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29-JANUARY-2005 NADA ABDALA AL-SMADI 44 YEARS RESIDUAL AFTER L5-S1 DISCECTOMY
WITH MENINGOCELE FORMATION FROM THE LEFT L5 ROOT.
Anamnesis
The patient came to the emergency of Shmaisani
hospital with CSF leak after performed
discectomy elsewhere. The source of leakage is
from the left L5 root.
On examination: The patient is in agonizing
pain, limping with exaggerated scoliotic stance.
There is flail left foot. SLRS was 10 degrees with pain left
side. There is analgesia left L5, S1
territories.
Revision of the wound and the
meningocele of the left L5 root exposed and
modulated by circumferential bipolar to regain
normal structure. Above the axilla lateral, there
was 8 mm dural defect and repaired by 6 zero nylon. The patient was put in
Reverse Trendelenburg position with Valsalva
maneuver and hyperventilation. No CSF leak. Routine
closure of the wound.
Smooth postoperative recovery.
The power of the left foot still the same.
She was sent to the ward.
Follow Up
The patient came to the 09-February-2005 with
still mild oozing from the wound, for what she
was admitted and treated conservatively.
The patient then came 20-June-2005 with clean
wound and MRI showing resolution of the CSF
leak, but with still drop left foot with
analgesia left L5 territory.
The patient then came 26-January-2006 with MRI
of the brain showing recurrence of meningioma at
the right parietal convexity. She was advised
for surgery and disappeared.
Comments
There is still an estimated postoperative
disc recurrence around 7%, since the disc space is not
completely shallow.
Frequently, we see tiny dural defects
during surgery. Some of them treated by just coagulate the
pin-point defect, others by stitching as in this case.
It is not understandable why the
meningocele took place in this case.
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Notice: Not all operative activities
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Notice: Head injuries and very urgent surgeries are also
escaped from the plan .
