title: Delayed cervical epidural hemorrhage associated with silastic dural implant: case report.
abstract: OBJECTIVE
  This is the first report of delayed cervical epidural hemorrhage caused by an onlay silastic graft placed over the dura after laminectomy. There are several reports of intracranial hemorrhage associated with silastic implants in the literature.
  
  
  METHODS
  A 49-year-old woman suddenly developed severe neck pain and quadriplegia during sexual intercourse. A C5-C7 laminectomy had been performed 17 years earlier for cervical stenosis.
  
  
  METHODS
  Magnetic resonance imaging showed an epidural mass compressing the cord at the level of the previous laminectomy. Laminectomy was performed within 5 hours of symptom onset. Postoperatively, the patient regained leg strength. After 2 months of physical therapy, she had minimal residual leg rigidity and returned to work.
  
  
  METHODS
  At surgery, the cervical cord was compressed by a solid fibrous scar surrounding a silastic onlay graft and the dura. An epidural hematoma was beneath the silastic implant. The dense scar tissue, hematoma, and silastic implant were removed.
  
  
  CONCLUSIONS
  Bleeding associated with silastic sheets starts with movement of this nonadherent implant. The movement disrupts the underlying fine vessels on the surface of an encasing connective tissue membrane. Overgrowth of this membrane can cause mass effect and simulate a tumor, even without associated bleeding, within weeks. Delayed hemorrhage is more common. We recommend removal of these implants electively, especially if a thick membrane surrounding the dura is detected with postcontrast-enhanced magnetic resonance imaging.
authors.affiliation: Department of Neurological Surgery, Medical College of Ohio, Toledo, USA.
authors.forename: J J
authors.initials: JJ
authors.lastname: Gouda
authors.forename: J A
authors.initials: JA
authors.lastname: Brown
authors.forename: R A
authors.initials: RA
authors.lastname: Brinker
mesh_terms: D004388:Dura Mater / Q000473:pathology / Q000601:surgery*; D005260:Female; D006407:Hematoma, Epidural, Cranial / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D007796:Laminectomy; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009460:Neurologic Examination; D011183:Postoperative Complications / Q000175:diagnosis / Q000601:surgery*; D019736:Prostheses and Implants; D012086:Reoperation; D012826:Silicone Elastomers; D013117:Spinal Cord Compression / Q000175:diagnosis / Q000601:surgery*; D013130:Spinal Stenosis / Q000601:surgery*
chemical_list: D012826:Silicone Elastomers