RESUMEN
Percutaneous chemonucleolysis with condoliase has been available for painful lumbar disc herniation since 2018 in Japan. This study investigated clinical and radiographic outcomes three months after the administration because the secondary surgical removal is most required during this period for the insufficient pain relief, and analyzed whether the differences of intradiscal injection areas affected the clinical outcomes. We retrospectively investigated 47 consecutive patients (males, 31; median age, 40 years) three months after the administration. Clinical outcomes were evaluated using the Japanese Orthopaedic Association Back Pain Questionnaire (JOABPEQ), a visual analog scale (VAS) score for low back pain, and VAS scores for pains and numbness in the lower limbs. Radiographic outcomes were analyzed in 41 patients, using parameters such as mid-sagittal disc height and maximal protrusion length of herniation on MRI preoperatively and at the final follow-up. Postoperative median evaluation period was 90 days. The effective rate of low back pain based on the pain-related disorders at baseline and the last follow-up in the JOABPEQ reached 79.5%. The postoperative proportion of VAS scores recovery ≥ 2 points and ≥ 50% for pains in the lower limbs were 80.9% and 66.0%, respectively, revealing satisfactory effectiveness. Preoperative median mid-sagittal disc height significantly reduced from 9.5 to 7.6 mm postoperatively. There were no significant differences in pain relief in the lower limbs by injection areas in the center and the dorsal 1/3rd near the herniation of nucleus pulposus. Chemonucleolysis with condoliase revealed satisfactory short-term outcomes after the administration regardless of intradiscal injection areas.
Asunto(s)
Quimiólisis del Disco Intervertebral , Desplazamiento del Disco Intervertebral , Dolor de la Región Lumbar , Masculino , Humanos , Adulto , Desplazamiento del Disco Intervertebral/cirugía , Quimiólisis del Disco Intervertebral/efectos adversos , Dolor de la Región Lumbar/etiología , Estudios Retrospectivos , Manejo del Dolor , Vértebras Lumbares/cirugía , Resultado del TratamientoRESUMEN
The acute-stage intraoperative findings of the spinal dural laceration in patients with traumatic cerebrospinal fluid (CSF) leakage have not been clearly revealed so far. Herein, we report an interesting case of traumatic CSF leakage in a patient who underwent acute-stage direct closure for a dural laceration similar to a stab at the C1/2 level. Because a 41-year-old man strongly twisted his neck, he had a typical orthostatic headache. Whole-spine T2 fat-saturated magnetic resonance imaging and computed tomographic myelography were examined, and fluid collection between the intrathecal site and epidural dorsal space, including soft tissue, was confirmed as a direct CSF leakage at the C1/2 level. Direct surgical closure was performed 13 days after the onset of symptoms, and dural laceration with sharp edges was detected on the right side at the C1/2 level. The laceration was sutured and coated with dural sealant. Finally, the patient's orthostatic headache was relieved completely after the operation.
Asunto(s)
Pérdida de Líquido Cefalorraquídeo/cirugía , Duramadre/lesiones , Laceraciones/cirugía , Traumatismos del Cuello/diagnóstico por imagen , Adulto , Vértebra Cervical Axis , Pérdida de Líquido Cefalorraquídeo/complicaciones , Pérdida de Líquido Cefalorraquídeo/diagnóstico por imagen , Atlas Cervical , Cefalea/etiología , Humanos , Hipotensión Intracraneal/etiología , Imagen por Resonancia Magnética , Masculino , Traumatismos del Cuello/complicacionesRESUMEN
Metastatic paraganglioma (MPG) of the spine is a rare condition, with no established management. Herein, we report the longest survival case of a primary neck tumor that caused spinal MPG with a succinate dehydrogenase subunit B (SDHB) mutation (c.470delT, p.L157X) which could have promoted its malignancy. This male patient initially presented with a left neck PG which was diagnosed by a biopsy when he was 54 years-old. Simultaneously performed additional examinations revealed the spinal metastatic tumors on the T5-7 vertebrae and L3 vertebra-sacrum. These primary neck and metastatic spinal tumors' growths were once suppressed under the radiation therapy. Nineteen years later, he developed acute progressive paraparesis due to a mass located at the T2-3 level, tightly compressing the spinal cord, and protruding into the left thoracic cavity. We resected the maximum possible area of tumor in the spinal canal, confirmed MPG by histological examination, and then, we administered radiation therapy of 40 Gy in 20 fractions. Eventually, the patient was able to walk unaided with no evidential tumor recurrence for 3 years after treatment. Generally, clinical feature of MPG with SDHB mutation from abdominal lesion is thought to be poor prognosis. However, our case suggests the possibility of long-term control of spinal MPG with the adequate combination of radiation therapy and resection if metastatic lesions from primary-neck lesion with an SDHB mutation are remained to spine.
Asunto(s)
Neoplasias de Cabeza y Cuello , Paraganglioma , Neoplasias de la Columna Vertebral , Succinato Deshidrogenasa/genética , Anciano , Codón sin Sentido , Terapia Combinada , Neoplasias de Cabeza y Cuello/genética , Neoplasias de Cabeza y Cuello/patología , Neoplasias de Cabeza y Cuello/radioterapia , Neoplasias de Cabeza y Cuello/cirugía , Humanos , Masculino , Persona de Mediana Edad , Paraganglioma/genética , Paraganglioma/radioterapia , Paraganglioma/secundario , Paraganglioma/cirugía , Supervivencia sin Progresión , Radioterapia Adyuvante , Neoplasias de la Columna Vertebral/genética , Neoplasias de la Columna Vertebral/radioterapia , Neoplasias de la Columna Vertebral/secundario , Neoplasias de la Columna Vertebral/cirugía , Resultado del TratamientoRESUMEN
Whether posterior lumbar interbody fusion (PLIF) is effective in patients older than 55 years remains questionable because of the high prevalence of adjacent segment disease. We retrospectively investigated early clinical outcomes and radiological changes at upper adjacent disc (UAD) level in such age-group patients who underwent advanced dynamic stabilization (ADS) or PLIF. ADS or PLIF were performed in patients with grade 1 spondylolisthesis or disc degeneration complicated by apparent vacuum phenomenon. All patients suffered from neurological symptoms in lower limbs with/without low back pain. In all, 16 patients (six females; mean age, 69.0 ± 8.5 years) who underwent ADS and 14 patients (seven females; mean age, 67.8 ± 9.3 years) who underwent PLIF were followed-up, and preoperative and postoperative final disc height (DH) and range of motion (ROM) were investigated retrospectively using dynamic radiography at the operated and UAD levels. Clinical data of patients who underwent ADS and PLIF were as follows: postoperative follow-up, 459.3 ± 263.5 and 507.7 ± 288.3 days; preoperative Japanese Orthopaedic Association (JOA) score, 14.4 ± 4.1 and 13.4 ± 4.5; and recovery rate of JOA score, 67.5 ± 18.5 and 50.1 ± 23.4%, respectively. Recovery rate of JOA score in ADS group was significantly high compared to PLIF group (P = 0.044). At UAD level, ROM decreased from 4.7 ± 2.9° preoperatively to 3.6 ± 2.6° postoperatively in the ADS group and increased from 3.4 ± 4.1° preoperatively to 5.6 ± 2.8° postoperatively with significant hypermobility (P = 0.020) in the PLIF group. ADS has the advantage in clinical outcomes even in the postoperative early stage, avoiding the early hypermobility at UAD level, compared to PLIF in patients older than 55 years.
Asunto(s)
Degeneración del Disco Intervertebral/cirugía , Vértebras Lumbares , Fusión Vertebral , Espondilolistesis/cirugía , Factores de Edad , Anciano , Femenino , Humanos , Degeneración del Disco Intervertebral/complicaciones , Degeneración del Disco Intervertebral/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Rango del Movimiento Articular , Recuperación de la Función , Estudios Retrospectivos , Espondilolistesis/complicaciones , Espondilolistesis/diagnóstico por imagen , Factores de Tiempo , Resultado del TratamientoRESUMEN
OBJECTIVE: To investigate the noninferiority of facet joint- and nuchal ligament-sparing laminectomy (FNL) compared with conventional open-door laminoplasty. METHODS: This retrospective study analyzed 31 patients who underwent FNL (7 women; median age, 71 years) and 29 patients who underwent laminoplasty (9 women; median age, 61 years) with cervical myelopathy due to degenerative cervical spine diseases. The surgical concept in laminectomy was to spare the facet joints and nuchal ligament, providing laminectomy with deviation to the side of dominant symptoms. In both groups, recovery rate of Japanese Orthopaedic Association (JOA) score, mean decompression ratio (decompressed width/distance between outermost edges of the lateral mass on computed tomography ×100) at decompressed laminas, and pre- and postoperative final cervical Cobb angle and cervical sagittal vertical axis were mainly examined. RESULTS: Clinical and radiologic median data with interquartile range for patients who underwent FNL and laminoplasty were as follows: postoperative follow-up, 783.0 days (535.0-1128.0 days) and 731.0 days (524.0-1213.5 days); preoperative JOA score (full score 17), 13.0 (9.5-15.0) and 13.0 (10.0-14.0); recovery rate of JOA score, 72.2% (33.3-100.0%) and 50.0% (31.0-75.0%); and mean decompression ratio, 41.9% (40.0-43.6%) and 51.6% (48.9-55.4%), respectively. The FNL group showed a comparable recovery rate of JOA score to the laminoplasty group, despite the significantly smaller mean decompression ratio (P < 0.001). Furthermore, no significant differences in pre- or postoperative median cervical Cobb angle or sagittal vertical axis were observed between groups. CONCLUSIONS: FNL was not inferior to conventional open-door laminoplasty in terms of clinical or radiologic outcomes, reducing the detachment of muscle from each lamina.
Asunto(s)
Laminectomía/métodos , Laminoplastia/métodos , Ligamentos Articulares/cirugía , Articulación Cigapofisaria/cirugía , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Enfermedades de la Médula Espinal/cirugíaRESUMEN
OBJECTIVE: The effects of large-volume epidural blood patch (EBP) remain unclear in patients with cerebrospinal fluid (CSF) leak. We report excellent outcomes from 15 consecutive CSF leak cases that underwent a large-volume EBP using an intravenous catheter from a single lumbar entry point, together with outcomes from 4 patients who underwent direct surgical closure or drip-and-rest therapy during the same period. METHODS: Nineteen patients with idiopathic CSF leaks were enrolled in this study since November 2011 (12 women; mean age, 43.3 ± 14.0 years). Patient demographic data, radiologic findings, symptoms, administrated therapies, complications, and clinical courses were investigated retrospectively. RESULTS: Different types of headache were observed, including typical orthostatic headache alone (n = 10), orthostatic headache with chronic subdural hematoma (CSDH) (n = 3), and posture-unrelated headache accompanied with CSDH (n = 6). Regarding treatments, in 1 case, direct surgical closure was performed. In 15 cases, large-volume EBPs were performed, and the volume of injected blood was 44.8 ± 21.6 mL. The other 3 cases were treated by simple drip infusion regardless of the drainage for CSDH. Out of 9 cases with accompanied CSDH, recurrence of subdural hematoma was completely prevented by the application of an EBP after drainage in 5 cases and without drainage in 3 cases, and by simple intravenous drip-and-rest therapy after drainage in 1 case. Among 10 patients suffering from typical orthostatic headache alone, symptoms disappeared completely in 7 cases and were relieved in 3 cases. CONCLUSIONS: We demonstrate here a perfect control of spinal CSF leaks with the administration of a large-volume EBP through an intravenous catheter.
Asunto(s)
Parche de Sangre Epidural/tendencias , Cateterismo Periférico/tendencias , Pérdida de Líquido Cefalorraquídeo/diagnóstico por imagen , Pérdida de Líquido Cefalorraquídeo/terapia , Adolescente , Adulto , Anciano , Parche de Sangre Epidural/métodos , Cateterismo Periférico/métodos , Femenino , Humanos , Hipotensión Intracraneal/diagnóstico por imagen , Hipotensión Intracraneal/terapia , Masculino , Persona de Mediana Edad , Resultado del Tratamiento , Adulto JovenRESUMEN
OBJECTIVE: We investigated cerebrospinal fluid (CSF) dynamics at the craniocervical junction (CCJ) using Time-SLIP magnetic resonance imaging to demonstrate the significance of ventral and dorsal combined CSF dynamics in assessing CSF flow disturbance in patients with Chiari malformation type I. METHODS: Fifteen examinations were performed in 9 cases of CM-I (3 female patients; mean age, 24.7 years; age range, 11-46 years) before or after craniocervical decompression. The longitudinal maximum movement of the caudal edge of tagged midsagittal CSF at the CCJ was measured as length of motion (LOM), and total on the ventral and dorsal sides was defined as total LOM. RESULTS: In 8 conditions, where it was concluded that no craniocervical decompression was necessary or where symptoms improved following craniocervical decompression based on the clinical symptoms, total LOM was 49.8 ± 13.1 mm. In contrast, in the 7 cases where craniocervical decompression was mandatory, total LOM was 23.2 ± 9.2 mm. Significant differences were identified between the 2 groups. Total LOM <35.0 mm resulted to indicate the insufficiency of CSF dynamics, because it corresponded to the necessity of craniocervical decompression based on patients' symptoms. CONCLUSIONS: Time-SLIP MRI enabled clinicians to use novel dynamic indices, such as CSF motions, in addition to the conventional findings acquired by MRI. In particular, it was essential to examine combined ventral and dorsal CSF dynamics in assessing CSF patency at the CCJ in patients with CM-I.
Asunto(s)
Malformación de Arnold-Chiari/líquido cefalorraquídeo , Malformación de Arnold-Chiari/diagnóstico por imagen , Angiografía por Resonancia Magnética/métodos , Neuroimagen/métodos , Adolescente , Adulto , Niño , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto JovenRESUMEN
Cerebrospinal fluid (CSF) leak, which usually occurs idiopathically or traumatically as a rare situation, is a rare disease that causes orthostatic headache or idiopathic chronic subdural hematoma (CSDH). We report our therapeutic experience of consecutive 20 cases for this disease, and review the current status and problems. Consecutive 20 patients (11 women; age 44.7±12.1 years) between April, 2006 and March, 2014, who were diagnosed by MRI and/or CT myelography (CTM), were evaluated retrospectively about clinical features. The main symptoms were as follows: orthostatic headache only; 10 cases, orthostatic headache with CSDH; 6, and none-orthostatic headache accompanied with CSDH; 4. As a treatment, direct surgeries were performed in 2 cases. Epidural blood patch (EBP) was applied in 14 cases (direct surgery was performed finally in the early one case), and widespread EBP with a single lumbar entry point utilizing an intravenous catheter was performed especially in the latest 9 cases. Another 5 cases were treated simply with the administration of a drip infusion regardless of the drainage for CSDH. Of 10 cases suffering from headache only, the headache disappeared completely or it was relieved in 9 cases. Of 10 cases accompanied with CSDH, recurrence of hematoma was prevented in all cases with a drip infusion after the drainage in one case and EBP after the drainage in another 9 cases. It was certified that we could diagnose CSF leak correctly with MRI and/or CTM and control this disorder almost completely with widespread EBP utilizing an intravenous catheter.
Asunto(s)
Pérdida de Líquido Cefalorraquídeo/diagnóstico , Adulto , Anciano , Parche de Sangre Epidural , Pérdida de Líquido Cefalorraquídeo/complicaciones , Pérdida de Líquido Cefalorraquídeo/cirugía , Femenino , Cefalea/etiología , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Mielografía , Tomografía Computarizada por Rayos XRESUMEN
Lumbar interbody fusion is a widely accepted surgical procedure for patients with lumbar degenerative spondylolisthesis and lumbar spinal instability in the active age group. However, in elderly patients, it is often questionable whether it is truly necessary to construct rigid fixation for a short period of time. In recent years, we have been occasionally performing posterior dynamic stabilization in elderly patients with such lumbar disorders. Posterior dynamic stabilization was performed in 12 patients (6 women, 70.9 ± 5.6 years old at the time of operation) with lumbar degenerative spondylolisthesis in whom % slip was less than 20% or instability associated with lumbar disc herniation between March 2011 and March 2013. Movement occurs through the connector linked to the pedicle screw. In practice, 9 pairs of D connector system where the rod moves in the perpendicular direction alone and 8 pairs of Dynamic connector system where the connector linked to the pedicle screw rotates in the sagittal direction were installed. The observation period was 77-479 days, and the mean recovery rate of lumbar Japanese Orthopedic Association (JOA) score was 65.6 ± 20.8%. There was progression of slippage due to slight loosening in a case with lumbar degenerative spondylolisthesis, but this did not lead to exacerbation of the symptoms. Although follow-up was short, there were no symptomatic adjacent vertebral and disc disorders during this period. Posterior dynamic stabilization may diminish the development of adjacent vertebral or disc disorders due to lumbar interbody fusion, especially in elderly patients, and it may be a useful procedure that facilitates decompression and ensures a certain degree of spinal stabilization.
Asunto(s)
Degeneración del Disco Intervertebral/cirugía , Inestabilidad de la Articulación/cirugía , Vértebras Lumbares/cirugía , Complicaciones Posoperatorias/etiología , Fusión Vertebral/instrumentación , Fusión Vertebral/métodos , Espondilolistesis/cirugía , Factores de Edad , Anciano , Falla de Equipo , Femenino , Humanos , Degeneración del Disco Intervertebral/diagnóstico , Inestabilidad de la Articulación/diagnóstico , Vértebras Lumbares/patología , Imagen por Resonancia Magnética , Persona de Mediana Edad , Neuronavegación/instrumentación , Neuronavegación/métodos , Tornillos Pediculares , Complicaciones Posoperatorias/diagnóstico , Espondilolistesis/diagnósticoRESUMEN
Clinical manifestations of 16 patients with spontaneous spinal epidural hematoma were presented. We examined the point similar to that of stroke. During the initial visit of our hospital, the patients showed the hemiplegia in 10 cases (62.5%), Horner syndrome in 4 cases (25%), the painless onset in 1 case (6.3%). And one case showed the impairment of consciousness due to vagal reflex in severe pain onset, which was similar to those of subarachnoid hemorrhage. MRI images are useful to confirm the diagnosis. The frequent site of hematoma was the lower cervical spinal cord. The oval shaped hematomas shifted to the left or right in spinal canals, compressed spinal cords in axial image, which was a cause of hemiplegia. Many cases developed during active periods, and the hemorrhage might be relevant to oral antithrombotic agent, C hepatitis, and chronic renal failure. Rapidly progressive cases were indications for emergency surgery, but conservative therapy is also possible and was better prognosis.
Asunto(s)
Diagnóstico Diferencial , Hematoma Espinal Epidural/diagnóstico , Accidente Cerebrovascular/diagnóstico , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Fibrinolíticos , Hematoma Espinal Epidural/complicaciones , Hematoma Espinal Epidural/patología , Hematoma Espinal Epidural/terapia , Hepatitis C , Humanos , Fallo Renal Crónico , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Paresia/etiología , Pronóstico , Factores de RiesgoRESUMEN
OBJECT: An epidural blood patch (EBP) is a widely accepted standard procedure to treat CSF hypovolemia, especially when the epidural CSF leak is detected by spinal MRI or CT myelography (CTM). In quite a few cases, however, the leaked CSF is spread over a large area along the spinal epidural space, making it difficult for the surgeon to clearly identify the true leakage points. In such cases, autologous blood can be infused at multiple spinal levels with multiple entries. In this paper, the authors have devised a new multiple-site EBP method with a single lumbar entry point by way of using an intravenous catheter as a slidable device for continuous infusion. In this report, they introduce this new, single-entry, continuous multiple-site EBP administration technique and report some of the results that they have obtained. METHODS: An EBP was applied via an epidural catheter in 5 patients with spontaneous CSF hypovolemia (3 men and 2 women; mean age 47.2 years, range 34-65 years). The detection of an epidural CSF leak was based on MRI and/or CTM findings. In all cases, however, the leakage sites could not be identified clearly. The main symptoms of these patients were recurrent spontaneous chronic subdural hematoma with orthostatic headache (3 patients) and orthostatic headache only (2 patients). All patients underwent surgery in the prone position on an angiography table, and biplane fluoroscopy was used for accurate manipulation. After administration of a local anesthetic, the authors inserted a 4-Fr short sheath (which is standard in angiography) through the lumbar interlaminar window and placed it in the dorsal epidural space. They then introduced a 4.2-Fr straight catheter through the sheath and navigated it upward along a 35-gauge guidewire whose tip was moved upward beyond the cranial end of the detected CSF leakage. Blood was obtained from each patient from a previously secured venous entry on the forearm, and it was injected slowly into the epidural catheter. Each time, the authors tried to infuse as much autologous blood as possible into the epidural space, while moving the catheter gradually in the caudal direction in response to the patient's expression of pain. RESULTS: In all 3 cases of chronic subdural hematoma, its recurrence was prevented. In 1 patient, the orthostatic headache disappeared completely, and it was relieved in the other 4 patients. CONCLUSIONS: An efficient treatment option for CSF hypovolemia is provided by the new application method of EBP with the aid of an intravenous catheter as a slidable device, which enables infusion of a sufficient amount of autologous blood into multiple epidural areas with a single lumbar entry point.
Asunto(s)
Parche de Sangre Epidural/métodos , Líquido Cefalorraquídeo/fisiología , Hipotensión Intracraneal/terapia , Adulto , Anciano , Angiografía , Cateterismo , Espacio Epidural/anatomía & histología , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Médula Espinal/patología , Columna Vertebral/patologíaRESUMEN
A 29-year-old man presented with an intramedullary schwannoma of the conus medullaris manifesting as an 8-month history of mild bladder dysfunction, sexual impotence, and paresthesia in the buttocks. Subtotal removal of the lesion was achieved, as part of the tumor showed dense adhesion to the rostral neural tissue, with only postoperative transient deterioration of bladder dysfunction. Intramedullary schwannoma, especially involving the conus medullaris and the proximal spinal cord, is relatively rare and the pathogenesis and pathophysiology are unclear. Complete resection is often advised to avoid recurrence, but tumor adhesion to neural tissue sometimes renders complete resection difficult, and may create the risk of unacceptable operative morbidity. The present case shows that transient neurological deterioration may occur even with just subtotal removal, leaving the adherent part. Therefore, recognition of the particular features and the strategy for treatment in intramedullary schwannoma of the conus medullaris is essential for making appropriate decisions on the degree of removal.
Asunto(s)
Neurilemoma/patología , Compresión de la Médula Espinal/patología , Neoplasias de la Médula Espinal/patología , Médula Espinal/patología , Adulto , Biomarcadores de Tumor/análisis , Biomarcadores de Tumor/metabolismo , Descompresión Quirúrgica , Progresión de la Enfermedad , Disfunción Eréctil/etiología , Humanos , Laminectomía , Vértebras Lumbares/patología , Vértebras Lumbares/cirugía , Imagen por Resonancia Magnética , Masculino , Invasividad Neoplásica/patología , Invasividad Neoplásica/fisiopatología , Neurilemoma/complicaciones , Neurilemoma/cirugía , Procedimientos Neuroquirúrgicos , Parestesia/etiología , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/fisiopatología , Complicaciones Posoperatorias/prevención & control , Canal Medular/patología , Canal Medular/cirugía , Médula Espinal/fisiopatología , Médula Espinal/cirugía , Compresión de la Médula Espinal/etiología , Compresión de la Médula Espinal/fisiopatología , Neoplasias de la Médula Espinal/complicaciones , Neoplasias de la Médula Espinal/cirugía , Resultado del Tratamiento , Vejiga Urinaria Neurogénica/etiologíaRESUMEN
A woman in her early twenties presented with cerebellar tonsillar herniation with syrinx in the cervicothoracic spinal cord manifesting as postural headache after suffering trauma to the hip. She was treated under a diagnosis of traumatic intracranial hypotension. Cranial magnetic resonance (MR) imaging demonstrated tonsillar herniation to the upper rim of the C1 lamina, associated with effacement of the basal cisterns and flattening of the pons against the clivus, sagging of the optic chiasm, and protrusion of the pituitary gland into the suprasellar cistern. Spinal MR imaging and computed tomography (CT) myelography showed cervicothoracic syrinx and arachnoid diverticulum. Three applications of epidural blood patches produced no improvement. Surgery identified cerebrospinal fluid leakage from two small holes in the spinal dural sac, slightly proximal from the origin of the left L1 root sleeve, and arachnoid diverticulum. These two holes were sutured and a few sheets of gelatin sponge were placed around the arachnoid diverticulum and sealed with fibrin glue. The cervicothoracic syrinx was reduced significantly and tonsillar herniation disappeared within 10 days. Simple surgical repair of the dural tears may rapidly improve symptoms and imaging findings in patients with tonsillar herniation caused by traumatic intracranial hypotension.