Postoperative MR Imaging of Spontaneous Transdural Spinal Cord Herniation: Expected Findings and Complications

Gaudino, Simona; Colantonio, Raffaella; Schiarelli, Chiara; Martucci, Matia; Calandrelli, Rosalinda; Botto, Annibale; Pileggi, Marco; Gangemi, Emma; Maira, Giulio; Colosimo, Cesare

doi:10.3174/ajnr.a4537

Cited by 10 publications

(15 citation statements)

References 23 publications

(28 reference statements)

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“…In recent years, several reports have described postoperative ventral CSF collections, [1][2][3]6 indicating that they may be caused by subsequent CSF leakage through the dural defect. The first report of postoperative ventral CSF collection was written by Nakamura et al 6 and described sixteen patients with ISCH treated by enlargement of the dural defect.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, few studies have investigated the long-term outcomes and MRI findings of postoperative changes in the spinal cord or surrounding structures. 1 In recent years, several reports have described postoperative ventral cerebrospinal fluid (CSF) collections in patients with ISCH. 1,6,7 However, these collections are asymptomatic in most patients, and whether they are part of the natural history or a complication remains unclear.…”

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confidence: 99%

“…1 In recent years, several reports have described postoperative ventral cerebrospinal fluid (CSF) collections in patients with ISCH. 1,6,7 However, these collections are asymptomatic in most patients, and whether they are part of the natural history or a complication remains unclear.…”

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confidence: 99%

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Symptomatic interdural cerebrospinal fluid collections after surgery for idiopathic spinal cord herniation: illustrative case

Ohtake

Senoo

Fukuda

et al. 2021

Journal of Neurosurgery: Case Lessons

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BACKGROUND Idiopathic spinal cord herniation (ISCH) is very rare. Some reports have described postoperative ventral cerebrospinal fluid (CSF) collections in patients with ISCH; however, such collections are asymptomatic in most patients, and there is no consensus regarding whether they are part of the natural history or a complication. OBSERVATIONS A 30-year-old man with ISCH underwent direct closure of a duplicated dura mater. Eight months postoperatively, he developed reworsening of right lower limb paresis and new severe right arm pain and paresis. Three-dimensional magnetic resonance imaging revealed ventral CSF collections, which the authors judged as the responsible lesions. The authors initially considered these collections to be present in the epidural space, extradurally compressing the dural sac and resulting in myelopathy. An epidural blood patch failed; however, a CSF drainage test resulted in dramatic improvement. The authors therefore determined that the CSF collections were located in the interdural space, not the epidural space. A lumboperitoneal (LP) shunt was performed to reduce the CSF pressure. The patient’s symptoms improved immediately postoperatively. He had developed no recurrence of symptoms 6 months after surgery. LESSONS Ventral interdural CSF collections after ISCH surgery can cause reworsening of myelopathy and may be cured by a LP shunt to control CSF pressure.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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Symptomatic interdural cerebrospinal fluid collections after surgery for idiopathic spinal cord herniation: illustrative case

Ohtake

Senoo

Fukuda

et al. 2021

Journal of Neurosurgery: Case Lessons

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“…Complications from such procedures may include anterior epidural CSF collection and superficial siderosis. 5 Direct visualization of the DAW remains difficult using conventional imaging techniques. A web was not confidently identified in any of the 14 cases reported by Reardon et al 12 and was identified in only 2 of 7 cases by Hakky et al 8 Improved visualization of these webs may be achieved by the addition of "myelographic" high-resolution T2-weighted MRI sequences 6 such as constructive interference in steady state (CISS) or SPACE, or their equivalents (Fig.…”

Section: Discussionmentioning

confidence: 99%

Differentiation of idiopathic spinal cord herniation from dorsal arachnoid webs on MRI and CT myelography

Schultz

Steven

Wessell

et al. 2017

SPI

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OBJECTIVEDorsal arachnoid webs (DAWs) and spinal cord herniation (SCH) are uncommon abnormalities affecting the thoracic spinal cord that can result in syringomyelia and significant neurological morbidity if left untreated. Differentiating these 2 entities on the basis of clinical presentation and radiological findings remains challenging but is of vital importance in planning a surgical approach. The authors examined the differences between DAWs and idiopathic SCH on MRI and CT myelography to improve diagnostic confidence prior to surgery.METHODSReview of the picture archiving and communication system (PACS) database between 2005 and 2015 identified 6 patients with DAW and 5 with SCH. Clinical data including demographic information, presenting symptoms and neurological signs, and surgical reports were collected from the electronic medical records. Ten of the 11 patients underwent MRI. CT myelography was performed in 3 patients with DAW and in 1 patient with SCH. Imaging studies were analyzed by 2 board-certified neuroradiologists for the following features: 1) location of the deformity; 2) presence or absence of cord signal abnormality or syringomyelia; 3) visible arachnoid web; 4) presence of a dural defect; 5) nature of dorsal cord indentation (abrupt “scalpel sign” vs “C”-shaped); 6) focal ventral cord kink; 7) presence of the nuclear trail sign (endplate irregularity, sclerosis, and/or disc-space calcification that could suggest a migratory path of a herniated disc); and 8) visualization of a complete plane of CSF ventral to the deformity.RESULTSThe scalpel sign was positive in all patients with DAW. The dorsal indentation was C-shaped in 5 of 6 patients with SCH. The ventral subarachnoid space was preserved in all patients with DAW and interrupted in cases of SCH. In no patient was a web or a dural defect identified.CONCLUSIONSDAW and SCH can be reliably distinguished on imaging by scrutinizing the nature of the dorsal indentation and the integrity of the ventral subarachnoid space at the level of the cord deformity.

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“…Additionally, SS may be detected in cortical sulci, interhemispheric fissure, or the Sylvian fissure. Possible pathogenetic causes include bleeding from spinal epidural fistulas, arteriovenous malformations, intracranial aneurysms, tumors, and CAA, as mentioned before [1,8,[14][15][16][17].…”

Section: Introductionmentioning

confidence: 99%

Unusual Presentation in Infratentorial Superficial Siderosis: Acute Intracranial Hypertension

et al. 2021

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Superficial siderosis (SS) of the nervous system is a rare acquired condition related to hemosiderin deposits in subpial layers of the brain, brainstem, cerebellum, cranial nerves, and spinal cord, leading to brain iron-mediated neurodegeneration. The cardinal neurological features are slowly progressive hearing loss, ataxia, and pyramidal signs. Here we describe an atypical case of infratentorial SS evolving with acute intracranial hypertension in the absence of typical chronic signs.

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Postoperative MR Imaging of Spontaneous Transdural Spinal Cord Herniation: Expected Findings and Complications

Cited by 10 publications

References 23 publications

Symptomatic interdural cerebrospinal fluid collections after surgery for idiopathic spinal cord herniation: illustrative case

Symptomatic interdural cerebrospinal fluid collections after surgery for idiopathic spinal cord herniation: illustrative case

Differentiation of idiopathic spinal cord herniation from dorsal arachnoid webs on MRI and CT myelography

Unusual Presentation in Infratentorial Superficial Siderosis: Acute Intracranial Hypertension

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