PMC9617493_01
anterior (A) and lateral (B) illustrations (the upper part of the image is the chin) showing a clinical defect at the left part of the scar (white arrow) (A) and a significant compressive curvature (B) in a short neck patient
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F1
Despite neurological post op improvement from myelopathy signs, it was decided of rehospitalization urgently for 2d surgery with evacuation of the collection, bacteriological sampling and closure of the dural tear at the origin of the meningocele fistulizing to the skin (Figure 1).
MRI in sagittal T2 section showing the anterior meningocele
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F2
Material-related artifacts did not allow accurate visualization of the dural disruption (Figure 2, Figure 3).
axial T2-weighted MRI showing anterior meningocele with left-displaced esophageal structures and skin fistula
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F3
Material-related artifacts did not allow accurate visualization of the dural disruption (Figure 2, Figure 3).
intraoperative microscopic photograph of the dural tear with steady pulsed flow of cerebrospinal fluid (A), and with placement of a fat patch in the breach prior to placement of the TachoSil (B)
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F4
Under the microscope, we observe a dural breach lateralized on the right side at the level of the nerve emergence (Figure 4). It was therefore decided to place fatty tissue at the level of the breach and then apply a new TachoSil patch to close the breach, which was difficult to suture given the limited space available (Figure 4).
lateral (left) and frontal (right) static and dynamic X-ray of cervical spine showing the implants at 2 months
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F5
He was evaluated clinically (score JOA 17/17, VAS score 0/10) and radiologically at 2 and 6 months postoperatively and had no documented complications suggesting persistent leakage (Figure 5). In addition, tear and meningocele has not caused any complications of mechanical failure to the prosthesis for the moment (Figure 5).