Title: Introduzione alla diagnostica per immagini della patologia rachidea ed endorachidea
1Idiopathic herniation of the thoracic spinal
cord a case report and technique note. Ulivieri
S.¹, Oliveri G.¹, Petrini C.¹, D'Elia F.2, Cuneo
G.L.3, Cerase A.4 Units of ¹Neurosurgery, and
4Neuroradiology, Santa Maria alle Scotte
Hospital, Siena, Italy 2Unit of Radiology, and
3Section of Neuroradiology, Unit of Neurology,
San Donato Hospital, Arezzo, Italy
2- A 35-year-old man presented with insidiously
progressive and disabling pain in the left leg.
There was no history of trauma or surgery
neurological examination revealed features
suggestive of thoracic level Brown-Séquard
syndrome.
3(No Transcript)
4- The patient underwent a thoracic laminectomy at
T9T10. The dura was opened under the microscope
and an atrophic spinal cord displaced to the left
was visible. The spinal cord was incarcerated
through a 2.5 cm wide anterolateral dural defect
and had an exophytic edematous appearance. In
order to perform an anterior untethering, the
dentate ligament was transected and the nerve
roots were preserved. The spinal cord was gently
mobilised out of the dural defect. Notably, there
were no major adhaesions and thus there was no
need to manipulate the cord. Then, it was decided
to position hemostatic material (Spongostan) and
glue (Tissucol) around the defect and finally a
sheet of collagenous membrane (DuraGen) anterior
to the spinal cord. The wound was closed in
layers without external cerebrospinal fluid
drainage. No spinal cord monitoring was used. The
initial post-operative neurological deficit was
unchanged and there was no sign of cerebrospinal
fluid leakage. The patient was discharged seven
days after surgery to rehabilitation.