Suresh Rishishankar E, Eckert Thomas, Kasem Rahim Abo, Small Coulter, Saway Brian, Hubbard Zachary, Gunasekaran Arunprasad, Rowland Nathan, Varma Abhay, Nowicki Kamil W, Rosenstein Cory C, Sefcik Roberta
College of Medicine, Medical University of South Carolina, Charleston, South Carolina.
MUSC Institute of Neuroscience Discovery (MIND), Medical University of South Carolina, Charleston, South Carolina.
J Neurosurg Case Lessons. 2025 Apr 28;9(17). doi: 10.3171/CASE25108.
Spinal intradural hematoma (SIH) is a rare condition with potential for permanent neurological deficit. SIH can be managed conservatively with serial imaging or surgically with lumbar drainage or open evacuation. We present 3 SIH cases managed with multiple surgical techniques, including a novel lumbar drainage-and-advancement technique, and review the literature.
Patient 1 was a 35-year-old peripartum female with cauda equina syndrome after epidural analgesia. MRI revealed SIH at L4-5, necessitating urgent L3-S1 laminectomy and hematoma evacuation. Patient 2 was a 47-year-old male with bilateral lower extremity radiculopathy following posterior decompression and fusion for an L5 compression fracture. MRI revealed SIH extending from T3-L5. Focal decompression and lumbar drain placement with cranial advancement were performed for complete evacuation. Patient 3 was a 75-year-old male with urinary retention after restarting anticoagulation 4 days postlaminectomy for resection of a large synovial cyst at L4-5. MRI demonstrated a subdural collection suggestive of hygroma. A focal laminectomy with intrathecal decompression and a lumbar drain were used to completely evacuate the lesion.
SIH management should be individualized. Focal decompression is effective for localized hematomas, while extensive, multilevel SIH may benefit from a lumbar drain with controlled cranial advancement, irrigation, and decompression. https://thejns.org/doi/10.3171/CASE25108.
脊髓硬膜内血肿（SIH）是一种罕见疾病，有导致永久性神经功能缺损的可能。SIH可通过连续影像学检查进行保守治疗，也可通过腰椎引流或开放血肿清除术进行手术治疗。我们报告3例采用多种手术技术治疗的SIH病例，包括一种新型的腰椎引流推进技术，并对文献进行回顾。
患者1是一名35岁的围产期女性，硬膜外镇痛后出现马尾综合征。MRI显示L4 - 5水平存在SIH，需紧急行L3 - S1椎板切除术并清除血肿。患者2是一名47岁男性，因L5压缩性骨折行后路减压融合术后出现双侧下肢神经根病。MRI显示SIH从T3延伸至L5。进行了局部减压、腰椎引流管置入及向头端推进以完全清除血肿。患者3是一名75岁男性，在L4 - 5行大滑膜囊肿切除术后4天重新开始抗凝治疗后出现尿潴留。MRI显示硬膜下积液提示为脑脊膜囊肿。采用局部椎板切除术、鞘内减压及腰椎引流以完全清除病变。
SIH的治疗应个体化。局部减压对局限性血肿有效，而广泛的多节段SIH可能受益于带可控头端推进、冲洗和减压的腰椎引流。https://thejns.org/doi/https://thejns.org/doi/10.3171/CASE25108. 10.3171/CASE25108.
