RESUMEN
Posterior cranial vault distraction is recognized as a viable initial approach to patients with syndromic craniosynostosis. It offers advantages to initial anterior vault surgery and to traditional 1-stage advancements. Reports of posterior vault distraction have thus far focused on the use of standard titanium distractors. We present a case of posterior vault distraction with resorbable distraction devices, obviating the need for a second surgery and anesthetic for distractor removal. Distraction was performed successfully without complications or device-related issues.
Asunto(s)
Implantes Absorbibles , Disostosis Craneofacial/cirugía , Craneotomía/instrumentación , Ácido Láctico , Osteogénesis por Distracción/instrumentación , Ácido Poliglicólico , Preescolar , Disostosis Craneofacial/diagnóstico por imagen , Diseño de Equipo , Femenino , Estudios de Seguimiento , Humanos , Copolímero de Ácido Poliláctico-Ácido Poliglicólico , Tomografía Computarizada por Rayos XRESUMEN
INTRODUCTION: Intrathecal (IT) medication delivery is a commonly used technique for the treatment of chronic intractable pain. Cerebrospinal fluid (CSF) loculation at the catheter tip has been described as a cause of progressive loss of drug effect that can often be difficult to diagnose. METHODS: The clinical course of a 56-year-old woman was reviewed, including past imaging studies. RESULTS: The patient presented with acute lower extremity paresis secondary to air trapped within an arachnoid cyst thought to be due to long-term use of IT morphine and an undiagnosed CSF loculation. She rapidly recovered after surgical decompression. DISCUSSION: Symptomatic pneumorachis is rare. In this case, because of radiographically impressive compression and severe deficit, we felt that the trapped air was equivalent to a mass lesion and treated it aggressively. The arachnoid cyst was near the level of the catheter tip prior to revision, and we have retrospectively inferred a causal relationship.