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Sarigul B, Ogrenci A, Dalbayrak S. Surgical management of idiopathic thoracal ventral spinal cord herniation: a case report. EGYPTIAN JOURNAL OF NEUROSURGERY 2023. [DOI: 10.1186/s41984-023-00187-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023] Open
Abstract
Abstract
Introduction
Idiopathic spinal cord herniation is a rare entity that is characterized by the displacement of the spinal cord through a defect in the dural layer and presents with symptoms of myelopathy. Surgical management usually results in good outcomes.
Case presentation
A 58-year-old female patient presented with weakness of both legs since four months. Her neurological examination showed paraplegia in the lower extremities, and ventral herniation was detected in the T9 vertebral level. The patient underwent surgery. Left T9 hemilaminectomy was followed by the reduction in the herniated spinal cord into its physiological location and the covering the anteriorly located dural defect via circumferentially covering the dural surface of the corresponding vertebral level. Postoperatively, the patient’s neurological status improved gradually and radiological scans showed a total reduction in the herniation.
Conclusion
Despite the rarity of the pathology, spinal cord herniation should be included in the differential diagnosis of the patients presenting with myelopathy or Brown–Séquard syndrome.
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Yang C, Lin G, Zhang J, Yang J, Xie J. Case Report: Idiopathic Spinal Cord Herniation: An Overlooked and Frequently Misdiagnosed Entity. Front Surg 2022; 9:905038. [PMID: 35711698 PMCID: PMC9195413 DOI: 10.3389/fsurg.2022.905038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 05/05/2022] [Indexed: 11/29/2022] Open
Abstract
Background Idiopathic spinal cord herniation is an extremely rare entity that is characterized by protrusion of the spinal cord through a defect in the ventral dura. Due to the paucity of enough clinical evidence, the treatment and prognosis of idiopathic spinal cord herniation are still elusive. Herein, we reported a case of idiopathic spinal cord herniation occurring at the C7–T1 levels that was treated by surgical reduction. Case description A 44-year-old Chinese woman presented with a 5-year history of numbness and weakness in the bilateral lower limbs. Spinal magnetic resonance imaging demonstrated ventral displacement of the spinal cord at the C7–T1 levels, and there seemed to be a cuneiform space-occupying lesion dorsal to the spinal cord. A diagnosis of the spinal intradural extramedullary tumor was suspected. An exploratory operation was performed via a posterior midline approach. Intraoperatively, we found a defect in the ventral dura through which the spinal cord herniated to the epidural space. After the herniated parenchyma was returned, an artificial dura matter was used to repair the defect. The postoperative course was uneventful. After a 3-month follow-up, the lower-extremity weakness was significantly improved, and there was no recurrence of the spinal cord herniation. Conclusion Preoperative diagnosis of idiopathic spinal cord herniation is exceedingly challenging. Surgical reduction of the herniated spinal cord with the repair of the dural defect is an effective approach for the treatment of this rare disorder, and the surgical outcome is favorable.
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Bartels RHMA, Grotenhuis JA, Stegmann APA, Brunner H. Genetic analysis of spinal dysraphism with a hamartomatous growth (appendix) of the spinal cord: a case series. BMC Neurol 2020; 20:121. [PMID: 32252670 PMCID: PMC7132931 DOI: 10.1186/s12883-020-01710-7] [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: 10/11/2019] [Accepted: 03/29/2020] [Indexed: 12/03/2022] Open
Abstract
Background Spinal dysraphism with a hamartomatous growth (appendix) of the spinal cord is better known as herniated spinal cord. There are many arguments in favour of considering it a developmental defect. From this point of view, it is a type of neural tube disorder. Neural tube disorders can be caused by multiple factors, including a genetic factor. A common genetic defect in patients with a spinal dysraphism with a hamartomatous growth of the spinal cord is sought for. Case presentation In two patients with a symptomatic lesion and referred to an academic hospital a genetic analysis was performed after informed consent. Whole-exome analysis was performed. : Whole-exome analysis did not result in identification of a clinically relevant genetic variant. Conclusions This the first study to investigate the genetic contribution to spinal dysraphism with a hamartomatous growth (appendix) of the spinal cord. We could not establish a genetic cause for this entity. This conclusion cannot be definitive due to the small sample size. However, the incidental occurrence, the lack of reports of inheritance of this disorder and the absence of contribution to syndromal disorders favours a defect of normal development of the spinal cord.
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Sarath Chander V, Govindasamy R, Masapu D, Preethish-Kumar V, Rudrappa S. Role of expansile duraplasty and neural monitoring in surgery for Anterior Thoracic Spinal Cord Herniation. INTERDISCIPLINARY NEUROSURGERY 2020. [DOI: 10.1016/j.inat.2020.100859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Bhatia K, Madhavan A, Coutinho C, Mathur S. Idiopathic spinal cord herniation. Clin Radiol 2020; 75:721-729. [PMID: 32499121 DOI: 10.1016/j.crad.2020.04.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Accepted: 04/28/2020] [Indexed: 11/28/2022]
Abstract
Idiopathic spinal cord herniation is a rare but important and increasingly recognised cause of myelopathy seen in the thoracic spine. The factors that contribute to the aetiology of the condition and of the dural defect through which the cord herniates remain under debate. We discuss the clinical features and proposed pathophysiology of the condition, and illustrate key imaging findings on MRI, fluoroscopy and computed tomography (CT) myelography to establish the diagnosis, and discuss relevant differential diagnoses. Awareness and recognition of the condition is key as surgical intervention can improve outcomes for patients.
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Affiliation(s)
- K Bhatia
- Department of Neuroradiology, Lancashire Teaching Hospitals NHS Trust, Sharoe Green Lane, Preston, PR2 9HT, UK.
| | - A Madhavan
- Department of Neuroradiology, Lancashire Teaching Hospitals NHS Trust, Sharoe Green Lane, Preston, PR2 9HT, UK
| | - C Coutinho
- Department of Neuroradiology, Lancashire Teaching Hospitals NHS Trust, Sharoe Green Lane, Preston, PR2 9HT, UK
| | - S Mathur
- Department of Neuroradiology, Lancashire Teaching Hospitals NHS Trust, Sharoe Green Lane, Preston, PR2 9HT, UK.
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Iunes EA, Barletta EA, Suzuki FS, Barba Belsuzarri TA, de Araújo Paz D, Veiga de Castro Sparapani F, Onishi FJ, Cavalheiro S, Salati T, de Meldau Benites V, Riechelmann G, Joaquim AF. Idiopathic Ventral Spinal Cord Herniation: Video Report and Systematic Review. World Neurosurg 2020; 139:592-602. [PMID: 32376383 DOI: 10.1016/j.wneu.2020.04.190] [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: 04/04/2020] [Revised: 04/23/2020] [Accepted: 04/24/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Idiopathic ventral spinal cord herniation (ISCH) is a rare disease; however, it is an important differential diagnosis. Its treatment presents some controversies. CASE DESCRIPTION We report on a 55-year-old woman who had been presenting with relevant back pain and leg weakness for the past 3 years and urinary incontinence for the past 3 months. Clinical examination disclosed paresis on the right inferior limb and right foot, as well as a T6-level painful hypoesthesia. Magnetic resonance imaging disclosed a T4/T5 ISCH. The patient underwent surgical decompression. During the procedure, we opened the arachnoid and cut the dentate ligaments of the spine, which considerably improved the mobility and safety of the procedure. In the early follow-up, our patient presented a partial improvement regarding the paresis grades and hypoesthesia pain relief on the left side. A video showing the surgical procedure and case evolution is presented. We also assembled literature reviews to compare our case with others. ISCH is becoming a more recognized cause of progressive thoracic myelopathy. However, this condition is still frequently misdiagnosed. Magnetic resonance imaging is the key for diagnosis. The objective of surgical treatment is to prevent myelopathy progression. The technique presented in this report is an appropriate surgical option, once it is a safer way to identify and treat the defect. The neurologic condition usually improves greatly after surgical treatment, especially when the patient presents positive predictive factors. CONCLUSIONS ISCH is being more recognized. The technique presented is an appropriate surgical option.
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Affiliation(s)
- Eduardo Augusto Iunes
- Federal University of São Paulo, Medical School, Neurosurgery Department, São Paulo, Brazil
| | - Enrico Affonso Barletta
- Medical School, Post Graduation Program, Pontifical Catholic University of Campinas, São Paulo, Brazil.
| | - Fernando Seiji Suzuki
- Federal University of São Paulo, Medical School, Neurosurgery Department, São Paulo, Brazil
| | - Telmo Augusto Barba Belsuzarri
- Neurosurgery Department, Medical School, Post Graduation Program, Pontifical Catholic University of Campinas, São Paulo, Brazil
| | - Daniel de Araújo Paz
- Federal University of São Paulo, Medical School, Neurosurgery Department, São Paulo, Brazil
| | | | - Franz Jooji Onishi
- Federal University of São Paulo, Medical School, Neurosurgery Department, São Paulo, Brazil
| | - Sergio Cavalheiro
- Federal University of São Paulo, Medical School, Neurosurgery Department, São Paulo, Brazil
| | - Thiago Salati
- Federal University of São Paulo, Medical School, Neurosurgery Department, São Paulo, Brazil
| | | | - Guilherme Riechelmann
- Federal University of São Paulo, Medical School, Neurosurgery Department, São Paulo, Brazil
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Groen RJ, Lukassen JN, Boer GJ, Vergeer RA, Coppes MH, Drost G, Middel B. Anterior Thoracic Spinal Cord Herniation: Surgical Treatment and Postoperative Course. An Individual Participant Data Meta-Analysis of 246 Cases. World Neurosurg 2019; 123:453-463.e15. [DOI: 10.1016/j.wneu.2018.11.229] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 11/25/2018] [Accepted: 11/27/2018] [Indexed: 12/16/2022]
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