Marsupialization and distal obliteration of a lumbosacral dural ectasia in a nonsyndromic, adult patient
Dural ectasia is frequently associated with connective tissue disorders or inflammatory conditions. Presentation in a patient without known risk factors is rare. Moreover, the literature regarding the treatment options for symptomatic dural ectasia is controversial, variable, and limited. A 62-year-...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer Medknow Publications
2015-01-01
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| Series: | Journal of Craniovertebral Junction and Spine |
| Subjects: | |
| Online Access: | http://www.jcvjs.com/article.asp?issn=0974-8237;year=2015;volume=6;issue=4;spage=219;epage=222;aulast=Nguyen |
| _version_ | 1818621242142359552 |
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| author | Ha Son Nguyen Andrew Lozen Ninh Doan Michael Gelsomin Saman Shabani Dennis Maiman |
| author_facet | Ha Son Nguyen Andrew Lozen Ninh Doan Michael Gelsomin Saman Shabani Dennis Maiman |
| author_sort | Ha Son Nguyen |
| collection | DOAJ |
| description | Dural ectasia is frequently associated with connective tissue disorders or inflammatory conditions. Presentation in a patient without known risk factors is rare. Moreover, the literature regarding the treatment options for symptomatic dural ectasia is controversial, variable, and limited. A 62-year-old female presents with intractable, postural headaches for years. A lumbar puncture revealed opening pressure 3 cm of water. A computed tomography myelogram of the spine demonstrated erosion of her sacrum due to a large lumbosacral dural ectasia. An initial surgery was attempted to reduce the size of the expansile dura, and reconstruct the dorsal sacrum with a titanium plate (Depuy Synthes, Westchester, PA, USA) to prevent recurrence of thecal sac dilatation. Her symptoms initially improved, but shortly thereafter recurred. A second surgery was then undertaken to obliterate the thecal sac distal to the S2 nerve roots. This could not be accomplished through simple ligation of the thecal sac circumferentially as the ventral dura was noted to be incompetent and attempts to develop an extradural tissue plane were unsuccessful. Consequently, an abundance of fibrin glue was injected into the thecal sac distal to S2, and the dural ectasia was marsupialized rostrally, effectively obliterating the distal thecal sac while further reducing the size of the expansile dura. This approach significantly improved her symptoms at 5 months follow-up. Treatment of dural ectasia is not well-defined and has been variable based on the underlying manifestations. We report a rare patient without risk factors who presented with significant lumbosacral dural ectasia. Moreover, we present a novel method to treat postural headaches secondary to dural ectasia, where the thecal sac is obliterated distal to the S2 nerve roots using an abundance of fibrin glue followed by marsupialization of the thecal sac rostally. This method may offer an effective therapy option as it serves to limit the expansile dura, reducing the cerebrospinal fluid sump and the potential for intracranial hypotension. |
| first_indexed | 2024-12-16T18:06:09Z |
| format | Article |
| id | doaj.art-314cef9ce9b04ad28a434ff85c5e45ef |
| institution | Directory Open Access Journal |
| issn | 0974-8237 |
| language | English |
| last_indexed | 2024-12-16T18:06:09Z |
| publishDate | 2015-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Journal of Craniovertebral Junction and Spine |
| spelling | doaj.art-314cef9ce9b04ad28a434ff85c5e45ef2022-12-21T22:21:55ZengWolters Kluwer Medknow PublicationsJournal of Craniovertebral Junction and Spine0974-82372015-01-016421922210.4103/0974-8237.167887Marsupialization and distal obliteration of a lumbosacral dural ectasia in a nonsyndromic, adult patientHa Son NguyenAndrew LozenNinh DoanMichael GelsominSaman ShabaniDennis MaimanDural ectasia is frequently associated with connective tissue disorders or inflammatory conditions. Presentation in a patient without known risk factors is rare. Moreover, the literature regarding the treatment options for symptomatic dural ectasia is controversial, variable, and limited. A 62-year-old female presents with intractable, postural headaches for years. A lumbar puncture revealed opening pressure 3 cm of water. A computed tomography myelogram of the spine demonstrated erosion of her sacrum due to a large lumbosacral dural ectasia. An initial surgery was attempted to reduce the size of the expansile dura, and reconstruct the dorsal sacrum with a titanium plate (Depuy Synthes, Westchester, PA, USA) to prevent recurrence of thecal sac dilatation. Her symptoms initially improved, but shortly thereafter recurred. A second surgery was then undertaken to obliterate the thecal sac distal to the S2 nerve roots. This could not be accomplished through simple ligation of the thecal sac circumferentially as the ventral dura was noted to be incompetent and attempts to develop an extradural tissue plane were unsuccessful. Consequently, an abundance of fibrin glue was injected into the thecal sac distal to S2, and the dural ectasia was marsupialized rostrally, effectively obliterating the distal thecal sac while further reducing the size of the expansile dura. This approach significantly improved her symptoms at 5 months follow-up. Treatment of dural ectasia is not well-defined and has been variable based on the underlying manifestations. We report a rare patient without risk factors who presented with significant lumbosacral dural ectasia. Moreover, we present a novel method to treat postural headaches secondary to dural ectasia, where the thecal sac is obliterated distal to the S2 nerve roots using an abundance of fibrin glue followed by marsupialization of the thecal sac rostally. This method may offer an effective therapy option as it serves to limit the expansile dura, reducing the cerebrospinal fluid sump and the potential for intracranial hypotension.http://www.jcvjs.com/article.asp?issn=0974-8237;year=2015;volume=6;issue=4;spage=219;epage=222;aulast=NguyenDural ectasiaintracranial hypotensionmarsupialization |
| spellingShingle | Ha Son Nguyen Andrew Lozen Ninh Doan Michael Gelsomin Saman Shabani Dennis Maiman Marsupialization and distal obliteration of a lumbosacral dural ectasia in a nonsyndromic, adult patient Journal of Craniovertebral Junction and Spine Dural ectasia intracranial hypotension marsupialization |
| title | Marsupialization and distal obliteration of a lumbosacral dural ectasia in a nonsyndromic, adult patient |
| title_full | Marsupialization and distal obliteration of a lumbosacral dural ectasia in a nonsyndromic, adult patient |
| title_fullStr | Marsupialization and distal obliteration of a lumbosacral dural ectasia in a nonsyndromic, adult patient |
| title_full_unstemmed | Marsupialization and distal obliteration of a lumbosacral dural ectasia in a nonsyndromic, adult patient |
| title_short | Marsupialization and distal obliteration of a lumbosacral dural ectasia in a nonsyndromic, adult patient |
| title_sort | marsupialization and distal obliteration of a lumbosacral dural ectasia in a nonsyndromic adult patient |
| topic | Dural ectasia intracranial hypotension marsupialization |
| url | http://www.jcvjs.com/article.asp?issn=0974-8237;year=2015;volume=6;issue=4;spage=219;epage=222;aulast=Nguyen |
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