Herniação medular idiopática – relato de caso

Resumo

Herniação medular idiopática é uma causa rara de mielopatia progressiva, especialmente na ausência de história clínica de trauma raquimedular ou cirúrgico. O diagnóstico radiológico é feito por meio de mielotomografia ou ressonância magnética. A medula espinal é deslocada anteriormente, tamponando o defeito dural e levando na maioria dos casos a uma síndrome de Brown-Séquard. O presente estudo demonstra o caso de um paciente do sexo masculino com quadro clínico de mielopatia torácica progressiva. Na investigação clínica e radiológica, foi identificada uma herniação medular idiopática ao nível torácico. Durante a cirurgia, a medula espinal foi reduzida ao local natural, tomando sua forma elíptica habitual, e a falha dural foi reparada com substituto dural. O paciente melhorou da dormência, e houve desaparecimento dos choques nos membros inferiores. A ressonância pós-operatória confirmou a redução cirúrgica da herniação e o restabelecimento de coluna liquórica anterior à medula espinal. Os autores descreveram os achados clínicos, radiológicos e intraoperatórios, bem como a evolução pós-operatória.

Abstract

Idiopathic spinal cord herniation is a rare cause of progressive myelopathy, especially in the absence of a history of spinal or surgical trauma. Myelography or MRI makes the radiological diagnosis. The spinal cord is pushed anteriorly, buffering the dural defect and leading in most cases to Brown-Séquard syndrome. This study demonstrates the case of a male patient with clinical picture of progressive thoracic myelopathy. In clinical and radiological investigation was identified idiopathic spinal cord herniation to the chest level. During surgery, the spinal cord was reduced to the natural site, taking his usual elliptical shape, and the dural defect was repaired with dural substitute. The patient improved the numbness and shock disappearance of the lower limbs. Postoperative resonance confirms the surgical reduction of herniation and restoring previous CSF column to the spinal cord. The authors described the clinical, radiological, intraoperative, and postoperative evolution.

Palavras-Chave

doenças da medula espinal - síndrome de Brown-Séquard - mielografia - ressonância magnética - hérnia - cirurgia

Keywords

spinal cord diseases - Brown-Séquard syndrome - myelography - magnetic resonance imaging - hernia - surgery

• Referências

• 1 Brus-Ramer M, Dillon WP. Idiopathic thoracic spinal cord herniation: retrospective analysis supporting a mechanism of diskogenic dural injury and subsequent tamponade. AJNR Am J Neuroradiol 2012; 33 (1) 52-56
• 2 Parmar H, Park P, Brahma B, Gandhi D. Imaging of idiopathic spinal cord herniation. Radiographics 2008; 28 (2) 511-518
• 3 Imagama S, Matsuyama Y, Sakai Y , et al. Image classification of idiopathic spinal cord herniation based on symptom severity and surgical outcome: a multicenter study. J Neurosurg Spine 2009; 11 (3) 310-319
• 4 Karadeniz-Bilgili MY, Castillo M, Bernard E. Transdural spinal cord herniation: pre- and postoperative MRI findings. Clin Imaging 2005; 29 (4) 288-290
• 5 Aydin AL, Sasani M, Erhan B, Sasani H, Ozcan S, Ozer AF. Idiopathic spinal cord herniation at two separate zones of the thoracic spine: the first reported case and literature review. Spine J 2011; 11 (8) e9-e14
• 6 Berg-Johnsen J, Ilstad E, Kolstad F, Züchner M, Sundseth J. Idiopathic ventral spinal cord herniation: an increasingly recognized cause of thoracic myelopathy. J Cent Nerv Syst Dis 2014; 6 (6) 85-91
• 7 Saito T, Anamizu Y, Nakamura K, Seichi A. Case of idiopathic thoracic spinal cord herniation with a chronic history: a case report and review of the literature. J Orthop Sci 2004; 9 (1) 94-98
• 8 White BD, Tsegaye M. Idiopathic anterior spinal cord hernia: under-recognized cause of thoracic myelopathy. Br J Neurosurg 2004; 18 (3) 246-249
• 9 Hawasli AH, Ray WZ, Wright NM. Symptomatic thoracic spinal cord herniation: case series and technical report. Neurosurgery 2014; 10 (Suppl. 03) E498-E504 , discussion E504
• 10 Miyaguchi M, Nakamura H, Shakudo M, Inoue Y, Yamano Y. Idiopathic spinal cord herniation associated with intervertebral disc extrusion: a case report and review of the literature. Spine 2001; 26 (9) 1090-1094
• 11 Samuel N, Goldstein CL, Santaguida C, Fehlings MG. Spontaneous resolution of idiopathic thoracic spinal cord herniation: case report. J Neurosurg Spine 2015; 23 (3) 306-308