Herniación transdural espontánea de la médula espinal con recidiva temprana / Spontaneous transdural spinal cord herniation with early relapse

La herniación transdural idiopática de la médula espinal (HTIME) es una entidad muy poco conocida que suele cursar con una clínica de mielopatía progresiva de largo tiempo de evolución cuyas manifestaciones radiológicas mediante resonancia magnética (RM) previo a la cirugía son diagnósticas. Presentamos un caso de una paciente de 61 años de edad con una clínica de mielopatía espástica (síndrome de Brown-Séquard) cuyo diagnóstico de HTIME en RM fue concluyente. Se intervino quirúrgicamente mediante reducción y cierre del defecto dural, con mejoría clínica aunque quedando una paraplejia con nivel metamérico D5 (ASIA D). Sin embargo, posteriormente, la paciente refirió un nuevo episodio de empeoramiento clínico progresivo estableciéndose el diagnóstico de recidiva de la hernia, confirmada mediante RM. Se intervino por segunda vez a los 6 meses de la intervención inicial, cubriendo la sutura dural con un parche sintético. Aunque es habitual la persistencia de déficits neurológicos residuales tras la cirugía, la recidiva de la hernia medular transdural espontánea resulta extraordinariamente rara y hay que considerarla, como un posible diagnóstico diferencial, en caso de empeoramiento progresivo tras una evolución inicial favorable(AU)

Idiopathic transdural spinal cord herniation (ITSCH) is a little-known medical condition that causes large duration progressive myelopathy that can be diagnosed based on the radiological manifestations on magnetic resonance imaging (MRI) prior to surgery. We present the case of a 61-year-old woman with spastic myelopathy (Brown-Sequard syndrome) and conclusive diagnosis of ITSCH by MRI. Surgery was carried out with reduction of the spinal cord and repair of the dural defect with clinical improvement but paraplegia at the metameric D5 level (ASIA D). However, six months after surgery a new progressive neurologic worsening was present with recurrent spinal cord herniation diagnosis confirmed with MRI. A second surgery was carried out, covering the dural defect with synthetic patch. Although persistence of neurologic deficits after spinal surgery is common, recurrence of spinal cord herniation is extremely rare. It must be considered as a possible differential diagnosis in case of progressive neurologic deterioration after an initial favorable course(AU)

[Tumoral degeneration occurring over a non-healing meningocele. Report of two cases]. / Degeneración tumoral en meningocele no intervenido. Descripción de dos casos.

A giant meningocelic sac has not been usually described in adult patients, due to the fact that it shows a low incidence and few newborn have survived to date though the malformation is benign. We report two cases of patients born with the described malformation and who were not operated at that time, so they reached adulthood with bigger sacs. They needed surgery to remove the sacs, for a different reason. The older one had a fistulous abcess but the LCR did not come out, and it did not improved by the application of topic and antibiotic treatment. The other patient showed a progressive growth of the malformation during the last year, skin hardening and pain. The histological study of the dried sacs proved the existence of a carcinomatous degeneration. In the patients we have treated, it seems that a chronic irritation of the LCR and the appearance of multipotent cells in the meningocele may favour the malignancy of the tissues surrounding the sac. This possible malignancy, already described in the bibliography, suggests a prompt elective surgical treatment of the patients with these congenital lesions as soon as possible.

[Coexistence of syringomyelia and extramedullary intradural meningioma]. / Coexistencia de siringomielia y meningioma intradural extramedular.

INTRODUCTION: The coexistence of non-communicating syringomyelia with extramedullary intradural tumours in surgical series is extremely rare. CASE REPORT: We report the case of a 68-year-old female who had been suffering from predominantly proximal asymmetrical progressive paraparesis, with no involvement of the sphincters; the clinical exploration revealed a band of thermal hypaesthesia D7-D8. Magnetic resonance imaging (MRI), following the administration of gadolinium, confirmed the coexistence of an extramedullary intradural expansive lesion, which had features suggesting it could be a meningioma, and a dorsal syringomyelia. The cavity involved two medullary segments situated above the tumour and there were no associated anomalies at the junction of the medulla and upper spinal cord. Following complete resection of the tumour, which was diagnosed histologically as being a transitional meningioma with abundant psammoma bodies, the patient recovered the ability to walk independently. CONCLUSIONS: MRI with contrast is the best diagnostic means available for the detection and delimitation of the two components in this rare association, although its capacity to detect signs suggesting turbulences in the intracavity fluid, especially in small cavities, has still to be confirmed. The variations in the size and situation of the cavity with respect to the seat of the tumour, and the fact that progress is seldom monitored with MRI in the cases published to date, do not allow us to identify the pathogenic mechanism responsible for this association or to suggest the best type of shunt to prevent a possible expansion of the syringomyelic cavity.