Department of Orthopaedics and Spine Surgery, Ganga Hospital, Coimbatore, India.
Spine (Phila Pa 1976). 2012 Apr 15;37(8):E511-3. doi: 10.1097/BRS.0b013e3182373b95.
Clinical case report and review of the literature.
To highlight the importance of including cerebrospinal fluid leak and pseudomeningocele in the differential diagnosis in a patient presenting with diplopia due to abducens palsy after spine surgery and to highlight the possibility of cure after successful surgical repair of the dural defect.
Abducens nerve palsy after spine surgery is extremely rare, with only 3 reported cases in the literature. We report the first case of abducens nerve palsy associated with a clinically evident pseudomeningocele, which was completely cured by successful repair of the dural defect.
A 53-year-old male patient with diabetes presented 6 weeks after lumbar disc surgery with persistent headache, a fluctuant swelling at the operated site, and diplopia secondary to left abducens nerve palsy. Clinical examination revealed a left abducens nerve palsy and magnetic resonance imaging showed a pseudomeningocele due to dural tear at L4-L5. He underwent exploration, and the dural defect was repaired using 6-0 Vicryl and reinforced with a fibrin sealant.
After dural closure, pseudomeningocele and headache resolved completely and diplopia improved partially. At 4-week follow-up, there was complete resolution of diplopia. Clinical examination showed full recovery of the lateral rectus function, indicating resolution of the abducens palsy. Magnetic resonance imaging showed complete resolution of pseudomeningocele.
Although uncommon, abducens nerve palsy after cerebrospinal fluid leak should be considered in the differential diagnosis of diplopia developing in a patient who has undergone spine surgery. After confirmation of pseudomeningocele radiologically, early surgical intervention with repair of the dural defect can result in complete recovery of the abducens nerve palsy.
临床病例报告及文献复习。
强调在脊柱手术后出现外展神经麻痹伴复视的患者中，将脑脊液漏和假性脑膜膨出纳入鉴别诊断的重要性，并强调在成功修复硬脑膜缺损后，患者可能完全治愈。
脊柱手术后外展神经麻痹极为罕见，文献中仅报道过 3 例。我们报告首例与临床明显假性脑膜膨出相关的外展神经麻痹病例，该患者通过成功修复硬脑膜缺损完全治愈。
一名 53 岁男性糖尿病患者，腰椎间盘手术后 6 周出现持续性头痛、手术部位波动性肿胀以及左眼外展神经麻痹引起的复视。临床检查发现左侧外展神经麻痹，磁共振成像显示 L4-L5 处硬脑膜撕裂导致假性脑膜膨出。患者接受了探查，使用 6-0 薇乔缝线修复硬脑膜缺损，并使用纤维蛋白胶加固。
硬脑膜关闭后，假性脑膜膨出和头痛完全缓解，复视部分改善。4 周随访时，复视完全缓解。临床检查显示外直肌功能完全恢复，表明外展神经麻痹已缓解。磁共振成像显示假性脑膜膨出完全缓解。
虽然不常见，但脑脊液漏后外展神经麻痹应纳入脊柱手术后发生复视的鉴别诊断。在影像学确认假性脑膜膨出后，早期进行硬脑膜缺损修复的手术干预可导致外展神经麻痹完全恢复。
