A 48-year-old female presented 3 years after being thrown against a wall with a sequela of traumatic brain injury (TBI) with cerebral palsy, worsening myelopathy, and gait ataxia. She initially utilized a walker for ambulation, but progressed to wheelchair bound by the time of presentation [].\nShe underwent MRI studies of the brain and spine, plus EMG and NCV of the lower extremities. The thoracic MRI showed a ventral thecal sac irregularity with accompanying distortion of the ventral cord, consistent with “tethering;” cervical and lumbar studies were unremarkable []. The CT myelogram was suggestive of ventral dural tear and spinal cord herniation at the T7-8 levels and a diffuse ventral subdural fluid collection extending from T1 to T10 [].\nWe performed a T7-T8 laminectomy and unilateral facetectomy with removal of the right T7 pedicle and transverse process, exposing the T7-8 nerve roots []. After using ultrasounds to confirm the level, the right T7 nerve root was ligated. Using microsurgical technique, the dural defect was approached from the right side intra- and extradurally. Once the dural defect was identified, it was repaired with onlay and inlay DuraGen (Integra LifeSciences, Princeton, NJ, USA) and, after weighing the risk and benefits, we reinforced with DuraSeal (Integra LifeSciences, Princeton, NJ, USA) to minimize risk of postoperative CSF leak.\nPostoperatively, the patient went to rehab and within 2 months, she was ambulating with assistance using a walker. Her strength continued to improve at her 4-month and 1-year neurosurgical follow-up visits []. She is now ambulating independently with a walker. On repeat, MRI at 4 months postoperatively demonstrates postsurgical changes with a well-circumscribed right paraspinal fluid collection with minimal mass effect on the spinal cord []. There was no clinical or radiographic evidence of recurrent herniation, and the patient did not experience clinical signs or symptoms of CSF leak.
This 58-year-old female complained about temperature changes and hyperpathy in her left leg for the past 12 months. On the right side, the sensibility was different but not normal. The strength in her left leg was diminished. These complaints ascended over time, initially starting at the foot and developing further to the groin at the time of presentation.\nNeurological examination revealed only a paretic quadriceps femoris muscle on the left side. Vital sensibility was disturbed on the left side below T10. The plantar reflexes on both sides were indifferent.\nAn MRI revealed a herniation of the SC at T8 (Figure ).\nDuring surgery, a laminectomy on T8 and T7 was performed. The dentate ligaments were transected. While gently mobilizing the SC from the left to the right, a large defect in the ventral dura was observed. The same maneuver at the right side revealed a fixed SC with the defect. After transection of some adhesions, a tumor-like extension of the SC was seen (Figure ) and was finally mobilized completely intradurally. To prevent re-herniation, an artificial graft was gently placed in front of the SC covering the defect and fixated laterally to the dural sleeve. Throughout the entire surgery, MEPs, SSEPs, and D-waves were monitored. Changes were not noticed. Post-operatively, the patient did not notice any new complaints.