Cord Herniation Research Articles

Operative Management of Idiopathic Spinal Cord Herniation: Case Series and Novel Technique for Repair of Recurrent Herniation

Idiopathic spinal cord herniation (ISCH) is a rare pathology of the spine defined by herniation of the spinal cord through a dural defect. To highlight the operative management of ISCH and the surgical nuances of ISCH repairs conducted at our institution. This retrospective review examines consecutive patients with ISCH who were treated surgically between January 1, 2010, and July 31, 2017, at Barrow Neurological Institute, Phoenix, Arizona. Four patients with ISCH presented with thoracic myelopathy and lower extremity weakness during the study period. Treatment consisted of reduction of the herniated spinal cord and filling of the dural defect with a collagen-based dural regeneration matrix. In 3 patients the dural edges were covered with a collagen-matrix intradural sling, and in 1 patient they were repaired primarily with interrupted sutures. Three of the 4 patients experienced improvement in myelopathic symptoms; the fourth patient suffered neurological decline in the immediate postoperative period. ISCH is a complex pathological condition likely to result in progressive myelopathy. Surgery offers patients the possibility of stabilizing the progression of the spinal cord dysfunction and perhaps restoring neurological function. However, extreme care must be taken during surgery to minimize manipulation of the fragile herniated cord.

Spinal cord herniation with characteristic bone change: a case report.

Spinal cord herniation (SCH) is a rare disease characterized by herniation of the thoracic spinal cord through an anterior dural defect, presenting with progressive myelopathy. A case of a 69-year-old woman who presented with Brown-Sequard syndrome and a bone defect, in which an osteophyte created a hemisphere-like cavity with spinal cord herniation, is presented. The strangled spinal cord was released, and the defect was closed microsurgically using an artificial dural patch to prevent re-herniation. Postoperatively, the patient experienced gradual improvement in neurologic function. The SCH mechanism and surgical strategy are discussed.

Spinal Cord Herniation: Why Anterior Thoracic?

Background: Spinal cord herniation and thoracic anterior adhesion syndrome make up the two extremes of a rare condition; characterized by anterior dural adhesion or protrusion of the spinal cord through the arachnoideal and dural membrane into the extradural space, respectively. Summary: We present the main features of the condition by our case series and forward a hypothesis for the consistent anterior, mid-thoracic localization. We surmise the role of an anterior pulling force by the Hofmann (meningo-vertebral) ligaments; acting when the physiologic thoracic kyphosis suddenly increases. The traction may tear the anterior dura; resulting in a dural defect; it allows the nipping/ protrusion of the spinal cord. Key messages: Because the spinal cord compression syndrome caused by adhesion or herniation of the spinal cord may be surgically treatable; the recognition of the condition is essential. The pathogenetic traction effect of the Hofmann ligament in the affected level may have surgical an prognostic implications.

Inguinal Hernia—A Rare Complication of Ventricuoloperitoneal Shunt

To the Editor : A 6-mo-old male child presented to us with a swelling over his lower back since birth and weakness of both lower limbs (Power 3/5). MRI revealed open dysraphic spine defect in lumbar region with herniation of spinal cord, suggestive of myelomenigocele, hydrocephalous and chiari type 2 malformation. He underwent right ventriculoperitoneal shunt (VPS) and repair of myelomeningocele. A week after the surgery, patient started having reducible swelling of left scrotum, which used to increase on coughing (Fig. 1a). He didn’t have any scrotal abnormality prior to the surgery. Clinical examination revealed hydrocele with completely reducible indirect hernia (Fig. 1b). Scrotal ultrasonogram revealed

Herniation of spinal cord into nerve root avulsion pseudomeningocele: A rare cause of delayed progressive neurological deficit

We present a patient with old traumatic right brachial plexus injury, who developed progressive neurological deterioration 4 years after the initial injury. On magnetic resonance imaging (MRI), herniation of the upper dorsal cord was noted into a post-traumatic pseudomeningocele. Though the herniation of cord into a post-traumatic pseudomeningocele is very rare, it should be suspected in cases of delayed progressive myelopathy. A three dimensional (3-D) T2-weighted sequence such as Sampling Perfection with Application optimized Contrasts using different flip angle Evolution (SPACE) or constructive interference in steady state (CISS) provides optimal visualization of the herniated cord and helps in surgical planning.

Incarcerated spinal cord: A preventable surgical debacle

Incarcerated spinal cord: A preventable surgical debacle

A rare cause of CSF shunt “failure” in a patient with NPH

An 80-year-old male presented with a 12-month history of gait disturbance, urinary incontinence and memory impairment. On admission, he showed no motor or sensory disturbance. His tandem gait was uncertain with enlarged base, deep tendon reflexes were symmetric, plantar cutaneous reflex was in flexion. A head MRI-scan revealed diffuse leukoencephalopathy, with signs of a previous left parietal ictus cerebri and an enlargement of supratentorial ventricles (Evan’s ratio 0.6) associated with narrowed CSF spaces at convexity. Neuropsycological evaluation revealed frontal and subcortical deficits, with impaired attention, executive slowing and visuospatial dysfunction. Katzmann intraventricular infusion test showed an alteration of CSF dynamics [1]. Patient underwent ventriculo-peritoneal shunt. Postoperatory course was uneventful, with a mild gait and cognitive improvement. Three months after discharge, patient presented cervical pain, progressive gait worsening and right brachio-crural palsy. Neurological examination showed the presence of an asymmetry of deep tendon reflexes, with right hyperreflexia and the presence of a right brachio-crural palsy (strength 3/5). Brain MRI showed a slight reduction of Evan’s ratio (0.5). Spinal cord MRI displayed a right ventral extra-axial mass located in the spinal canal, compressing the spinal cord at C2 level. Motor evoked potentials suggested suffering of central motor pathways. Gross total tumor removal was performed (Histological diagnosis: meningioma-WHO grade I) (Fig. 1). At 2-year follow-up, a significant improvement of the right paresis was observed. In the literature, reports exist about spinal tumors causing high-pressure hydrocephalus [2]. A widely accepted hypothesis is that protein overproduction can lead to a high CSF viscosity thus causing an increased resistance to its absorption, resulting in hydrocephalus [3]. Some authors detected an increased level of fibrinogen in CSF due to various mechanisms. Deposit of fibrinogen and its conversion to fibrin at the level of the subarachnoid spaces induces arachnoiditis and fibrosis, causing obstruction of CSF outflow [3]. Malignant tumors can also produce metastatic arachnoiditis by dissemination through the subarachnoid space. Moreover, hydrocephalus can occur in cervical tumors with high rostral cysts producing thickening of the leptomeninges at the cervico-medullary junction [4]. Koshu et al. described a patient showing ventriculomegaly associated with signs of increased intracranial pressure; after shunting, patient presented acute spinal cord signs and neurological deterioration [5]. Patient was diagnosed to harbor a cervical tumor. In that case, the authors hypothesized an almost complete obstruction of CSF circulation at cervical level due to the tumor. Shunt placement caused a significant decrease in subarachnoid space pressure above the tumor level with resulting dissociation of CSF pressure between above and below the tumor level which caused an upward herniation of the spinal cord below tumor level. As a result, a further decrease in subarachnoid space above the tumor was considered responsible of neurological signs. In all the reported cases, patients presented with clinical and radiological signs of acute hydrocephalus. In our case, instead, clinical history, neurological examination and brain imaging before surgery were all in favor of the diagnosis of INPH; no signs of intracranial hypertension or spinal cord compression were evident. In particular, patient neither presented signs of P. De Bonis P. P. Mattogno (&) G. Capone A. Mangiola C. Anile Institute of Neurosurgery, Catholic University School of Medicine, l.go F. Vito, 1, 00168 Rome, Italy e-mail: pierpaolo.mattogno@gmail.com

Parasitic rachiopagus conjoined twins with herniation of the autosite spinal cord into the parasite: case report

A female newborn was found to have a rachiopagus parasite consisting of hypoplastic lower limbs attached to the dorsal thoracolumbar region; at surgery, when the infant was 30 days old, the autosite spinal cord was found to have herniated through a spina bifida into the parasite.

Herniation of the Spinal Cord

Herniation of the Spinal Cord

Idiopathic dural herniation of the thoracic spinal cord

Idiopathic dural herniation of the thoracic spinal cord

Herniation of the spinal cord 38 years after childhood trauma

Herniation of the spinal cord 38 years after childhood trauma

Effects of Maternal Administration of Endoxan, Vitamin A and Vitamin B<sub>12</sub> on the Development of the Fetal Spinal Cord of the Albino Mouse

The effects of maternal administration of endoxan, vitamin A and vitamine B12 were studied on the cervical fetal spinal cord of the albino mouse. Endoxan caused dorsal and ventral herniation of the spinal cord, chromatolysis and degeneration of the neuroblasts together with neuroglial proliferation. Vitamin A and B12 resulted in an increase in the surface areas of both grey and white matter and an increase in the volume of the neuroblasts. The possible mechanisms concerned were discussed.

UNUSUAL CAUSE OF BROWN-SEQUARD SYNDROME.

With few exceptions 4 most authors consider that the several varieties of rachischisis are due to defective closure of the dorsal aspect of the neural tube. 2,5 This theory is not only in accord with the embryological facts but also explains why the closure defects are almost exclusively present in the dorsal aspect of the neural axis. Anterior defects are rare but by no means unknown. Such defects are usually present as anterior meningoceles 3,8 or sinus tracts connecting the neural axis to the enteric tube. 6,7 The case to be reported here is quite unique. A small herniation of the thoracic spinal cord through a defect in the dura mater was found. The patient presented himself with a modified Brown-Sequard syndrome. Perusal of the literature has failed to reveal the presence of any similar case. Report of Case This 33-year-old man was referred to the neurosurgical service of the