Satoru Shimizu1, Yosuke Kobayashi2, Hidehiro Oka3,4, Toshihiro Kumabe4. 1. Department of Neurosurgery, Yokohama Brain and Spine Center, l-2-1 Takigashira, Isogo-ku, Yokohama, Kanagawa, 235-0012, Japan. Satoru4756@aol.com. 2. Department of Spinal Surgery, Yokohama Brain and Spine Center, Yokohama, Kanagawa, Japan. 3. Department of Neurosurgery, Kitasato University Medical Center, Kitamoto, Saitama, Japan. 4. Department of Neurosurgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan.
Abstract
INTRODUCTION: We present a patient with idiopathic spinal cord herniation (ISCH) whose dura mater was histopathologically examined to elucidate its pathogenesis. CASE REPORT: A 33-year-old previously healthy man presented with progressive walking difficulty, spasticity of the right lower leg, and hyperesthesia below the right chest. Neuroimaging revealed right ventral displacement of the spinal cord at T5-6. The diagnosis was ISCH and he underwent release of the herniation from the ventral dural opening. Dural biopsy at the edge of the ventral opening and in the dorsal durotomy was performed. Postoperatively, his gait was improved. Histopathological examination of the ventral dural specimen showed non-specific degeneration, i.e., loose arrangements of collagen fibers, edematous changes, minor inflammatory cell infiltration, and angiogenesis. The specimen from the dorsal durotomy was normal. CONCLUSION: It is unclear whether the observed degeneration besides the ventral opening was the primary cause of ISCH or reflected secondary changes resulting from cumulative damage due to pulsation of the herniated spinal cord. However, the degeneration limited to the ventral opening suggests that ISCH was a local event in an individual with a normal dural theca.
INTRODUCTION: We present a patient with idiopathic spinal cord herniation (ISCH) whose dura mater was histopathologically examined to elucidate its pathogenesis. CASE REPORT: A 33-year-old previously healthy man presented with progressive walking difficulty, spasticity of the right lower leg, and hyperesthesia below the right chest. Neuroimaging revealed right ventral displacement of the spinal cord at T5-6. The diagnosis was ISCH and he underwent release of the herniation from the ventral dural opening. Dural biopsy at the edge of the ventral opening and in the dorsal durotomy was performed. Postoperatively, his gait was improved. Histopathological examination of the ventral dural specimen showed non-specific degeneration, i.e., loose arrangements of collagen fibers, edematous changes, minor inflammatory cell infiltration, and angiogenesis. The specimen from the dorsal durotomy was normal. CONCLUSION: It is unclear whether the observed degeneration besides the ventral opening was the primary cause of ISCH or reflected secondary changes resulting from cumulative damage due to pulsation of the herniated spinal cord. However, the degeneration limited to the ventral opening suggests that ISCH was a local event in an individual with a normal dural theca.
Authors: Rob J M Groen; Berrie Middel; Jan F Meilof; J B Margot de Vos-van de Biezenbos; Roelien H Enting; Maarten H Coppes; Louis H Journee Journal: Neurosurgery Date: 2009-03 Impact factor: 4.654