Intracranial arachnoid cysts are believed to be congenital; they can become symptomatic in pediatric patients. Chronic subdural hematomas tend to occur in elderly patients with a history of mild head injury a few months prior to the onset of symptoms. However, these two distinct clinical entities sporadically occur together in relatively young patients. We report a 29-year-old man who presented with headache and dizziness of 2 months' duration. Brain computed tomography revealed a huge chronic subdural hematoma over the left frontoparietal lobe, with an incidental finding of an arachnoid cyst over the left sylvian fissure. In light of a literature review, we discuss arachnoid cysts as a possible risk factor for subdural hematoma, especially in young adults.
Even minor surgery can cause unexpected complications and symptoms. We report an unusual case of nerve root herniation after microsurgical discectomy. A patient who presented with low-back pain and right sciatica underwent microsurgical discectomy. Two days after the operation and after initial improvement, he suddenly experienced severe low-back pain and right sciatica again. Additionally, persistent muscle cramps and fasciculations in the right lower limb were noted. Magnetic resonance imaging revealed not only the recurrent ruptured disc fragment, but also a cerebrospinal fluid-like intensity accumulating within the epidural space and paraspinal muscle. At surgery, it was observed that nerve roots of the cauda equina were squeezed into the cavity of the intervertebral space. Surgical reposition of nerve roots and dural repair were performed, and the patient eventually recovered. Dural tears should be repaired at the time of the original operation even when the arachnoid appears intact. Dural substitution using polyglycolic acid mesh and fibrin glue is an alternative method for dural repair. An increase in abdominal pressure may play a role in cerebrospinal fluid leakage and extrusion of the cauda equina. The presence of muscle cramps and fasciculations after microsurgical discectomy or any intraspinal procedure may indicate a nerve pinch and entrapment. Nerve root incarceration should be considered in the differential diagnosis.
Objectives: A two-stage operation is essential for patients with cervical spine myelopathy that is the result of concomitant ligamentum flavum and posterior longitudinal ligament ossification.Methods: Modified open door laminoplasty with a miniplate and screw from the posterior approach was carried out first. Then anterior decompression and fusion with a Casper plate and Surgibone at the C5-6 intervertebral space were carried out 1 week after the first operation. Results: One week after the second procedure, the postoperative Nurick score improved from four to two. The patient withstood the whole procedure well and within one week was noted to have improved muscle strength.
Conclusions:The two-stage operation is a safe and effective choice for treating concomitant OPLL and OLF in the cervical spine with radiculomyelopathy.
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