Atormac
Neurology India
menu-bar5 Open access journal indexed with Index Medicus
  Users online: 686  
 Home | Login 
About Editorial board Articlesmenu-bullet NSI Publicationsmenu-bullet Search Instructions Online Submission Subscribe Videos Etcetera Contact
  Navigate Here 
 Search
 
  
 Resource Links
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Article in PDF (740 KB)
    Citation Manager
    Access Statistics
    Reader Comments
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this Article
   References
   Article Figures

 Article Access Statistics
    Viewed1243    
    Printed33    
    Emailed2    
    PDF Downloaded38    
    Comments [Add]    

Recommend this journal

 


 
Table of Contents    
LETTER TO EDITOR
Year : 2013  |  Volume : 61  |  Issue : 6  |  Page : 664-665

Post-operative intradural tension pneumorrhachis


1 Department of Neurosurgery, Sir JJ Group of Hospitals, Mumbai, Maharashtra, India
2 Department of Neurosurgery, Grant Medical College, Sir JJ Group of Hospitals, Mumbai, Maharashtra, India

Date of Submission20-Oct-2013
Date of Decision28-Oct-2013
Date of Acceptance04-Dec-2013
Date of Web Publication20-Jan-2014

Correspondence Address:
Jasmit Singh
Department of Neurosurgery, Sir JJ Group of Hospitals, Mumbai, Maharashtra
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.125284

Rights and Permissions



How to cite this article:
Singh J, Kharosekar H, Velho V. Post-operative intradural tension pneumorrhachis. Neurol India 2013;61:664-5

How to cite this URL:
Singh J, Kharosekar H, Velho V. Post-operative intradural tension pneumorrhachis. Neurol India [serial online] 2013 [cited 2019 Dec 5];61:664-5. Available from: http://www.neurologyindia.com/text.asp?2013/61/6/664/125284


Sir,

sA 30-year-old male patient presented with progressive weakness of both lower limbs associated with numbness and no bladder/bowel involvement. On examination, patient had asymmetric spastic paraparesis (power right 3/5 and left 4/5) with dissociate sensory loss, pain and temperature being more affected than touch/vibration. Magnetic resonance imaging (MRI) whole spine revealed heterogeneously enhancing intradural intramedullary lesion at D1-D2 level associated with holocord syrinx extending into the brainstem [Figure 1]a. Patient underwent C7-D2 laminoplasty with gross total microsurgical excision. Intraoperatively tumor was greyish yellow with no abnormal vascularity. Tumor was suckable with no well-defined tumor-tissue interface. Patient was extubated and neurologically assessed. Motor power deteriorated after surgery. MRI revealed entrapped air at L3-L4 level with reduction in size of syrinx [Figure 1]b. Computed tomography (CT) was done to confirm the diagnosis and air was aspirated [Figure 1]c. Patient had sensory improvement after aspiration, however motor improvement was delayed.
Figure 1: (a) Pre - operative magnetic resonance imaging (MRI) Whole spine showing D2 - 7 intramedullary lesion with syrinx. (b) Post - operative MRI whole spine showing exision of lesion with laminotomy with pneumorachis at L2 - 3 level. (c) Post - operative computed tomography lumbar spinal spne showing the pneumo

Click here to view


The term PR was primarily reported by Gordon in 1977 and the term coined 10 years later. [1] Most of the cases of PR are reported in association with traumatic brain injury. PR can be classified as internal (intradural) or external (extradural); and etiologically as traumatic, iatrogenic and non-traumatic. [1],[2] Extradural air is usually seen in association with penetrating injuries, whereas intradural air is seen in patients with severe traumatic brain injury or is iatrogenic. [1],[2] Most of the cases of PR are asymptomatic and are detected on routine screening. Symptomatic tension PR is rare and only few cases are reported so far, most of which are posttraumatic. CT scan is the diagnostic modality of choice. Due to the rarity and the different etiologies and pathogenesis, no empiric guidelines for the treatment of PR exist. Hence the management of PR has to be individualized and frequently require multidisciplinary regime. Our patient had PR following intramedullary tumor excision. Presence of holocord syrinx and air getting entrapped during dural closure appears to be the likely cause of PR. Tension PR when present requires urgent intervention to prevent neurological deficits.

 
  References Top

1.Sang-Don Kim, Jin-Sung Kim, Ju-Yong Seong, Young-Geun Choi, Ik-Seong Park, Min-Woo Baik, Traumatic Pneumorrhachis, J Kor Neurotraumatol Soc 2007;3:113-115.  Back to cited text no. 1
    
2.Oertel MF, Korinth MC, Reinges MH, Krings T, Terbeck S, Gilsbach JM. Pathogenesis, diagnosis and management of pneumorrhachis. Eur Spine J 2006;15 Suppl 5:636-43.  Back to cited text no. 2
[PUBMED]    


    Figures

  [Figure 1]



 

Top
Print this article  Email this article
   
Online since 20th March '04
Published by Wolters Kluwer - Medknow