spinal dural scarring, and should be evaluated clinically.

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Herniation of the spinal cord

Journal of Neurosurgery ◽

10.3171/jns.1995.82.1.0131 ◽

1995 ◽

Vol 82 (1) ◽

pp. 131-136 ◽

Cited By ~ 91

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.

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Spinal Cord Herniation After Cervical Corpectomy with Cerebrospinal Fluid Leak: Case Report and Review of the Literature

World Neurosurgery ◽

10.1016/j.wneu.2017.01.078 ◽

2017 ◽

Vol 100 ◽

pp. 711.e7-711.e12 ◽

Cited By ~ 2

Author(s):

Kern H. Guppy ◽

James W. Silverthorn

Keyword(s):

Spinal Cord ◽

Cerebrospinal Fluid ◽

Case Report ◽

Cerebrospinal Fluid Leak ◽

Review Of The Literature ◽

Cervical Corpectomy ◽

Spinal Cord Herniation ◽

Fluid Leak

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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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Idiopathic Spinal Cord Herniation—Case Report

Arquivos Brasileiros de Neurocirurgia Brazilian Neurosurgery ◽

10.1055/s-0036-1581084 ◽

2016 ◽

Vol 37 (03) ◽

pp. 280-283

Author(s):

Rogerio Sacco ◽

Ricardo Gepp ◽

Marco Quiroga ◽

Henrique Souza ◽

Vitor Aguiar ◽

...

Keyword(s):

Spinal Cord ◽

Lower Limbs ◽

Surgical Trauma ◽

Dural Defect ◽

Thoracic Myelopathy ◽

Radiological Investigation ◽

Postoperative Mri ◽

Spinal Cord Herniation ◽

History Of ◽

Idiopathic Spinal Cord Herniation

AbstractIdiopathic spinal cord herniation is a rare cause of progressive myelopathy, especially in the absence of a history of spinal or surgical trauma. The radiological diagnosis is made through a myelography or an MRI exam. The spinal cord is pushed anteriorly, buffering the dural defect and leading in most cases to Brown-Séquard syndrome. The present study describes the case of a male patient with a clinical picture of progressive thoracic myelopathy. In the clinical and radiological investigation, an idiopathic spinal cord herniation on the chest level was identified. During the surgery, the spinal cord was reduced to the natural site, taking its usual elliptical shape, and the dural defect was repaired with a dural substitute. The numbness of the patient improved, and the shocks in the lower limbs disappeared. A postoperative MRI confirmed the surgical reduction of the herniation and the restoration of the anterior cerebrospinal fluid (CSF) column to the spinal cord. The authors describe the clinical, radiological, intraoperative, and postoperative evolution.

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

Journal of Neurosurgery Spine ◽

10.3171/spi.2001.95.2.0169 ◽

2001 ◽

Vol 95 (2) ◽

pp. 169-172 ◽

Cited By ~ 16

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.

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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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