It may be related to a dilated epidural venous plexus
and/or persistent/redeveloped arachnoid granulations.
The findings reported more frequently are asymmetrical or symmetrical atrophy of lower cervical cord, prominence and enhancement of posterior epidural venous plexus
on flexion studies and anterior shifting of posterior dural sac on flexion.
Furthermore, the fragility of epidural venous plexus
is responsible for increasing bleeding tendency.
The CTA also demonstrated multiple dilated and serpiginous vessels surrounding the right vertebral artery at the level of C1 and opacification of the right internal jugular vein and epidural venous plexus
on the right, suggesting a potential arteriovenous fistula (AVF) involving the right vertebral artery (Figures 1(a) and 1(b)).
Weplanned a 2-stage surgery to achieve both safe removal of the OYL lesion and reliable intervertebral fusion and to avoid excess blood loss from manipulating the epidural venous plexus
. In this case, there was muscle weakness due to severe canal stenosis by osseous intracanal lesion, so we considered that indirect decompression by ligamentotaxis would not be obtained, and direct decompression would be necessary .
Most researchers claim that it occurs at the epidural venous plexus
in the spinal epidural space of the thoracic spine, and the abdominal cavity can also be directly affected.
[sup],, Although the exact pathogenesis of SSEH is unclear, bleeding from posterior epidural venous plexus
is the most possible origin.
However, total excision is usually difficult because the cyst generally tightly adheres to the neural tissue of the dura, or because of intraoperative bleeding from a well-developed epidural venous plexus
. If complete resection is impossible, partial resection and fenestration of the cyst wall are performed commonly (6,8,9), however, results of the surgery are sometimes unfavorable.
(1) Ninety-seven per cent of spontaneous spinal AVFs associated with NF1 occur in the cervical spine and arise from the vertebral artery.(1) These fistulae usually drain into the vertebral venous plexus, or intrathecally via the epidural venous plexus
. (2) The clinical presentations of spinal AVFs include radiculomyelopathy (78%), bruit (50%), tinnitus (10%), cranial neuropathy (3%) or a pulsatile neck mass (3%).
The resultant obstruction of the epidural venous plexus
leads to vasogenic oedema of the spinal cord.
Symptomatic enlarged cervical anterior epidural venous plexus
in a patient with Marfan syndrome.