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Kögl N, Thomé C, Gindlhuber K, Dazinger F, Gizewski E, Kiechl S, Petr O. Sacral fracture associated with a Tarlov cyst causing an anterior sacral CSF fistula and intraventricular fat emboli - a case report and review of the literature. Br J Neurosurg 2024; 38:591-595. [PMID: 34397315 DOI: 10.1080/02688697.2021.1940848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 05/30/2021] [Accepted: 06/07/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Sacral fractures are rare and either associated with high-energy trauma or osteoporosis in most cases. A search of the current literature on sacral fractures and cerebrospinal fluid fistula identified only few cases. Pathological fractures are uncommon and exceedingly rare in case of Tarlov cysts. Sacral fractures can be missed in oligosymptomatic patients. However, severe complications may emerge as shown by this case report. METHODS We present the case of a pathological sacral fracture at the level S2/3 following a low-impact trauma, associated with a Tarlov cyst, which was complicated by an anterior CSF fistula and intraventricular fat emboli. RESULTS The patient was treated conservatively with strict bedrest and a CT-guided blood patch. Postponed mobilization was successful with decreasing orthostatic symptoms. Follow-up MRI and CT imaging showed a complete resolution of the ventral CSF fistula and ossification of the fracture. The intraventricular fat did not resolve, however, there was no radiological sign of hydrocephalus with excellent clinical outcome at 6-months follow-up. CONCLUSION Although exceedingly rare, sacral Tarlov cysts may be associated with pathological fractures of the sacrum. Relevant complications can emerge and need to be properly addressed.
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Affiliation(s)
- Nikolaus Kögl
- Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria
| | - Claudius Thomé
- Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria
| | - Karin Gindlhuber
- Department of Neuroradiology, Medical University Innsbruck, Innsbruck, Austria
| | - Florian Dazinger
- Department of Neuroradiology, Medical University Innsbruck, Innsbruck, Austria
| | - Elke Gizewski
- Department of Neuroradiology, Medical University Innsbruck, Innsbruck, Austria
| | - Stefan Kiechl
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Ondra Petr
- Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria
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Pedrosa M, Martins B, Araújo R. It's in the game: A review of neurological lesions associated with sports. J Neurol Sci 2023; 455:122803. [PMID: 37995461 DOI: 10.1016/j.jns.2023.122803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 10/24/2023] [Accepted: 11/14/2023] [Indexed: 11/25/2023]
Abstract
INTRODUCTION The practice of sports may lead to neurological injuries. While relatively uncommon (overall incidence of approximately 2.5%), and mostly benign and transient, some conditions may be life-threatening and permanent. Thus, both clinical neurologists and sports physicians should be aware of their existence and relevance. We aimed to review all sports-related neurological injuries and illnesses reported in the literature. METHODS Following SANRA guidelines, we performed a narrative review and searched PubMed and Scopus databases. Relevant sports were selected based on their recognition as an Olympic sport by the International Olympic Committee. Chronic traumatic encephalopathy (CTE) and other neurodegenerative disorders were not included. RESULTS A total of 292 studies were included concerning 33 different sports. The most reported neurological injury was damage to the peripheral nervous system. Traumatic injuries have also been extensively reported, including cerebral haemorrhage and arterial dissections. Non-traumatic life-threatening events are infrequent but may also occur, e.g. posterior reversible encephalopathy syndrome, cerebral venous thrombosis, and arterial dissections. Some conditions were predominantly reported in specific sports, e.g. yips in baseball and golf, raising the possibility of a common pathophysiology. Spinal cord infarction due to fibrocartilaginous embolism was reported in several sports associated with minor trauma. CONCLUSION Sports-related neurological injuries are increasingly receiving more social and medical attention and are an important cause of morbidity and mortality. This review may serve as a guide to physicians managing these challenging situations.
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Affiliation(s)
| | - Bárbara Martins
- Neurology Department, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal; Clinical Neuroscience and Mental Health Department, Faculty of Medicine, University of Porto, Porto, Portugal.
| | - Rui Araújo
- Neurology Department, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal; Clinical Neuroscience and Mental Health Department, Faculty of Medicine, University of Porto, Porto, Portugal
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Banerjee C, Cross B, Rumley J, Devine J, Ritter E, Vender J. Multiple-Layer Lumbosacral Pseudomeningocele Repair with Bilateral Paraspinous Muscle Flaps and Literature Review. World Neurosurg 2020; 144:e693-e700. [PMID: 32942058 DOI: 10.1016/j.wneu.2020.09.038] [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: 06/13/2020] [Revised: 09/09/2020] [Accepted: 09/09/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Pseudomeningocele is an uncommon but widely recognized complication of spinal surgery that can be challenging to correct. When conservative measures fail, patients frequently require reoperation to attempt primary closure of the durotomy, yet attempts at true watertight closures of the dura or fascia sometimes fall short. We describe a technique of lumbosacral pseudomeningocele repair involving a 2-layer pants-over-vest closure of the pseudomeningocele coupled with mobilization of bilateral paraspinal musculature to create a Z-plasty, or a Z-shaped flap. We have demonstrated a high success rate with our small series. METHODS The technique used meticulous manipulation of the pseudomeningocele to make a 2-layer pants-over-vest closure. This closure coupled with wide mobilization and importation of paraspinous muscle into the wound effectively obliterated dead space with simultaneous tamponade of the dural tear. The lateral row perforators were left intact, providing excellent vascularity with adequate mobility to the patient. RESULTS This technique was incorporated into the care of 10 patients between 2004 and July 2019. All wounds were closed in a single stage after careful flap section based on the wound's needs. We demonstrated successful pseudomeningocele resolution in all 10 patients with no observed clinical recurrence of symptomatic pseudomeningocele after at least 6 months of follow-up. CONCLUSIONS This technique provides a straightforward option for the spine surgeon to manage these challenging spinal wounds with minimal, if any, need for further laminectomy as well as a high fistula control rate with minimal morbidity.
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Affiliation(s)
- Christopher Banerjee
- Department of Neurological Surgery, Medical College of Georgia at Augusta University, Augusta, Georgia, USA.
| | - Brandy Cross
- Department of General Surgery, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - Jacob Rumley
- Department of Orthopedic Surgery, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - John Devine
- Department of Orthopedic Surgery, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - Edmond Ritter
- Department of Plastic Surgery, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - John Vender
- Department of Neurological Surgery, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
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Kempen DHR, Delawi D, Altena MC, Kruyt MC, van den Bekerom MPJ, Oner FC, Poolman RW. Neurological Outcome After Traumatic Transverse Sacral Fractures: A Systematic Review of 521 Patients Reported in the Literature. JBJS Rev 2019; 6:e1. [PMID: 29870419 DOI: 10.2106/jbjs.rvw.17.00115] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND The purpose of this study was to determine the neurological outcome after transverse sacral fractures in patients with neurological impairment. METHODS A systematic review of the English, French, German, and Dutch literature was conducted. All study designs, including retrospective cohort studies and case reports, describing transverse sacral fractures were included. Two authors independently extracted the predefined data and scored the neurological impairment according to the Gibbons classification after the trauma and at the time of follow-up. The neurological outcomes were pooled according to the Gibbons classification. RESULTS No randomized controlled trials or prospective case series were found. A total of 139 articles were included, consisting of 81 case reports and 58 retrospective case series involving 521 patients. Regardless of the type of management, neurological recovery of at least 1 Gibbons category was reported in 62% of these patients. A comparison of the neurological outcome of nonoperatively treated patients and surgically treated patients showed similar neurological recovery rates. For the surgically treated patients, fixation of the fracture resulted in a better neurological improvement compared with an isolated decompression. CONCLUSIONS This review could not provide evidence of improved neurological recovery after surgical treatment compared with nonoperative treatment. When surgical treatment was considered, there was a low level of evidence that fixation of the fracture results in better neurological improvement compared with isolated decompression. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- D H R Kempen
- Department of Orthopaedic Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands
| | - D Delawi
- Department of Orthopaedic Surgery, Antonius Ziekenhuis, Nieuwegein, the Netherlands
| | - M C Altena
- Department of Orthopaedic Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands
| | - M C Kruyt
- Department of Orthopaedics, University Medical Center Utrecht, Utrecht, the Netherlands
| | - M P J van den Bekerom
- Department of Orthopaedic Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands
| | - F C Oner
- Department of Orthopaedics, University Medical Center Utrecht, Utrecht, the Netherlands
| | - R W Poolman
- Department of Orthopaedic Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands
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Vanek P, Benes V. Successful Management of a Giant Anterior Sacral Meningocele Associated with Low-Dysplastic Spondylolisthesis from a Single Posterior Approach: Case Report. World Neurosurg 2019; 129:522-525. [PMID: 31009790 DOI: 10.1016/j.wneu.2019.04.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 04/10/2019] [Accepted: 04/11/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Anterior sacral meningocele (ASM) is characterized by a herniation of the dural sac through a bony defect of the anterior sacral wall. Symptoms of ASMs are usually directly related to their mass effect on the adjacent pelvic structures, often causing chronic constipation and urinary disturbances. The low-dysplastic spondylolisthesis results from congenital abnormalities of the upper sacral facets or the neural arch of L5. Its symptoms are related to neural compression and/or segmental instability. The main aim of this case report is to present a patient who underwent surgery for low dysplastic spondylolisthesis combined with an ASM that were both considered symptomatic. CASE DESCRIPTION A 23-year-old male patient, with no medical history, no signs of neurologic deficit was admitted for lower back pain and irritation, numbness and paresthesia in the L5 dermatomes bilaterally, together with alternating constipation and diarrhea with no response to conservative treatment. Computed tomography and magnetic resonance imaging of the lumbar spine and pelvis showing a large retroperitoneal mass with fluid contend causing compression and displacement of the pelvic structures, in particular the bladder and the colon and there was also a low-dysplastic spondylolisthesis of L5/S1 with pressure on both L5 nerve roots. Surgery was done in one session purely from a posterior approach with no complications. CONCLUSIONS In the present case, we have demonstrated the suitability of a standard midline posterior approach in the treatment not only for ASM itself, but also for a low-dysplastic spondylolisthesis in 1 session.
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Affiliation(s)
- Petr Vanek
- Department of Neurosurgery and Neurooncology First Faculty of Medicine, Charles University and Military University Hospital, Prague, Czech Republic.
| | - Vladimir Benes
- Department of Neurosurgery and Neurooncology First Faculty of Medicine, Charles University and Military University Hospital, Prague, Czech Republic
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Lim J, Berkman R. Profound Finger Extension Weakness 21 Years After a Traumatic Lumbar Spine Pseudomeningocele. World Neurosurg 2018; 120:244-248. [PMID: 30165213 DOI: 10.1016/j.wneu.2018.08.126] [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: 05/20/2018] [Revised: 08/17/2018] [Accepted: 08/18/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND We present a case report of traumatic pseudomeningocele and a review of the literature and discussion of the neuro-cytoarchitecture to address the disproportionate weakness of extensor neurons seen in the case. CASE DESCRIPTION A 42-year old man developed profound hand weakness 21 years after a lumbar spinal fracture. An examination revealed bilateral hand weakness affecting the extensors of the hands. Imaging studies revealed an extensive ventral epidural pseudomeningocele extending from the area of the lumbar spinal fracture to the cervical spine posteriorly displacing the spinal cord and the ventral motor roots. CONCLUSIONS The patient was successfully treated with a subarachnoid-peritoneal shunt, which completely resolved the epidural pseudomeningocele and resulted in improvement but not resolution of his neurologic deficits.
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Affiliation(s)
- Jaims Lim
- Department of Neurosurgery, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York at Buffalo, Buffalo, New York, USA.
| | - Richard Berkman
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Anterior sacral meningocele presenting as intracystic bleeding. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2017; 27:276-280. [PMID: 28523383 DOI: 10.1007/s00586-017-5128-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 05/07/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE To report a case of anterior sacral meningocele with intralesional bleeding secondary to sacrococcygeal trauma. Likewise, there is a discussion about the physiopathology and the surgical approach to these types of lesions. METHODS A 43-year-old man diagnosed with Marfan syndrome suffered sacrococcygeal trauma. He was admitted to the emergency room due to symptoms of headache, nausea, and lower limb subjective weakness. CT and MRI showed a large retroperitoneal mass with hemorrhagic content close to the sacrum. Likewise, the MRI showed an image compatible with subarachnoid hemorrhage in the thoracic spinal area, cerebral convexity, and the basal cisterns. The patient went into surgery for an anterior abdominal approach in the midline to reduce the content of the lesion, and subsequently, in the same act, a posterior approach was done with an S1-S2 laminectomy and obliteration of the pedicle. Postoperative MRI 5 months later showed resolution of the ASM. RESULTS Anterior sacral meningocele is characterized by herniation of the dura mater and the arachnoid mater outside the spinal canal through a defect of the sacrum. We add the risk of bleeding after trauma-never seen in the literature-as one of the possible inherent complications of this lesion. CONCLUSIONS This report highlights a complication never seen in the literature of a relatively rare condition. In our case, the combined approach was effective for both clinical control and lesion regression.
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Sunna TP, Westwick HJ, Zairi F, Berania I, Shedid D. Successful management of a giant anterior sacral meningocele with an endoscopic cutting stapler: case report. J Neurosurg Spine 2016; 24:862-6. [PMID: 26745349 DOI: 10.3171/2015.8.spine15129] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Anterior sacral meningoceles (ASMs) are rare defects in the sacrum with thecal sac herniations and symptoms that commonly include constipation, dysmenorrhea, and urinary disturbances. An ASM causing hydronephrosis and acute renal failure from compression of the lower portion of the urinary tract is a rare clinical entity. Only one other case has been reported. The authors present the case of a 37-year-old man admitted for obstructive renal failure and hydronephrosis due to a giant ASM that measured 25 × 12 × 18 cm and compressed the ureters and bladder. The ASM was successfully treated via an anterior transabdominal approach in which the authors used a novel technique for watertight closure of the meningocele pedicle with an endoscopic cutting stapler. The authors review the literature and discuss the surgical options for the treatment of ASMs, specifically the management of ASMs in the context of obstructive renal failure and hydronephrosis.
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Affiliation(s)
- Tarek P Sunna
- Department of Surgery, Division of Neurosurgery, Centre Hospitalier de l'Université de Montréal, Hôpital Notre-Dame, Montreal, Quebec, Canada
| | - Harrison J Westwick
- Department of Surgery, Division of Neurosurgery, Centre Hospitalier de l'Université de Montréal, Hôpital Notre-Dame, Montreal, Quebec, Canada
| | - Fahed Zairi
- Department of Surgery, Division of Neurosurgery, Centre Hospitalier de l'Université de Montréal, Hôpital Notre-Dame, Montreal, Quebec, Canada
| | - Ilyes Berania
- Department of Surgery, Division of Neurosurgery, Centre Hospitalier de l'Université de Montréal, Hôpital Notre-Dame, Montreal, Quebec, Canada
| | - Daniel Shedid
- Department of Surgery, Division of Neurosurgery, Centre Hospitalier de l'Université de Montréal, Hôpital Notre-Dame, Montreal, Quebec, Canada
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Elgafy H, Truitt M, Liu X. Vertebral body erosion by pseudomeningocele. Spine J 2015; 15:548-9. [PMID: 25463980 DOI: 10.1016/j.spinee.2014.10.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 10/30/2014] [Indexed: 02/07/2023]
Affiliation(s)
- Hossein Elgafy
- Department of Orthopaedic Surgery, University of Toledo Medical Center, 3065 Arlington Ave, Toledo, OH 43614, USA
| | - Melissa Truitt
- Department of Orthopaedic Surgery, University of Toledo Medical Center, 3065 Arlington Ave, Toledo, OH 43614, USA
| | - Xiaochen Liu
- Department of Orthopaedic Surgery, University of Toledo Medical Center, 3065 Arlington Ave, Toledo, OH 43614, USA
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