Spine Surgery Complicated by an Engorged Lumbar Epidural Venous Plexus from Cerebrospinal Fluid Overshunting: A Case Report and Review of the Literature

Fredrickson, Vance L; Patel, Arati; Pham, Martin H.; Strickland, Ben A.; Ohiorhenuan, Ifije; Chen, Thomas

doi:10.1016/j.wneu.2017.12.027

Cited by 7 publications

(4 citation statements)

References 26 publications

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“…Bilateral vertebral venous sinus thrombosis and dilation causing cervical spinal cord compression were also recently detected in a 10-year-old male mixed dog [ 28 ]. In another study, the visibility of the IVVP was significantly ( p < 0.001) different between Great Danes with and without clinical signs of cervical spondylomyelopathy [ 29 ]. Variation in the size of the IVVP in the central nervous system (CNS) can be explained by the Monro-Kellie doctrine, which establishes an inverse relationship between cerebrospinal fluid (CSF) volume and intracranial blood volume [ 30 ].…”

Section: Discussionmentioning

confidence: 99%

Morphometrical Study of the Lumbar Segment of the Internal Vertebral Venous Plexus in Dogs: A Contrast CT-Based Study

Ariete

Barnert

Gómez

et al. 2021

Animals

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The internal vertebral venous plexus (IVVP) is a thin-walled, valveless venous network that is located inside the vertebral canal, communicating with the cerebral venous sinuses. The objective of this study was to perform a morphometric analysis of the IVVP, dural sac, epidural space and vertebral canal between the L1 and L7 vertebrae with contrast-enhanced computed tomography (CT). Six clinically healthy adult dogs weighing between 12 kg to 28 kg were used in the study. The CT venographic protocol consisted of a manual injection of 880 mgI/kg of contrast agent (587 mgI/kg in a bolus and 293 mgI/mL by continuous infusion). In all CT images, the dimensions of the IVVP, dural sac, and vertebral canal were collected. Dorsal reconstruction CT images showed a continuous rhomboidal morphological pattern for the IVVP. The dural sac was observed as a rounded isodense structure throughout the vertebral canal. The average area of the IVVP ranged from 0.61 to 0.74 mm2 between L1 and L7 vertebrae (6.3–8.9% of the vertebral canal), and the area of the dural sac was between 1.22 and 7.42 mm2 (13.8–72.2% of the vertebral canal). The area of the epidural space between L1 and L7 ranged from 2.85 to 7.78 mm2 (27.8–86.2% of the vertebral canal). This CT venography protocol is a safe method that allows adequate visualization and morphometric evaluation of the IVVP and adjacent structures.

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Section: Discussionmentioning

confidence: 99%

Morphometrical Study of the Lumbar Segment of the Internal Vertebral Venous Plexus in Dogs: A Contrast CT-Based Study

Ariete

Barnert

Gómez

et al. 2021

Animals

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“…Notably, EVP at the cervical and thoracic levels have different regional etiologies. [1,13] EVPs are variously attributed to: vascular anomalies such as IVC thrombosis/ hypoplasia, iliac vein stenosis, obesity related IVC obstruction, bladder distention, intracranial hypotension, previous microdiscectomy, coagulopathy, Factor V Leiden mutation, protein C deficiency, Behcet's, and Budd-Chiari syndrome. [18,22] ese conditions block normal venous drainage into or through the IVC, and divert blood flow into collaterals through the vertebral venous plexus; this results in venous engorgement and compression of the thecal sac, nerve roots, or cauda equine.…”

Section: Location and Pathology Of Evpsmentioning

confidence: 99%

“…Although we were able to control the venous bleeding, cases of extensive intraoperative hemorrhages have been reported. [13]…”

Section: Location and Pathology Of Evpsmentioning

confidence: 99%

“…However, new adjacent level disease may occasionally be attributed to engorged venous plexuses (EVP) rather than new disk herniations. [2,13,27] Furthermore, EVPs may mimic the symptoms of a new herniated disk and exhibit comparable magnetic resonance imaging (MRI) findings as they both have similar signal intensities. [2,13,17,26] Implementing EVPs among differential diagnostic considerations should enable spine surgeons to better anticipate surgical options and deal with attendant rapid intraoperative blood loss.…”

Section: Introductionmentioning

confidence: 99%

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Engorged venous plexus mimicking adjacent segment disease: Case report and review of the literature

Hassan

Lewis

Aradhyula

et al. 2020

Surgical Neurology International

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Background: An engorged venous plexus may mimic nerve compression from a herniated disk on the magnetic resonance (MR) studies as they both have similar signal intensities. During a laminectomy, if an engorged venous plexus is encountered instead of a disk herniation, there may be marked unanticipated bleeding. Case Description: A 58-year-old female who had a prior anterior lumbar interbody fusion later returned with recurrent radiculopathy. Adjacent segment disease from a spinal disk herniation was suspected based on the surgical history, physical examination, and imaging (MRI) findings. Rather than a disk, an engorged venous plexuses (EVP) was encountered intraoperatively. Conclusion: Here, we discussed our findings regarding a lumbar EVP rather than a herniated disk and reviewed the current literature. Although rare, a higher index of suspicion for these vascular malformations based on combined historical information and MRI studies should allow one to better detect and/or anticipate an EVP rather than a routine disk.

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Lumbar Epidural Varices

Akhaddar

2023

Atlas of Sciatica

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Spine Surgery Complicated by an Engorged Lumbar Epidural Venous Plexus from Cerebrospinal Fluid Overshunting: A Case Report and Review of the Literature

Cited by 7 publications

References 26 publications

Morphometrical Study of the Lumbar Segment of the Internal Vertebral Venous Plexus in Dogs: A Contrast CT-Based Study

Morphometrical Study of the Lumbar Segment of the Internal Vertebral Venous Plexus in Dogs: A Contrast CT-Based Study

Engorged venous plexus mimicking adjacent segment disease: Case report and review of the literature

Lumbar Epidural Varices

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