Related Experiment Videos
Postoperative cervical pseudomeningocele with herniation of the spinal cord
1Department of Orthopaedic Surgery, Center for Adult Diseases, Osaka, Japan.
Study Design:
This is a report of a patient in whom spinal cord herniation into a pseudomeningocele resulted in progressive myelopathy.
Objective:
To describe the outcome of a 59-year-old man who visited Osaka University Hospital complaining of gait disturbance. He had undergone cervical laminectomy to resect a spinal cord tumor 14 years previously.
Summary Of Background Data:
Pseudomeningocele is an extremely rare condition and can be overlooked. In addition, cord herniation into the pseudomeningocele rarely can be diagnosed before surgical exploration. Our patient represents the first case we are aware of in which magnetic resonance imaging could clearly demonstrate not only the pseudomeningocele, but the herniation of the cord into the cyst.
Methods:
Magnetic resonance imaging was used for preoperative and postoperative investigation.
Results:
The pseudomeningocele was resected to improve the neurologic status of the patient. During the operation, the herniated cord was successfully reduced into the original subarachnoid space by the release of adhesion. Most symptoms subsided soon after surgery. Magnetic resonance imaging could delineate not only the cyst and cord herniation, but the medullary pathology. The distribution of high-intensity areas on T2-weighted images suggested the cord damage.
Conclusion:
Magnetic resonance imaging revealed not only the cyst and cord herniation, but medullary pathology, too.
Insights
Spinal cord herniation into a pseudomeningocele caused progressive myelopathy. Magnetic resonance imaging successfully diagnosed this rare condition, and surgical intervention led to symptom improvement.
Area of Science:
- Neurosurgery
- Radiology
- Neurology
Background:
- Pseudomeningocele is a rare condition that can be overlooked.
- Spinal cord herniation into a pseudomeningocele is rarely diagnosed pre-operatively.
- This case highlights the diagnostic capabilities of MRI for this condition.
Observation:
- A 59-year-old man presented with gait disturbance 14 years after cervical laminectomy.
- He was diagnosed with spinal cord herniation into a pseudomeningocele.
- Magnetic resonance imaging (MRI) clearly visualized the pseudomeningocele and cord herniation.
Findings:
- Surgical resection of the pseudomeningocele and reduction of the herniated cord improved the patient's neurologic status.
- Postoperative MRI confirmed the successful reduction and revealed medullary pathology.
- High-intensity areas on T2-weighted images indicated spinal cord damage.
Implications:
- MRI is crucial for diagnosing spinal cord herniation into pseudomeningoceles.
- Early diagnosis and surgical intervention can lead to significant neurologic recovery.
- This case expands understanding of rare post-surgical complications.