Postoperative spinal cord herniation with pseudomeningocele in the cervical spine: a case report
Tokuhide Moriyama1, Toshiya Tachibana, Keishi Maruo
1Department of Orthopedic Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan.
Background Context:
Postoperative spinal cord herniation with pseudomeningocele is a rare disease, with only five cases reported before the present study.
Purpose:
To describe the clinical features and radiologic findings of postoperative spinal cord herniation with pseudomeningocele.
Study Design:
Case report.
Methods:
A case of a 51-year-old man who suffered from postoperative spinal cord herniation with pseudomeningocele was reported, and previous reports on this subject are reviewed.
Results:
He had undergone excision of a spinal cord tumor in the cervical spine 10 years previously. He had progressive paraparesis and urinary disturbance 10 years later. The Computed Tomography Multi Planner Reconstruction myelogram showed dilation of the ventral subarachnoid space with left deviation of the spinal cord into the pseudomeningocele at C7. On observation at surgery, the spinal cord appeared displaced dorsally and herniated through the defect of the dorsal dura mater. The spinal cord was tightly adhesive around the dural defect. We released the adhesion of the spinal cord and the dural defect under the spinal cord, and the dural defect was repaired using an artificial dura mater.
Conclusions:
The release of adhesion around dural defect and repair of dural defect under spinal cord monitoring resulted in a satisfactory neurologic recovery. Surgical repair of the dural defect with a dural substitute was necessary.
Insights
Postoperative spinal cord herniation with pseudomeningocele, a rare condition, can cause progressive neurological deficits. Surgical repair of the dural defect and adhesion release led to satisfactory recovery in this case.
Area of Science:
- Neurosurgery
- Neurology
- Radiology
Background:
- Postoperative spinal cord herniation with pseudomeningocele is an exceptionally rare complication.
- Only five cases were previously documented in medical literature.
Observation:
- A 51-year-old male presented with progressive paraparesis and urinary dysfunction 10 years after cervical spine tumor excision.
- Radiological imaging revealed a dilated ventral subarachnoid space with spinal cord deviation into a pseudomeningocele at C7.
Findings:
- Intraoperative findings confirmed dorsal displacement and herniation of the spinal cord through a dural defect, with significant adhesion.
- Release of adhesions and dural defect repair using artificial dura mater were performed under spinal cord monitoring.
Implications:
- Surgical intervention involving adhesion release and dural repair is crucial for managing spinal cord herniation with pseudomeningocele.
- This approach resulted in satisfactory neurological recovery, highlighting the importance of timely surgical management.
