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Tu YT, Chiang YH, Lin JH. Delta Cord as a Radiological Localization Sign of Postoperative Adhesive Arachnoiditis: A Case Report and Literature Review. Diagnostics (Basel) 2023; 13:2942. [PMID: 37761311 PMCID: PMC10529766 DOI: 10.3390/diagnostics13182942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 09/06/2023] [Accepted: 09/11/2023] [Indexed: 09/29/2023] Open
Abstract
Postoperative adhesive arachnoiditis is an inflammatory response of the spinal leptomeninges that occurs after surgery and results in scar formation in the avascular nature of the arachnoid layer. Clinical manifestations of postoperative adhesive arachnoiditis include pain, sensory deficits, motor dysfunction, reflex abnormalities, and bladder or bowel impairment. In magnetic resonance imaging scans, signs of postoperative adhesive arachnoiditis can vary; however, some indicators can assist surgeons in locating the lesion accurately and, thus, in planning effective surgical interventions. This paper reports the case of a 37-year-old man with postoperative adhesive arachnoiditis after two surgeries for Chiari I malformation. This case illustrates the progressive development of the "delta cord sign", which refers to the formation of a thick arachnoid band causing the spinal cord to adopt a triangular shape in the axial view. This phenomenon is accompanied by the sequential occurrence of syringomyelia. During intraoperative examination, we identified the presence of the delta cord sign, which had been formed by an arachnoid scar that tethered the dorsal spinal cord to the dura. This discovery enabled us to precisely pinpoint the location of the arachnoid scar and thus provided us with guidance that enabled us to avoid unnecessary exploration of unaffected structures during the procedure. Other localization signs were also reviewed.
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Affiliation(s)
- Yi-Ting Tu
- Department of Neurosurgery, Taipei Medical University Hospital, Taipei City 110301, Taiwan; (Y.-T.T.); (Y.-H.C.)
- Taipei Neuroscience Institute, Taipei Medical University, Taipei City 110301, Taiwan
| | - Yung-Hsiao Chiang
- Department of Neurosurgery, Taipei Medical University Hospital, Taipei City 110301, Taiwan; (Y.-T.T.); (Y.-H.C.)
- Taipei Neuroscience Institute, Taipei Medical University, Taipei City 110301, Taiwan
- Division of Neurosurgery, Department of Surgery, School of Medicine, Taipei Medical University, Taipei City 110301, Taiwan
| | - Jiann-Her Lin
- Department of Neurosurgery, Taipei Medical University Hospital, Taipei City 110301, Taiwan; (Y.-T.T.); (Y.-H.C.)
- Taipei Neuroscience Institute, Taipei Medical University, Taipei City 110301, Taiwan
- Division of Neurosurgery, Department of Surgery, School of Medicine, Taipei Medical University, Taipei City 110301, Taiwan
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Yue JK, Lee YM, Quintana D, Aabedi AA, Krishnan N, Wozny TA, Andrews JP, Huang MC. Paraparesis caused by intradural thoracic spinal granuloma secondary to organizing hematoma: illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2022; 4:CASE22432. [PMID: 36411545 PMCID: PMC9678799 DOI: 10.3171/case22432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 10/24/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Spinal granulomas form from infectious or noninfectious inflammatory processes and are rarely present intradurally. Intradural granulomas secondary to hematoma are unreported in the literature and present diagnostic and management challenges. OBSERVATIONS A 70-year-old man receiving aspirin presented with encephalopathy, subacute malaise, and right lower extremity weakness and was diagnosed with polysubstance withdrawal and refractory hypertension requiring extended treatment. Seven days after admission, he reported increased bilateral lower extremity (BLE) weakness. Magnetic resonance imaging showed T2-3 and T7-8 masses abutting the pia, with spinal cord compression at T2-3. He was transferred to the authors' institution, and work-up showed no vascular shunting or malignancy. He underwent T2-3 laminectomies for biopsy/resection. A firm, xanthochromic mass was resected en bloc. Pathology showed organizing hematoma without infection, vascular malformation, or malignancy. Subsequent coagulopathy work-up was unremarkable. His BLE strength significantly improved, and he declined resection of the inferior mass. He completed physical therapy and was cleared for placement in a skilled nursing facility. LESSONS Spinal granulomas can mimic vascular lesions and malignancy. The authors present the first report of paraparesis caused by intradural granuloma secondary to organizing hematoma, preceded by severe refractory hypertension. Tissue diagnosis is critical, and resection is curative. These findings can inform the vigilant clinician for expeditious treatment.
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Affiliation(s)
- John K. Yue
- Department of Neurosurgery, University of California, San Francisco, San Francisco, California; and ,Department of Neurosurgery, Veterans Affairs Medical Center, San Francisco, California
| | - Young M. Lee
- Department of Neurosurgery, University of California, San Francisco, San Francisco, California; and ,Department of Neurosurgery, Veterans Affairs Medical Center, San Francisco, California
| | - Daniel Quintana
- Department of Neurosurgery, University of California, San Francisco, San Francisco, California; and ,Department of Neurosurgery, Veterans Affairs Medical Center, San Francisco, California
| | - Alexander A. Aabedi
- Department of Neurosurgery, University of California, San Francisco, San Francisco, California; and ,Department of Neurosurgery, Veterans Affairs Medical Center, San Francisco, California
| | - Nishanth Krishnan
- Department of Neurosurgery, University of California, San Francisco, San Francisco, California; and ,Department of Neurosurgery, Veterans Affairs Medical Center, San Francisco, California
| | - Thomas A. Wozny
- Department of Neurosurgery, University of California, San Francisco, San Francisco, California; and ,Department of Neurosurgery, Veterans Affairs Medical Center, San Francisco, California
| | - John P. Andrews
- Department of Neurosurgery, University of California, San Francisco, San Francisco, California; and ,Department of Neurosurgery, Veterans Affairs Medical Center, San Francisco, California
| | - Michael C. Huang
- Department of Neurosurgery, University of California, San Francisco, San Francisco, California; and ,Department of Neurosurgery, Veterans Affairs Medical Center, San Francisco, California
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Palackdkharry CS, Wottrich S, Dienes E, Bydon M, Steinmetz MP, Traynelis VC. The leptomeninges as a critical organ for normal CNS development and function: First patient and public involved systematic review of arachnoiditis (chronic meningitis). PLoS One 2022; 17:e0274634. [PMID: 36178925 PMCID: PMC9524710 DOI: 10.1371/journal.pone.0274634] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 08/31/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND & IMPORTANCE This patient and public-involved systematic review originally focused on arachnoiditis, a supposedly rare "iatrogenic chronic meningitis" causing permanent neurologic damage and intractable pain. We sought to prove disease existence, causation, symptoms, and inform future directions. After 63 terms for the same pathology were found, the study was renamed Diseases of the Leptomeninges (DLMs). We present results that nullify traditional clinical thinking about DLMs, answer study questions, and create a unified path forward. METHODS The prospective PRISMA protocol is published at Arcsology.org. We used four platforms, 10 sources, extraction software, and critical review with ≥2 researchers at each phase. All human sources to 12/6/2020 were eligible for qualitative synthesis utilizing R. Weekly updates since cutoff strengthen conclusions. RESULTS Included were 887/14286 sources containing 12721 DLMs patients. Pathology involves the subarachnoid space (SAS) and pia. DLMs occurred in all countries as a contributor to the top 10 causes of disability-adjusted life years lost, with communicable diseases (CDs) predominating. In the USA, the ratio of CDs to iatrogenic causes is 2.4:1, contradicting arachnoiditis literature. Spinal fusion surgery comprised 54.7% of the iatrogenic category, with rhBMP-2 resulting in 2.4x more DLMs than no use (p<0.0001). Spinal injections and neuraxial anesthesia procedures cause 1.1%, and 0.2% permanent DLMs, respectively. Syringomyelia, hydrocephalus, and arachnoid cysts are complications caused by blocked CSF flow. CNS neuron death occurs due to insufficient arterial supply from compromised vasculature and nerves traversing the SAS. Contrast MRI is currently the diagnostic test of choice. Lack of radiologist recognition is problematic. DISCUSSION & CONCLUSION DLMs are common. The LM clinically functions as an organ with critical CNS-sustaining roles involving the SAS-pia structure, enclosed cells, lymphatics, and biologic pathways. Cases involve all specialties. Causes are numerous, symptoms predictable, and outcomes dependent on time to treatment and extent of residual SAS damage. An international disease classification and possible treatment trials are proposed.
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Affiliation(s)
| | - Stephanie Wottrich
- Case Western Reserve School of Medicine, Cleveland, Ohio, United States of America
| | - Erin Dienes
- Arcsology®, Mead, Colorado, United States of America
| | - Mohamad Bydon
- Department of Neurologic Surgery, Orthopedic Surgery, and Health Services Research, Mayo Clinic School of Medicine, Rochester, Minnesota, United States of America
| | - Michael P. Steinmetz
- Department of Neurological Surgery, Cleveland Clinic Lerner College of Medicine Neurologic Institute, Cleveland, Ohio, United States of America
| | - Vincent C. Traynelis
- Department of Neurosurgery, Rush University School of Medicine, Chicago, Illinois, United States of America
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Nadeem SF, Baig AN, Tariq QUA, Shamim MS. Spinal arachnoiditis and syringomyelia: Review of literature with emphasis on postinfectious inflammation and treatment. Surg Neurol Int 2022; 13:299. [PMID: 35928312 PMCID: PMC9345109 DOI: 10.25259/sni_383_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 06/23/2022] [Indexed: 11/04/2022] Open
Abstract
Background:
Arachnoiditis refers to chronic inflammation of the arachnoid mater and subarachnoid space due to three major etiologies: chemical, mechanical, and postinfectious. As a rare disease with variable symptomatology and severity at presentation, arachnoiditis can be extremely debilitating with many complications, prominent among which is syringomyelia.
Methods:
We reviewed current literature concerning postinfectious spinal arachnoiditis and associated syringomyelia with emphasis on the treatment options that have been used to date and discuss their respective benefits and drawbacks.
Results:
It is critical to understand the natural history and potential complications of patient with postinfectious arachnoiditis. Surgical and medical treatments both have their own merits and demerits. Different surgical approaches have been employed with variable success rates.
Conclusion:
At present, no consensus exists regarding management of these patients due to the variable nature of the disease that affects treatment efficacy; however, surgical intervention in selected cases may be beneficial.
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Affiliation(s)
- Syed Faisal Nadeem
- Department of Neurosurgery, Medical College, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Ahmer Nasir Baig
- Department of Neurosurgery, Aga Khan University Hospital, Karachi, Sindh, Pakistan
| | - Qurat ul Ain Tariq
- Department of Neurosurgery, Aga Khan University Hospital, Karachi, Sindh, Pakistan
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González Alarcón JR, Gutiérrez Morales JC, Álvarez Vega MA, Antuña Ramos A. Spinal arachnoid cysts: A delayed becoming fact in post hemorrhagic arachnoiditys. Neurologia 2022; 37:152-154. [PMID: 34024657 DOI: 10.1016/j.nrl.2021.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 02/25/2021] [Accepted: 03/21/2021] [Indexed: 10/21/2022] Open
Affiliation(s)
- J R González Alarcón
- Servicio de Neurocirugía, Hospital Universitario Central de Asturias, Oviedo, España.
| | - J C Gutiérrez Morales
- Servicio de Neurocirugía, Hospital Universitario Central de Asturias, Oviedo, España
| | - M A Álvarez Vega
- Servicio de Neurocirugía, Hospital Universitario Central de Asturias, Oviedo, España
| | - A Antuña Ramos
- Servicio de Neurocirugía, Hospital Universitario Central de Asturias, Oviedo, España
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Mastorakos P, Pomeraniec IJ, Bryant JP, Chittiboina P, Heiss JD. Flexible thecoscopy for extensive spinal arachnoiditis. J Neurosurg Spine 2022; 36:325-335. [PMID: 34598155 PMCID: PMC9382886 DOI: 10.3171/2021.4.spine21483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 04/28/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Chronic adhesive spinal arachnoiditis (SA) is a complex disease process that results in spinal cord tethering, CSF flow blockage, intradural adhesions, spinal cord edema, and sometimes syringomyelia. When it is focal or restricted to fewer than 3 spinal segments, the disease responds well to open surgical approaches. More extensive arachnoiditis extending beyond 4 spinal segments has a much worse prognosis because of less adequate removal of adhesions and a higher propensity for postoperative scarring and retethering. Flexible neuroendoscopy can extend the longitudinal range of the surgical field with a minimalist approach. The authors present a cohort of patients with severe cervical and thoracic arachnoiditis and myelopathy who underwent flexible endoscopy to address arachnoiditis at spinal segments not exposed by open surgical intervention. These observations will inform subsequent efforts to improve the treatment of extensive arachnoiditis. METHODS Over a period of 3 years (2017-2020), 10 patients with progressive myelopathy were evaluated and treated for extensive SA. Seven patients had syringomyelia, 1 had spinal cord edema, and 2 had spinal cord distortion. Surgical intervention included 2- to 5-level thoracic laminectomy, microscopic lysis of adhesions, and then lysis of adhesions at adjacent spinal levels performed using a rigid or flexible endoscope. The mean follow-up was 5 months (range 2-15 months). Neurological function was examined using standard measures. MRI was used to assess syrinx resolution. RESULTS The mean length of syringes was 19.2 ± 10 cm, with a mean maximum diameter of 7.0 ± 2.9 mm. Patients underwent laminectomies averaging 3.7 ± 0.9 (range 2-5) levels in length followed by endoscopy, which expanded exposure by an average of another 2.4 extra segments (6.1 ± 4.0 levels total). Endoscopic dissection of extensive arachnoiditis in the dorsal subarachnoid space proceeded through a complex network of opaque arachnoidal bands and membranes bridging from the dorsal dura mater to the spinal cord. In less severely problematic areas, the arachnoid membrane was transparent and attached to the spinal cord through multifocal arachnoid adhesions bridging the subarachnoid space. The endoscope did not compress or injure the spinal cord. CONCLUSIONS Intrathecal endoscopy allowed visual assessment and safe removal of intradural adhesions beyond the laminectomy margins. Further development of this technique should improve its effectiveness in opening the subarachnoid space and untethering the spinal cord in cases of extensive chronic adhesive SA.
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Affiliation(s)
- Panagiotis Mastorakos
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, Bethesda, Maryland
- Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia; and
| | - I. Jonathan Pomeraniec
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, Bethesda, Maryland
- Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia; and
| | - Jean-Paul Bryant
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, Bethesda, Maryland
| | - Prashant Chittiboina
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, Bethesda, Maryland
- Neurosurgery Unit for Pituitary and Inheritable Diseases, National Institute of Neurological Disorders and Stroke, Bethesda, Maryland
| | - John D. Heiss
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, Bethesda, Maryland
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González Alarcón JR, Gutiérrez Morales JC, Álvarez Vega MA, Antuña Ramos A. Spinal arachnoid cysts: a delayed manifestation of post hemorrhagic arachnoiditys. NEUROLOGÍA (ENGLISH EDITION) 2022; 37:152-154. [PMID: 34969635 DOI: 10.1016/j.nrleng.2021.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 03/21/2021] [Indexed: 10/19/2022] Open
Affiliation(s)
- J R González Alarcón
- Servicio de Neurocirugía, Hospital Universitario Central de Asturias, Oviedo, Spain.
| | | | - M A Álvarez Vega
- Servicio de Neurocirugía, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - A Antuña Ramos
- Servicio de Neurocirugía, Hospital Universitario Central de Asturias, Oviedo, Spain
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Chen P, Guo Y, Huang R, Xiao J, Cheng Z. Spinal schwannoma causes acute subarachnoid haemorrhage: A case report and literature review. Neurochirurgie 2021; 67:495-499. [PMID: 33450272 DOI: 10.1016/j.neuchi.2020.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 11/23/2020] [Accepted: 12/22/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Spinal schwannomas that arise from spinal nerve root sheaths are the most common intradural extramedullary spinal tumours and are often accompanied by nerve roots or spinal cord irritation symptoms. The phenomenon of spinal schwannoma causing subarachnoid haemorrhage (SAH) is rare, with ependymoma of the conus medullaris accounting for most cases. CASE REPORT A 45-year-old man was admitted to our hospital due to progressive lower limb weakness and sudden back pain after hard physical work. The patient had not been able to walk for 2hours upon admission. An emergency magnetic resonance imaging (MRI) scan showed that the spinal cord at the C6-T4 level was severely compressed by a subdural mass. During the emergency operation, exploration of the dura and arachnoid mater revealed a fresh blood clot covering a tumour located on the ventral side of the spinal cord. The size of the tumour was approximately 3×2×1cm without adhesion to the surrounding tissue, but the drainage vein was ruptured. Postoperative pathology showed that the tumour was a schwannoma with areas of fresh haemorrhage and focal necrosis. CONCLUSIONS Spinal schwannomas presenting with SAH are rare events. In our opinion, spinal pathology with rapid progression of neurological symptoms requires early diagnosis and emergency management. Complete excision of haemorrhagic tumours is the goal of treatment to prevent recurrence, which can effectively avoid irreversible damage to the spinal cord resulting from spinal cord compression.
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Affiliation(s)
- P Chen
- Department of Neurosurgery, The Second Affiliated Hospital of Nanchang University, No. 1, Minde road, 330006 Nanchang, Jiangxi, China.
| | - Y Guo
- Department of Neurosurgery, The Second Affiliated Hospital of Nanchang University, No. 1, Minde road, 330006 Nanchang, Jiangxi, China.
| | - R Huang
- Department of Neurosurgery, The Second Affiliated Hospital of Nanchang University, No. 1, Minde road, 330006 Nanchang, Jiangxi, China.
| | - J Xiao
- Department of Neurosurgery, The Second Affiliated Hospital of Nanchang University, No. 1, Minde road, 330006 Nanchang, Jiangxi, China.
| | - Z Cheng
- Department of Neurosurgery, The Second Affiliated Hospital of Nanchang University, No. 1, Minde road, 330006 Nanchang, Jiangxi, China.
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Gutiérrez ML, Rodríguez EEE, Millán JMS, Urzaiz LL, Berrocal VR. Compressive myelopathy secondary to posthemorragic arachnoiditis: Case report and literature review. Clin Neurol Neurosurg 2020; 196:105964. [PMID: 32526489 DOI: 10.1016/j.clineuro.2020.105964] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 05/19/2020] [Accepted: 05/23/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Spinal arachnoiditis is an arachnoid inflammatory process frequently caused by infection or spinal surgery; there are different degrees of severity, including arachnoid thickening and severe adhesive lesions that can lead to the development of arachnoid cysts. Non-traumatic subarachnoid haemorrhage (ntSAH) is a relatively uncommon cause of arachnoiditis; further complication with spinal cord compression (SCC) is even more unusual. METHOD we describe a 70-year-old female, with SCC caused by arachnoid cysts. Her medical past history was relevant for an episode of ntSAH after rupture of a posterior communicating artery aneurysm, eight months prior to the onset of symptoms. We also present a literature review of previous published cases. RESULTS we selected 23 articles with 24 case reports. A noticeable female predominance (11:1) was observed. It is more common between the fourth and fifth decades. The majority of cases (58 %) were secondary to aneurysmal SAH due to rupture of a posterior circulation aneurysm. The most common location of the cyst is in the cervicothoracic spine. The average time between the initial bleeding and symptom development is 3-6 months. The most frequently described treatment is laminectomy and marsupialization of the cyst, but reports show a high recurrence rate. CONCLUSIONS ntSAH is an uncommon aetiology of arachnoiditis and arachnoid cysts. SCC from arachnoid cysts secondary to ntSAH is exceptional. Treatment through laminectomy has a relatively high recurrence rate (33 %). We present different hypotheses to try to explain how the alteration of cerebrospinal fluid (CSF) dynamics after ntSAH can lead to arachnoid cyst development and SCC. Although the small number of cases included in the present series precludes us to draw definite conclusions, ventriculoperitoneal shunt (VPS) placement can be considered as an alternative treatment in the management of known ntSAH patients that present recurrent symptomatic arachnoid cysts.
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Affiliation(s)
- María López Gutiérrez
- Department of Neurological Surgery, Hospital Universitario Ramón y Cajal, Madrid, Spain.
| | | | | | - Luis Ley Urzaiz
- Department of Neurological Surgery, Hospital Universitario Ramón y Cajal, Madrid, Spain
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Thompson J, Merrill RK, Qureshi SA, Leven DM. Compression of the S1 Nerve Root by an Extradural Vascular Malformation: A Case Report and Discussion of Atypical Causes of Lumbar Radiculopathy. Int J Spine Surg 2020; 14:96-101. [PMID: 32128309 DOI: 10.14444/7013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
We present a case of lumbar radiculopathy due to a vascular malformation in the lumbar spine and discuss various causes of atypical lumbar radiculopathy. Lumbar radiculopathy is a condition of neurologic deficits and painful symptoms of the lower extremities due to nerve root compression, most commonly at the L5 and S1 levels. Several factors contribute to lumbar radiculopathy, including intervertebral disc herniation, foraminal stenosis, and spinal instability. There are also a number of atypical causes, including medication side effects or metabolic disorders, which produce symptoms of radiculopathy but do not involve compression of the nerve root. Anatomic variations in the nerve roots or vascular supply surrounding the nerve root may also increase the risk of developing radiculopathy and serve as an obstacle to interpreting imaging during a preoperative workup. A 38-year-old woman presented with sudden onset radicular symptoms in her right lower extremity. Lumbar magnetic resonance imaging demonstrated a right-sided L5-S1 extruded nucleus pulposus. Her symptoms failed to improve after conservative management so she underwent surgical decompression of L4-S1. Intraoperatively, we discovered an extensive, extradural vascular malformation present at the L5-S1 level and believed this to be the true cause of her radiculopathy. This case represents an atypical cause of lumbar radiculopathy and demonstrates the importance of considering atypical causes during diagnostic workup and preoperative planning.
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Affiliation(s)
- Jeffrey Thompson
- Department of Orthopedic Surgery, Nassau University Medical Center-East Meadow, New York
| | - Robert K Merrill
- Department of Orthopedic Surgery, Montefiore Medical Center -New York, New York
| | - Sheeraz A Qureshi
- Department of Orthopedic Surgery, Hospital for Special Surgery - New York, New York
| | - Dante M Leven
- Department of Orthopedic Surgery, Nassau University Medical Center-East Meadow, New York
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Oses M, Zamarbide I, Gómez A, Val J, Herrera I. A Xanthochromic Cause of Headache and Neck Pain. Headache 2019; 59:802-803. [DOI: 10.1111/head.13474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Marta Oses
- Department of Neurology Hospital Universitario Fundación Jiménez Díaz Madrid Spain
| | - Ivana Zamarbide
- Department of Neurology Hospital Universitario Fundación Jiménez Díaz Madrid Spain
| | - Andrea Gómez
- Department of Neurology Hospital Universitario Fundación Jiménez Díaz Madrid Spain
| | - Javier Val
- Department of Neurology Hospital Universitario Fundación Jiménez Díaz Madrid Spain
| | - Isabel Herrera
- Neuroradiology Division, Department of Radiology Hospital Universitario Fundación Jiménez Díaz Madrid Spain
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12
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Maenhoudt W, Rasschaert R, Bontinck H, Pinson H, Van Roost D, Hallaert G. Postarachnoiditis Anterior Spinal Arachnoid Cyst Formation with Compressive Myelopathy: Report of 2 Cases. World Neurosurg 2018; 118:59-62. [PMID: 30017769 DOI: 10.1016/j.wneu.2018.07.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Revised: 06/29/2018] [Accepted: 07/02/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND Spinal cystic arachnoiditis is a rare complication of a subarachnoid haemorrhage or infectious meningitis. The inflammatory process leads to fibrosis, adhesions, and in severe cases cyst formation. Large arachnoid cysts are an uncommon cause of compressive myelopathy. The majority are located posterior of the spinal cord at the thoracic level. Anterior cyst formation is exceptional, especially at the cervical region. CASE DESCRIPTION We present 2 cases of progressive myelopathy secondary to anterior arachnoid cyst formation. In a 54-year-old female a large anterior symptomatic thoracic cyst arose 4 years after rupture of a posterior inferior cerebellar artery aneurysm. The other 59-year-old-patient, however, developed an anterior cervical cyst only weeks after a varicella meningoencephalitis. Both female patients were treated with a decompressive laminectomy and wide fenestration of the cysts. Partial recovery was obtained in 1 patient, but there was no improvement in the other case. CONCLUSIONS Spinal cystic arachnoiditis with anterior cyst formation is an extremely rare complication of subarachnoid haemorrhage and infectious meningitis but can cause severe neurologic deficits. Clinicians should be aware of this rare complication. Due to the risk of irreversible spinal cord injury, rapid surgical intervention is recommended in most cases.
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Affiliation(s)
- Wim Maenhoudt
- Department of Neurosurgery, Ghent University Hospital, Ghent, Belgium; Department of Neurosurgery, AZ Sint Jozef Hospital, Bornem, Belgium.
| | - Ricky Rasschaert
- Department of Neurosurgery, AZ Sint Jozef Hospital, Bornem, Belgium
| | - Hugo Bontinck
- Department of General Surgery, AZ Sint Jozef Hospital, Bornem, Belgium
| | - Harry Pinson
- Department of Neurosurgery, Ghent University Hospital, Ghent, Belgium
| | - Dirk Van Roost
- Department of Neurosurgery, Ghent University Hospital, Ghent, Belgium
| | - Giorgio Hallaert
- Department of Neurosurgery, Ghent University Hospital, Ghent, Belgium
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