Department of Spinal Surgery, Brain Attack Center, Ota Memorial Hospital, Fukuyama, Hiroshima, Japan.
Department of Spinal Surgery, Brain Attack Center, Ota Memorial Hospital, Fukuyama, Hiroshima, Japan; Department of Neurosurgery, University of Occupational and Environmental Health, Kitakyushu, Japan.
World Neurosurg. 2021 Apr;148:90-92. doi: 10.1016/j.wneu.2021.01.043. Epub 2021 Jan 18.
The acute-stage intraoperative findings of the spinal dural laceration in patients with traumatic cerebrospinal fluid (CSF) leakage have not been clearly revealed so far. Herein, we report an interesting case of traumatic CSF leakage in a patient who underwent acute-stage direct closure for a dural laceration similar to a stab at the C1/2 level. Because a 41-year-old man strongly twisted his neck, he had a typical orthostatic headache. Whole-spine T2 fat-saturated magnetic resonance imaging and computed tomographic myelography were examined, and fluid collection between the intrathecal site and epidural dorsal space, including soft tissue, was confirmed as a direct CSF leakage at the C1/2 level. Direct surgical closure was performed 13 days after the onset of symptoms, and dural laceration with sharp edges was detected on the right side at the C1/2 level. The laceration was sutured and coated with dural sealant. Finally, the patient's orthostatic headache was relieved completely after the operation.
目前，外伤性脑脊液（CSF）漏患者的脊柱硬脊膜撕裂的急性手术期内发现仍不明确。在此，我们报告一例 C1/2 水平类似刺伤的硬脊膜撕裂伤患者的急性手术期直接缝合的有趣案例。一名 41 岁男性因强烈扭动颈部，出现典型的直立性头痛。全脊柱 T2 脂肪饱和磁共振成像和计算机断层脊髓造影检查，证实椎管内和硬膜外背侧间隙之间有液体聚集，包括软组织，为 C1/2 水平的直接 CSF 漏。症状发作后 13 天进行直接手术缝合，在 C1/2 水平右侧发现硬脊膜撕裂，边缘锐利。对撕裂进行缝合，并使用硬脊膜密封剂进行覆盖。最终，患者术后直立性头痛完全缓解。
