Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria.
Department of Neuroradiology, Medical University Innsbruck, Innsbruck, Austria.
Br J Neurosurg. 2024 Jun;38(3):591-595. doi: 10.1080/02688697.2021.1940848. Epub 2021 Aug 16.
Sacral fractures are rare and either associated with high-energy trauma or osteoporosis in most cases. A search of the current literature on sacral fractures and cerebrospinal fluid fistula identified only few cases. Pathological fractures are uncommon and exceedingly rare in case of Tarlov cysts. Sacral fractures can be missed in oligosymptomatic patients. However, severe complications may emerge as shown by this case report.
We present the case of a pathological sacral fracture at the level S2/3 following a low-impact trauma, associated with a Tarlov cyst, which was complicated by an anterior CSF fistula and intraventricular fat emboli.
The patient was treated conservatively with strict bedrest and a CT-guided blood patch. Postponed mobilization was successful with decreasing orthostatic symptoms. Follow-up MRI and CT imaging showed a complete resolution of the ventral CSF fistula and ossification of the fracture. The intraventricular fat did not resolve, however, there was no radiological sign of hydrocephalus with excellent clinical outcome at 6-months follow-up.
Although exceedingly rare, sacral Tarlov cysts may be associated with pathological fractures of the sacrum. Relevant complications can emerge and need to be properly addressed.
骶骨骨折较为罕见，在大多数情况下，要么与高能创伤有关，要么与骨质疏松症有关。在对骶骨骨折和脑脊液瘘的现有文献进行检索后，仅发现少数病例。病理性骨折并不常见，而在 Tarlov 囊肿的情况下则极为罕见。在症状不明显的患者中，骶骨骨折可能会被漏诊。然而，正如本病例报告所示，严重的并发症可能会出现。
我们报告了一例低能量创伤后 S2/3 水平的病理性骶骨骨折，伴 Tarlov 囊肿，并发前性脑脊液瘘和脑室内脂肪栓塞。
患者采用严格卧床休息和 CT 引导下的血液贴敷进行保守治疗。延迟活动是成功的，直立症状减少。随访 MRI 和 CT 成像显示，腹侧脑脊液瘘完全愈合，骨折处骨化。脑室内脂肪未被吸收，但没有脑积水的影像学迹象，6 个月随访时临床结果良好。
尽管极为罕见，但骶骨 Tarlov 囊肿可能与骶骨病理性骨折有关。可能会出现相关并发症，需要妥善处理。
