Dural ectasia in the Marfan syndrome: MR and CT findings and criteria

Ahn, Nicholas U.; Sponseller, Paul D.; Ahn, Uri M.; Nallamshetty, Leelakrishna; Rose, Peter S.; Buchowski, Jacob M.; Garrett, Elizabeth; Kuszyk, Brian S.; Fishman, Elliot K.; Zinreich, S. James

doi:10.1097/00125817-200005000-00003

Cited by 98 publications

(86 citation statements)

References 24 publications

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“…This visual definition of perineural cysts was made according to Acosta et al 26 For the individual patient, the diagnosis of DE was based on the presence of Ն1 of the following findings: anterior sacral meningocele, Ն1 dural sac nerve root sleeve herniations, DSD at level S1 or below greater than the DSD at level L4 (DSD sacrum Ͼ DSDL4), DSR at L5 Ͼ 0.48, and DSR at S1 Ͼ 0.57. 4,6,9 In addition to diagnosing DE, we identified the level of the caudal end of the dural sac, the tip of the conus medullaris, and any disk herniations.…”

Section: Measurements and Definitionsmentioning

confidence: 99%

“…1 A more recent definition of DE is widening of the dural sac or spinal nerve root sleeves, usually associated with bony erosions of the posterior vertebral body. 3 Although a number of articles about MFS have presented methods on how to assess DE by using conventional x-ray films, CT, and MR imaging, [4][5][6][7] no gold standard for the diagnosis of DE has emerged. A number of radiologic features of DE have been suggested, including anterior meningoceles, herniations of the dura along the nerve root sleeves, 4 wider dural sac at S1 compared with L4, 4 and elevated dural sac ratios (DSR) (ie, the ratio between the dural sac diameter [DSD] and the vertebral body diameter [VBD] at the same level).…”

mentioning

confidence: 99%

“…3 Although a number of articles about MFS have presented methods on how to assess DE by using conventional x-ray films, CT, and MR imaging, [4][5][6][7] no gold standard for the diagnosis of DE has emerged. A number of radiologic features of DE have been suggested, including anterior meningoceles, herniations of the dura along the nerve root sleeves, 4 wider dural sac at S1 compared with L4, 4 and elevated dural sac ratios (DSR) (ie, the ratio between the dural sac diameter [DSD] and the vertebral body diameter [VBD] at the same level). 6 Although some MFS studies have included controls with respect to DE, these control groups, with 1 exception, tended to be small; they have not been sex-and age-matched; and they have included patients with low back symptoms.…”

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confidence: 99%

“…[6][7][8][9][10] The impact of DE in the diagnostic process of MFS has been discussed in several articles. 4,6,[8][9][10][11][12][13] However, in most studies describing cohorts of patients with MFS, the patients have not been examined for DE, 14 in spite of the fact that DE is seen in a high percentage of patients with this syndrome. The incidence of DE in patients fulfilling the Ghent criteria (Ghent-positive patients) has been reported to be from 63% to 92%.…”

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confidence: 99%

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Dural Ectasia in Marfan Syndrome: A Case Control Study

Lundby

Rand‐Hendriksen²,

Hald³

et al. 2009

AJNR Am J Neuroradiol

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Section: Measurements and Definitionsmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Dural Ectasia in Marfan Syndrome: A Case Control Study

Lundby

Rand‐Hendriksen²,

Hald³

et al. 2009

AJNR Am J Neuroradiol

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“…[12][13][14] The severity of DE can be evaluated by computed tomography or MRI using either quantitative (actual dural sac measurements) or qualitative (evaluating the prevalence of different features of DE, i.e., scalloping) criteria. There are no universally accepted quantitative criteria for diagnosing DE, and various methods have been used, including evaluation of dural sac ratio, 15 assessment of dural sac diameter at S1 and L4 levels, nerve root sleeve diameter, 16 and lumbar pedicle width. 17 According to Fattori et al, 5 the degree of DE can be classified as mild, moderate, or severe based on radiologic imaging.…”

Section: Discussionmentioning

confidence: 99%

Regional anesthesia in Marfan syndrome, not all dural ectasias are the same: a report of two cases

Baghirzada

Krings

Carvalho

2012

Can J Anesth/J Can Anesth

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Background The anesthetic management of women with Marfan syndrome and dural ectasia undergoing Cesarean delivery remains controversial. We present two cases of patients with Marfan syndrome and dural ectasia where neuraxial anesthesia was used successfully. Case 1 A 31-yr-old G1P0 female with Marfan syndrome presented for elective Cesarean delivery at 35 3/7 weeks' gestation. The magnetic resonance imaging of her spine revealed significant dural ectasia in the lumbosacral area with a mean lumbar dural sac area of 4.71 cm 2 . Intrathecal administration of 0.75% hyperbaric bupivacaine 9 mg produced only limited perineal analgesia. The epidural catheter was titrated, and 0.5% bupivacaine 150 mg were required to achieve a T4 sensory level. Case 2 A 34-yr-old G1P0 female with Marfan syndrome presented for elective Cesarean delivery at 37 weeks' gestation. The intrathecal administration of 0.75% hyperbaric bupivacaine 13.5 mg produced a T5 sensory level. Magnetic resonance imaging of her spine prior to discharge confirmed the diagnosis of moderate dural ectasia with a mean lumbar dural sac area of 3.61 cm 2 . Discussion The two patients described in this report responded differently to spinal anesthesia, most likely based on the severity of their dural ectasia. Although preoperative magnetic resonance imaging may help to identify patients at risk for a failed spinal, we suggest considering a combined spinal-epidural technique in cases of dural ectasia. RésuméContexte La prise en charge anesthe´sique de femmes ayant un syndrome de Marfan et une ectasie de la dure-me`re au cours d'un accouchement par ce´sarienne reste un sujet controverse´. Nous pre´sentons le cas de deux patientes ayant un syndrome de Marfan et une ectasie de la dure-me`re chez qui une anesthe´sie neuraxiale a e´te´re´alise´e avec succe`s. Cas n8 1 Une femme de 31 ans, G1P0, ayant un syndrome de Marfan a e´te´admise pour accouchement par ce´sarienne programme´a`35 semaines et 3 jours de grossesse. L'imagerie par re´sonance magne´tique de la colonne verte´brale a re´ve´le´une ectasie significative de la dure-me`re dans la re´gion lombosacre´e avec une surface moyenne du sac dural lombaire de 4,71 cm 2 . L'administration intrathe´cale de 9 mg de bupivacaı¨ne hyperbare a`0,75 % n'a procure´qu'une analge´sie pe´rine´ale limite´e. La dose du cathe´ter pe´ridural a e´te´titre´e et 150 mg de bupivacaı¨ne 0,5 % ont e´te´ne´cessaires pour atteindre le niveau sensitif D4. Cas n8 2 Une femme de 34 ans, G1P0, ayant un syndrome de Marfan a e´te´admise pour accouchement par ce´sarienne programme´a`37 semaines de grossesse. L'administration intrathe´cale de 13,5 mg de bupivacaı¨ne Author contributions Leyla Baghirzada and Jose C.A. Carvalho cared for patients, reviewed the literature, and wrote the manuscript. Jose C.A. Carvalho and Timo Krings revised the manuscript, and Leyla Baghirzada submitted the final version of the manuscript. Timo Krings interpreted the magnetic resonance imagings for both patients.

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