Abstract
BACKGROUNDIdiopathic spinal cord herniation (ISCH) is very rare. Some reports have described postoperative ventral cerebrospinal fluid (CSF) collections in patients with ISCH; however, such collections are asymptomatic in most patients, and there is no consensus regarding whether they are part of the natural history or a complication.OBSERVATIONSA 30-year-old man with ISCH underwent direct closure of a duplicated dura mater. Eight months postoperatively, he developed reworsening of right lower limb paresis and new severe right arm pain and paresis. Three-dimensional magnetic resonance imaging revealed ventral CSF collections, which the authors judged as the responsible lesions. The authors initially considered these collections to be present in the epidural space, extradurally compressing the dural sac and resulting in myelopathy. An epidural blood patch failed; however, a CSF drainage test resulted in dramatic improvement. The authors therefore determined that the CSF collections were located in the interdural space, not the epidural space. A lumboperitoneal (LP) shunt was performed to reduce the CSF pressure. The patient’s symptoms improved immediately postoperatively. He had developed no recurrence of symptoms 6 months after surgery.LESSONSVentral interdural CSF collections after ISCH surgery can cause reworsening of myelopathy and may be cured by a LP shunt to control CSF pressure.
Highlights
Idiopathic spinal cord herniation (ISCH) is very rare
ISCH is caused by herniation of the spinal cord through an anterior dural defect
ISCH is very rare, but it is being increasingly reported with the development of magnetic resonance imaging (MRI).[3]
Summary
Some reports have described postoperative ventral cerebrospinal fluid (CSF) collections in patients with ISCH; such collections are asymptomatic in most patients, and there is no consensus regarding whether they are part of the natural history or a complication. OBSERVATIONS A 30-year-old man with ISCH underwent direct closure of a duplicated dura mater Eight months postoperatively, he developed reworsening of right lower limb paresis and new severe right arm pain and paresis. Several reports have described postoperative ventral cerebrospinal fluid (CSF) collections in patients with ISCH.[1,6,7] these collections are asymptomatic in most patients, and whether they are part of the natural history or a complication remains unclear. The patient presented with severe pain and recurrence of myelopathy He dramatically recovered after performance of a lumboperitoneal (LP) shunt
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