Cerebrospinal fluid over-drainage associated with upper cervical myelopathy: Successful treatment using a gravitational add-on valve in two cases

摘要

BackgroundChronic cerebrospinal fluid (CSF) over-drainage can induce compressive myelopathy without typical over-drainage manifestations. We present two cases of cervical myelopathy due to chronic CSF over-drainage that were successfully treated by gravitational add-on valve placement.Case descriptionPatient 1 was a 38-year-old man who presented with pain and numbness in his left arm and hand, as well as weakness of the upper extremities. He had undergone cystoperitoneal shunting for a retro-cerebellar arachnoid cyst treatment. Patient 2 was an 83-year-old woman who presented with weakness and numbness of both upper and lower limbs. At the age of 72, ventriculoperitoneal shunting was performed for the treatment of hydrocephalus following subarachnoid hemorrhage. Magnetic resonance imaging (MRI) and three-dimensional computed tomography (3DCT) angiography revealed marked compression of the spinal cord and dural sac by enlarged epidural venous plexus in both patients. A gravitational valve was additionally inserted and patient’s symptoms improved. Post-operative MRI revealed decrease of the epidural venous plexus engorgement and resolution of the spinal cord compression.ConclusionsSome rare pathophysiological relationships between intracranial hypotension and cervical myelopathy, can be difficult for diagnosis. Our findings indicate that proper diagnosis of such relationships after CSF shunt placement can provide relief of myelopathic symptoms.