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| LETTER TO EDITOR |
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| Year : 2013 | Volume
: 61
| Issue : 6 | Page : 664-665 |
Post-operative intradural tension pneumorrhachis
Jasmit Singh1, Hrushikesh Kharosekar2, Vernon Velho1
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 Submission | 20-Oct-2013 |
| Date of Decision | 28-Oct-2013 |
| Date of Acceptance | 04-Dec-2013 |
| Date of Web Publication | 20-Jan-2014 |
Correspondence Address:
Jasmit Singh
Department of Neurosurgery, Sir JJ Group of Hospitals, Mumbai, Maharashtra
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0028-3886.125284
How to cite this article:
Singh J, Kharosekar H, Velho V. Post-operative intradural tension pneumorrhachis. Neurol India 2013;61:664-5 |
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
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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 | |  |
| 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. 
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| 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.
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