Surgical treatment of idiopathic transdural spinal cord herniation: a new technique to untether the spinal cord.
Idiopathic transdural spinal cord herniation is a rare but treatable cause of thoracic myelopathy caused by herniation of the spinal cord through a defect in the dura. The diagnosis is frequently missed or delayed, but the latest imaging techniques can document spinal cord herniation through a dural defect. Surgical treatment, consisting of reducing the herniation by closing the dural defect or widening the aperture to prevent spinal cord compression, is rather successful. We describe a new technique to untether the spinal cord by wrapping a dura graft around the myelum to prevent recurrent transdural herniation. Two patients and a review of the literature are discussed. We conclude that high-resolution T2 magnetic resonance imaging is the best imaging modality to detect the entity, and wrapping the myelum is an effective surgical technique to untether the spinal cord.
Arts
M P
MP
Department of Neurosurgery, Medical Center Haaglanden, Westeinde, The Hague, The Netherlands. m.arts@mchaaglanden.nl
Lycklama à Nijeholt
G
G
Wurzer
J A L
JA
D000328:Adult; D018437:Brown-Sequard Syndrome / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D018450:Disease Progression; D004388:Dura Mater / Q000473:pathology / Q000601:surgery* / Q000637:transplantation*; D004824:Epidural Space / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D005260:Female; D006547:Hernia / Q000175:diagnosis; D059685:Herniorrhaphy; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D013116:Spinal Cord / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D013118:Spinal Cord Diseases / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D019737:Transplants; D016896:Treatment Outcome