Spinal Anterior Dural Dissection: Moving From Differential to Unifying Diagnosis
Steven Knafo1,2, Anne Herbrecht1, Cécile Cauquil3
1Department of Neurosurgery, Bicêtre Hospital, AP-HP, Le Kremlin-Bicêtre , France.
Neurosurgery
|February 15, 2024
Summary
Spinal anterior dural dissection (SADD) unifies various CSF collections linked to brachial amyotrophy, intracranial hypotension, and superficial siderosis. This condition involves anterior interdural CSF collections causing motor deficits.
Area of Science:
- Neurology
- Neurosurgery
- Radiology
Background:
- Anterior spinal dural CSF collections present with diverse names and associations.
- Brachial amyotrophy (BA) is a potential clinical manifestation of these collections.
Purpose of the Study:
- To report cases of anterior interdural CSF collections associated with brachial amyotrophy.
- To investigate the relationship between these collections and other clinical variants.
Main Methods:
- Retrospective cohort study of patients with upper limb motor deficits and anterior interdural CSF collections on MRI.
- Systematic literature review for cases of spinal dural dissection revealed by brachial amyotrophy.
Main Results:
- Seven male patients with BA and dural dissection showed progressive, asymmetrical upper limb motor deficits.
- MRI revealed anterior CSF collections compressing cervical motor roots; CT myelography identified dural defects in 4/7 cases.
- Literature review identified 18 additional cases, including associations with intracranial hypotension and superficial siderosis.
Conclusions:
- Propose a unifying diagnosis: Spinal Anterior Dural Dissection (SADD).
- Subtypes include SADD-BA (brachial amyotrophy), SADD-SIH (spontaneous intracranial hypotension), and SADD-SS (superficial siderosis).
