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Spine
Diagnosis
Trauma
Cord, Dura, and Vessels
Traumatic Dural Tear
Traumatic Dural Tear
Jeffrey S. Ross, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Pathology

        • Clinical Issues

          TERMINOLOGY

          • Synonyms

            • Traumatic meningocele
            • Pseudomeningocele

          • Definitions

            • Traumatically acquired dural defect, with CSF leak ± pseudomeningocele
              • Different from chronic leaks as in spontaneous intracranial hypotension (dural defect, CSF-venous fistula)

          IMAGING

          • General Features

            • Radiographic Findings

              • CT Findings

                • MR Findings

                  • Imaging Recommendations

                    • Nuclear Medicine Findings

                      DIFFERENTIAL DIAGNOSIS

                        PATHOLOGY

                        • General Features

                          • Gross Pathologic & Surgical Features

                            CLINICAL ISSUES

                            • Presentation

                              • Demographics

                                • Natural History & Prognosis

                                  • Treatment

                                    DIAGNOSTIC CHECKLIST

                                    • Consider

                                      • Image Interpretation Pearls

                                        Selected References

                                        1. Clifton WE et al: Delayed myelopathy in patients with traumatic preganglionic brachial plexus avulsion injuries. World Neurosurg. 122:e1562-9, 2019
                                        2. Lee MJ et al: CSF flow jet: novel CT myelogram finding of CSF leak through dural tear in traumatic pseudomeningocele. Clin Imaging. 61:33-5, 2019
                                        3. Kareem H et al: Case series of posterior instrumentation for repair of burst lumbar vertebral body fractures with entrapped neural elements. J Spine Surg. 4(2):374-82, 2018
                                        4. Luszczyk MJ et al: Traumatic dural tears: what do we know and are they a problem? Spine J. 14(1):49-56, 2014
                                        5. Hoxworth JM et al: The role of digital subtraction myelography in the diagnosis and localization of spontaneous spinal CSF leaks. AJR Am J Roentgenol. 199(3):649-53, 2012
                                        6. Seo BR et al: An unusual stab wound causing a traumatic pseudomeningocele at the craniocervical junction. J Clin Neurosci. 16(10):1365-7, 2009
                                        7. Yokota H et al: Spinal cord herniation into associated pseudomeningocele after brachial plexus avulsion injury: case report. Neurosurgery. 60(1):E205; discussion E205, 2007
                                        8. Horn EM et al: Spinal cord compression from traumatic anterior cervical pseudomeningoceles. Report of three cases. J Neurosurg Spine. 5(3):254-8, 2006
                                        9. Sasaka KK et al: Lumbosacral nerve root avulsions: MR imaging demonstration of acute abnormalities. AJNR Am J Neuroradiol. 27(9):1944-6, 2006
                                        10. Kraemer N et al: Intrathecal gadolinium-enhanced MR myelography showing multiple dural leakages in a patient with Marfan syndrome. AJR Am J Roentgenol. 185(1):92-4, 2005
                                        11. Aydinli U et al: Dural tears in lumbar burst fractures with greenstick lamina fractures. Spine. 26(18):E410-5, 2001
                                        12. Carl AL et al: Anterior dural laceration caused by thoracolumbar and lumbar burst fractures. J Spinal Disord. 13(5):399-403, 2000
                                        13. Johnson JP et al: Traumatic lumbar pseudomeningocele occurring with spina bifida occulta. J Spinal Disord. 11(1):80-3, 1998
                                        14. Pau A et al: Can lacerations of the thoraco-lumbar dura be predicted on the basis of radiological patterns of the spinal fractures? Acta Neurochir (Wien). 129(3-4):186-7, 1994
                                        15. Maillard JC et al: Imaging in the exploration of lumbosacral plexus avulsion. Two cases. J Neuroradiol. 19(1):38-48, 1992
                                        16. Denis F et al: Diagnosis and treatment of cauda equina entrapment in the vertical lamina fracture of lumbar burst fractures. Spine. 16(8 Suppl):S433-9, 1991
                                        17. Silvestro C et al: On the predictive value of radiological signs for the presence of dural lacerations related to fractures of the lower thoracic or lumbar spine. J Spinal Disord. 4(1):49-53, 1991
                                        18. Suh PB: Dural laceration occurring with burst fractures and associated laminar fractures. J Bone Joint Surg Am. 73(2):314, 1991
                                        19. Cammisa FP Jr et al: Dural laceration occurring with burst fractures and associated laminar fractures. J Bone Joint Surg Am. 71(7):1044-52, 1989
                                        20. Verstraete KL et al: Traumatic lumbosacral nerve root meningoceles. The value of myelography, CT and MRI in the assessment of nerve root continuity. Neuroradiology. 31(5):425-9, 1989
                                        21. Brant-Zawadzki M et al: High resolution CT of thoracolumbar fractures. AJR Am J Roentgenol. 138(4):699-704, 1982
                                        22. Deans W et al: Cerebrospinal fluid hypotension secondary to traumatic rupture of lumbosacral meninges. Surg Neurol. 12(3):223-6, 1979
                                        23. Barberá J et al: Traumatic lumbosacral meningocele. Case report. J Neurosurg. 46(4):536-41, 1977
                                        Related Anatomy
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                                        Related Differential Diagnoses
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                                        References
                                        Tables

                                        Tables

                                        KEY FACTS

                                        • Terminology

                                          • Imaging

                                            • Pathology

                                              • Clinical Issues

                                                TERMINOLOGY

                                                • Synonyms

                                                  • Traumatic meningocele
                                                  • Pseudomeningocele

                                                • Definitions

                                                  • Traumatically acquired dural defect, with CSF leak ± pseudomeningocele
                                                    • Different from chronic leaks as in spontaneous intracranial hypotension (dural defect, CSF-venous fistula)

                                                IMAGING

                                                • General Features

                                                  • Radiographic Findings

                                                    • CT Findings

                                                      • MR Findings

                                                        • Imaging Recommendations

                                                          • Nuclear Medicine Findings

                                                            DIFFERENTIAL DIAGNOSIS

                                                              PATHOLOGY

                                                              • General Features

                                                                • Gross Pathologic & Surgical Features

                                                                  CLINICAL ISSUES

                                                                  • Presentation

                                                                    • Demographics

                                                                      • Natural History & Prognosis

                                                                        • Treatment

                                                                          DIAGNOSTIC CHECKLIST

                                                                          • Consider

                                                                            • Image Interpretation Pearls

                                                                              Selected References

                                                                              1. Clifton WE et al: Delayed myelopathy in patients with traumatic preganglionic brachial plexus avulsion injuries. World Neurosurg. 122:e1562-9, 2019
                                                                              2. Lee MJ et al: CSF flow jet: novel CT myelogram finding of CSF leak through dural tear in traumatic pseudomeningocele. Clin Imaging. 61:33-5, 2019
                                                                              3. Kareem H et al: Case series of posterior instrumentation for repair of burst lumbar vertebral body fractures with entrapped neural elements. J Spine Surg. 4(2):374-82, 2018
                                                                              4. Luszczyk MJ et al: Traumatic dural tears: what do we know and are they a problem? Spine J. 14(1):49-56, 2014
                                                                              5. Hoxworth JM et al: The role of digital subtraction myelography in the diagnosis and localization of spontaneous spinal CSF leaks. AJR Am J Roentgenol. 199(3):649-53, 2012
                                                                              6. Seo BR et al: An unusual stab wound causing a traumatic pseudomeningocele at the craniocervical junction. J Clin Neurosci. 16(10):1365-7, 2009
                                                                              7. Yokota H et al: Spinal cord herniation into associated pseudomeningocele after brachial plexus avulsion injury: case report. Neurosurgery. 60(1):E205; discussion E205, 2007
                                                                              8. Horn EM et al: Spinal cord compression from traumatic anterior cervical pseudomeningoceles. Report of three cases. J Neurosurg Spine. 5(3):254-8, 2006
                                                                              9. Sasaka KK et al: Lumbosacral nerve root avulsions: MR imaging demonstration of acute abnormalities. AJNR Am J Neuroradiol. 27(9):1944-6, 2006
                                                                              10. Kraemer N et al: Intrathecal gadolinium-enhanced MR myelography showing multiple dural leakages in a patient with Marfan syndrome. AJR Am J Roentgenol. 185(1):92-4, 2005
                                                                              11. Aydinli U et al: Dural tears in lumbar burst fractures with greenstick lamina fractures. Spine. 26(18):E410-5, 2001
                                                                              12. Carl AL et al: Anterior dural laceration caused by thoracolumbar and lumbar burst fractures. J Spinal Disord. 13(5):399-403, 2000
                                                                              13. Johnson JP et al: Traumatic lumbar pseudomeningocele occurring with spina bifida occulta. J Spinal Disord. 11(1):80-3, 1998
                                                                              14. Pau A et al: Can lacerations of the thoraco-lumbar dura be predicted on the basis of radiological patterns of the spinal fractures? Acta Neurochir (Wien). 129(3-4):186-7, 1994
                                                                              15. Maillard JC et al: Imaging in the exploration of lumbosacral plexus avulsion. Two cases. J Neuroradiol. 19(1):38-48, 1992
                                                                              16. Denis F et al: Diagnosis and treatment of cauda equina entrapment in the vertical lamina fracture of lumbar burst fractures. Spine. 16(8 Suppl):S433-9, 1991
                                                                              17. Silvestro C et al: On the predictive value of radiological signs for the presence of dural lacerations related to fractures of the lower thoracic or lumbar spine. J Spinal Disord. 4(1):49-53, 1991
                                                                              18. Suh PB: Dural laceration occurring with burst fractures and associated laminar fractures. J Bone Joint Surg Am. 73(2):314, 1991
                                                                              19. Cammisa FP Jr et al: Dural laceration occurring with burst fractures and associated laminar fractures. J Bone Joint Surg Am. 71(7):1044-52, 1989
                                                                              20. Verstraete KL et al: Traumatic lumbosacral nerve root meningoceles. The value of myelography, CT and MRI in the assessment of nerve root continuity. Neuroradiology. 31(5):425-9, 1989
                                                                              21. Brant-Zawadzki M et al: High resolution CT of thoracolumbar fractures. AJR Am J Roentgenol. 138(4):699-704, 1982
                                                                              22. Deans W et al: Cerebrospinal fluid hypotension secondary to traumatic rupture of lumbosacral meninges. Surg Neurol. 12(3):223-6, 1979
                                                                              23. Barberá J et al: Traumatic lumbosacral meningocele. Case report. J Neurosurg. 46(4):536-41, 1977