Delayed cervical epidural hemorrhage associated with silastic dural implant: case report

Area of Science:

• Neurosurgery
• Spinal Surgery
• Neurology

Background:

• Silastic implants are used in neurosurgery, but complications like intracranial hemorrhage have been reported.
• Delayed cervical epidural hemorrhage is a rare but serious complication associated with silastic grafts placed over the dura after laminectomy.

Observation:

• A 49-year-old woman with a history of C5-C7 laminectomy developed acute quadriplegia.
• MRI revealed an epidural mass compressing the spinal cord at the laminectomy site.

Findings:

• Surgical exploration identified a silastic graft with an overlying fibrous scar and a significant epidural hematoma.
• The silastic implant, scar tissue, and hematoma were removed, leading to improved leg strength postoperatively.

Implications:

• Silastic graft movement can cause delayed hemorrhage by disrupting vessels in surrounding connective tissue.
• Elective removal of silastic implants is recommended if a thick surrounding membrane is visualized on MRI to prevent mass effect and hemorrhage.