Central nervous system superficial siderosis following spinal surgery

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✓ Superficial siderosis of the central nervous system is a rare progressive disease associated with hemosiderin deposition on the leptomeninges of the neuraxis. In addition to tumors and vascular lesions, dural sleeve pseudomeningoceles caused by brachial plexus avulsion injury may be the bleeding source in this disease. The authors describe a patient who underwent anterior cervical spine surgery for spinal cord compression due to the ossification of posterior longitudinal ligament. The operation was complicated by a dural tear and subsequent psedomeningocele formation. Nine years later, this patient developed superficial siderosis. The possible mechanisms involved in the development of superficial siderosis in this patient will be discussed.

Article Information

Address reprint requests to: Aaron A. Cohen-Gadol, M.D., Department of Neurologic Surgery, Joseph 1-229, Saint Mary's Hospital, 1216 Second Street SW, Rochester, Minnesota 55902. email: cohengadol.aaron@mayo.edu.

© AANS, except where prohibited by US copyright law.

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Figures

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    Postoperative spinal sagittal T2-weighted MR image demonstrating C-5 and C-6 corpectomies and a pseudomeningocele at these levels. There is no significant residual spinal cord compression.

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    Axial (left) and sagittal (right) spinal MR images were significant for a rim of hypointensity around the spinal cord on T2-weighted sequences, which was consistent with hemosiderin deposition and superficial siderosis. Right: The pseudomeningocele is in close contact with the graft and CSF is especially discolored at this level inside the pseudomeningocele.

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    Axial T2-weighted MR image of the brain disclosed hemosiderin deposition along the sylvian fissures and brainstem.

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    Sagittal (left) and axial (right) cervical spine computerized tomography myelograms revealing a contained pseudomeningocele at the level of this patient's corpectomies in close contact with the bone autograft. The bone marrow of the graft may be in communication with the pseudomeningocele (arrows).

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