Postoperative cervical pseudomeningocele with herniation of the spinal cord.

Abstract

This is a report of a patient in whom spinal cord herniation into a pseudomeningocele resulted in progressive myelopathy. To describe the outcome of a 59-year-old man who visited Osaka University Hospital complaining of gait disturbance. He had undergone cervical laminectomy to resect a spinal cord tumor 14 years previously. Pseudomeningocele is an extremely rare condition and can be overlooked. In addition, cord herniation into the pseudomeningocele rarely can be diagnosed before surgical exploration. Our patient represents the first case we are aware of in which magnetic resonance imaging could clearly demonstrate not only the pseudomeningocele, but the herniation of the cord into the cyst. Magnetic resonance imaging was used for preoperative and postoperative investigation. The pseudomeningocele was resected to improve the neurologic status of the patient. During the operation, the herniated cord was successfully reduced into the original subarachnoid space by the release of adhesion. Most symptoms subsided soon after surgery. Magnetic resonance imaging could delineate not only the cyst and cord herniation, but the medullary pathology. The distribution of high-intensity areas on T2-weighted images suggested the cord damage. Magnetic resonance imaging revealed not only the cyst and cord herniation, but medullary pathology, too.