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.

Transdural herniation of the thoracic spinal cord: untethering via a posterolateral transpedicular approach

2004 ◽  
Vol 1 (2) ◽  
pp. 223-227 ◽  
Author(s):  
Ryder Gwinn ◽  
Fraser Henderson
Keyword(s):  
Spinal Cord ◽  
Posterior Approach ◽  
Thoracic Spinal Cord ◽  
Dural Repair ◽  
Content Type ◽  
Transpedicular Approach ◽  
Thoracic Spinal ◽  
Novel Approach ◽  
Spinal Cord Herniation ◽  
Thoracic Cord

✓ 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.

Posterior approach for cervical intramedullary arteriovenous malformation with diffuse-type nidus

1999 ◽  
Vol 91 (1) ◽  
pp. 105-111 ◽  
Author(s):  
Kenji Ohata ◽  
Toshihiro Takami ◽  
Alaa El-Naggar ◽  
Michiharu Morino ◽  
Akimasa Nishio ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Poor Prognosis ◽  
Posterior Approach ◽  
The Other ◽  
Anterior Spinal Artery ◽  
Neural Element ◽  
Feeding Artery ◽  
Diffuse Type ◽  
Content Type ◽  
Fine Print

✓ The treatment of spinal intramedullary arteriovenous malformations (AVMs) with a diffuse-type nidus that contains a neural element poses different challenges compared with a glomus-type nidus. The surgical elimination of such lesions involves the risk of spinal cord ischemia that results from coagulation of the feeding artery that, at the same time, supplies cord parenchyma. However, based on evaluation of the risks involved in performing embolization, together with the frequent occurrence of reperfusion, which necessitates frequent reembolization, the authors consider surgery to be a one-stage solution to a disease that otherwise has a very poor prognosis. Magnetic resonance (MR) imaging revealed diffuse-type intramedullary AVMs in the cervical spinal cords of three patients who subsequently underwent surgery via the posterior approach. The AVM was supplied by the anterior spinal artery in one case and by both the anterior and posterior spinal arteries in the other two cases. In all three cases, a posterior median myelotomy was performed up to the vicinity of the anterior median fissure that divided the spinal cord together with the nidus, and the feeding artery was coagulated and severed at its origin from the anterior spinal artery. In the two cases in which the posterior spinal artery fed the AVM, the feeding artery was coagulated on the dorsal surface of the spinal cord. Neurological outcome improved in one patient and deteriorated slightly to mildly in the other two patients. Postoperative angiography demonstrated complete disappearance of the AVM in all cases. Because of the extremely poor prognosis of patients with spinal intramedullary AVMs, this surgical technique for the treatment of diffuse-type AVMs provides acceptable operative outcome. Surgical intervention should be considered when managing a patient with a diffuse-type intramedullary AVM in the cervical spinal cord.

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.

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.

Comparison of anterior and posterior surgical approaches in the treatment of ventral spinal hemangioblastomas in patients with von Hippel—Lindau disease

2003 ◽  
Vol 98 (1) ◽  
pp. 117-124 ◽  
Author(s):  
Ryszard M. Pluta ◽  
Brian Iuliano ◽  
Hetty L. Devroom ◽  
Tung Nguyen ◽  
Edward H. Oldfield
Keyword(s):  
Spinal Cord ◽  
Anterior Approach ◽  
Posterior Approach ◽  
Long Term Results ◽  
Surgical Approaches ◽  
Content Type ◽  
Von Hippel Lindau ◽  
Vhl Disease ◽  
Ventral Spinal Cord ◽  
Fine Print

Object. Von Hippel—Lindau (VHL) disease is an autosomal-dominant neoplastic syndrome with manifestations in multiple organs, which is evoked by the deletion or mutation of a tumor suppressor gene on chromosome 3p25. Spinal hemangioblastomas (40% of VHL disease—associated lesions of the central nervous system) arise predominantly in the posterior aspect of the spinal cord and are often associated with an intraspinal cyst. Rarely, the tumor develops in the anterior aspect of the spinal cord. Ventral spinal hemangioblastomas are a surgical challenge because of difficult access and because vessels feeding the tumor originate from the anterior spinal artery. The goal of this study was to clarify whether an anterior or posterior surgical approach is better for management of hemangioblastomas of the ventral spinal cord. Methods. The authors performed a retrospective analysis of clinical outcomes and findings on magnetic resonance (MR) imaging studies in eight patients (two women and six men with a mean age of 34 ± 15 years) who underwent resection of ventral spinal hemangioblastomas (nine tumors: five cervical and four thoracic). Two surgical approaches were used to resect these tumors. A posterior approach was selected to treat five patients (laminectomy and posterior myelotomy in four patients and the posterolateral approach in one patient); an anterior approach (corpectomy and arthrodesis) was selected to treat the remaining three patients. Immediately after surgery, the ability to ambulate remained unchanged in patients in whom an anterior approach had been performed, but deteriorated significantly in patients in whom a posterior approach had been used, because of motor weakness (four of five patients) and/or proprioceptive sensory loss (three of five patients). This difference in ambulation, despite significant improvements over time among patients in the posterior access group, remained significant 6 months after surgery. In all cases, MR images revealed complete resection of the tumor and in five patients significant or complete resolution of the intramedullary cyst was demonstrated (present in six of eight patients). Conclusions. The outcomes of these eight patients with hemangioblastomas of the ventral spinal cord indicate that both immediate and long-term results are better when an anterior approach is selected for resection.

A novel dynamic model for experimental spinal cord compression

2005 ◽  
Vol 2 (4) ◽  
pp. 466-471 ◽  
Author(s):  
Gerhard Marquardt ◽  
Matthias Setzer ◽  
Alf Theisen ◽  
Edgar Dettmann ◽  
Volker Seifert
Keyword(s):  
Spinal Cord ◽  
Mr Imaging ◽  
Dynamic Model ◽  
Dura Mater ◽  
Spinal Cord Compression ◽  
Cord Compression ◽  
Neurological Deficits ◽  
Content Type ◽  
Interlaminar Approach ◽  
Fine Print

Object. The goal of this study was to develop a novel dynamic model for experimental spinal cord compression that closely approximates neoplastic epidural compression of the spinal cord in humans. Methods. In 30 New Zealand white rabbits, the thoracic spine was exposed via a posterior approach. On each side of one vertebral lamina a small hole was drilled caudal to the articular process. A silicone band was passed through these holes, forming a loop. The spinal dura mater was exposed via an interlaminar approach. The loop was brought into contact with the dura mater and fixed in its position encircling 270° of the circumference of the spinal cord. Thereafter, the loop was gradually tightened at set times by pulling at the ends of the band and fixing them again in their new position. The spinal cord was thus increasingly compressed in a circular and dynamic manner. Neurological deficits of various degrees were created in all animals in the compression group, and the compressive effect of the loop was reliably demonstrated on MR imaging. After decompression of the spinal cord, the neurological deficits were reversible in the majority of animals, and MR imaging revealed either no signal changes or only circumscribed ones within the cord. In contrast, MR images obtained in animals that did not recover revealed the occurrence of extensive chronic myelopathy. Conclusions. This novel model features reproducibility of paresis and neurological recovery. It is a dynamic model simulating circular tumor growth and is characterized by its easy, straightforward, and cost-saving applicability.

Alternating Horner's syndrome and hyperhidrosis due to dural adhesions following cervical spinal cord injury

1980 ◽  
Vol 53 (1) ◽  
pp. 97-100 ◽  
Author(s):  
Michinori Ottomo ◽  
Robert F. Heimburger
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Dura Mater ◽  
Cervical Spinal Cord ◽  
Cervical Spinal Cord Injury ◽  
Horner’S Syndrome ◽  
Content Type ◽  
Cord Injury ◽  
Intramedullary Cyst ◽  
Fine Print

✓ Alternating Horner's sign and hyperhidrosis appeared in this patient 8 years after a spinal cord injury at C6–7. An intramedullary cyst was suspected but was not found at operation. There was a striking improvement in both symptoms after adhesions between the spinal cord and the dura mater were freed.

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.

Direction of blood flow in the primate cervical spinal cord

1970 ◽  
Vol 33 (3) ◽  
pp. 325-330 ◽  
Author(s):  
Larry C. Fried ◽  
John L. Doppman ◽  
Giovanni Di Chiro
Keyword(s):  
Spinal Cord ◽  
Blood Flow ◽  
Cervical Spinal Cord ◽  
Cervical Cord ◽  
Content Type ◽  
Vertebral Arteries ◽  
Cast Doubt ◽  
Thoracic Cord ◽  
Cervical Level ◽  
Fine Print

✓ The direction of blood flow in the cervical spinal cord of monkeys was studied by direct cinematic observation of the results of dye injections, plus separate angiographic studies. The studies indicated that in monkeys blood enters the cervical spinal cord mainly from radicular arteries that are usually derived from branches of the costo-cervical trunk. Although some blood entering at the low cervical level flows toward the thoracic cord, the major component flows up to the C-2 level. The findings cast doubt on the established assumption that the vertebral arteries provide the main blood supply of the cervical cord.

Intraspinal mesenchymal chondrosarcoma

1994 ◽  
Vol 80 (5) ◽  
pp. 928-930 ◽  
Author(s):  
Alok Ranjan ◽  
Geeta Chacko ◽  
Thomas Joseph ◽  
Sushil M. Chandi
Keyword(s):  
Spinal Cord ◽  
Magnetic Resonance ◽  
Dura Mater ◽  
Microscopic Examination ◽  
Mesenchymal Chondrosarcoma ◽  
Pia Mater ◽  
Content Type ◽  
The Right ◽  
Fine Print

✓ A 52-year-old man presented with symptoms of progressive cervical radiculomyelopathy. A myelogram showed an intradural block at the C-6 level. Magnetic resonance T1-weighted imaging revealed a hypointense, sausage-shaped mass extending from C-3 to C-6, located posterolaterally on the right side and pushing the spinal cord to the left and anteriorly. At surgery, a mass was found attached solely to the pia mater, with a normal arachnoid and dura mater overlying it. The mass was excised completely and microscopic examination identified a mesenchymal chondrosarcoma. The patient was symptom-free 6 months after surgery.

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