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Case Reports
. 2019 Nov 11;11(11):e6123.
doi: 10.7759/cureus.6123.

A Case of Ventral Spinal Cord Herniation from a Chronic Dural-pleural Fistula Resulting in Thoracic Myelopathy

Ilyas Eli  1 , Jian Guan  1 , Michael Karsy  1 , Marcus D Mazur  1 , Andrew Dailey  1
Affiliations
Case Reports

A Case of Ventral Spinal Cord Herniation from a Chronic Dural-pleural Fistula Resulting in Thoracic Myelopathy

Ilyas Eli et al. Cureus. .

Abstract

Formation of a dural-pleural fistula is uncommon after anterior thoracic spine surgery, tumor, or trauma. The goal of surgical management is to terminate the connection between the pleura and subarachnoid space. We describe a case of chronic dural-pleural fistula in a 70-year-old woman and present a unique surgical treatment option. The patient presented 25 years after an anterior thoracic surgery she had undergone for a thoracic disc herniation, with a dural-pleural fistula and ventral herniation of the spinal cord into the defect. She was treated with a bovine pericardium sling patch to cover the defect. This case highlights the identification of a chronic thoracic dural-pleural fistula and surgical treatment with double intradural and extradural layering of bovine pericardium sling patch, which has not been described previously for chronic thoracic dural-pleural fistula.

Keywords: cerebrospinal fluid leak; dural-pleural fistula; myelopathy.

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Conflict of interest statement

The authors have declared financial relationships, which are detailed in the next section.

Figures

Figure 1
Figure 1. Preoperative MRI and CT imaging of the thoracic spine
(A) sagittal T2-weighted MRI demonstrating a ventrolateral defect at the left T8-9 level (arrow). (B) coronal T2-weighted MRI showing herniation of the pleural cavity into the surgical defect (arrow) and the presence of a pleural effusion. (C) axial T2-weighted MRI showing displacement of the ventral spinal cord into the defect and contact of the herniated pleura with the thecal sac contents (arrow). (D) axial CT myelogram demonstrating a hyperdense fluid extending from the spinal canal to adjacent pleural space consistent with a dural-pleural fistula (arrow). (E) sagittal CT image of the thoracic spine demonstrating the osseous defect (arrow)
Figure 2
Figure 2. Postoperative X-rays demonstrating T6-11 posterior spinal fusion
(A) anteroposterior X-ray. (B) lateral thoracic X-ray
Figure 3
Figure 3. Intraoperative images
(A) the ventrolateral defect signified by the arrow. (B) the exposure of the spinal cord. (C, D) the placement of a bovine pericardium sling patch to circumferentially cover the fistula
See this image and copyright information in PMC

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