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Dural Reduction Surgery: A Treatment Option for Frontotemporal Brain Sagging Syndrome

  • Emily Mostofi (a1), Wouter I. Schievink (a2) and Valerie L. Sim (a3)
Abstract

Frontotemporal brain sagging syndrome is a dementia associated with hypersomnolence, personality changes, and features of intracranial hypotension on magnetic resonance imaging. The literature is sparse with respect to treatment options; many patients simply worsen. We present a case in which this syndrome responded to lumbar dural reduction surgery. Postoperative magnetic resonance imaging indicated normalization of brain sagging and lumbar intrathecal pressure. Although no evidence of cerebrospinal leak was found, extremely thin dura was noted intraoperatively, suggesting that a thin and incompetent dura could result in this low-pressure syndrome. Clinicians who encounter this syndrome should consider dural reduction surgery as a treatment strategy.

Chirurgie réductrice du sac dural : Une option thérapeutique dans le cas de l’affaissement de la région fronto-temporale du cerveau. Le syndrome d’affaissement (brain sagging) fronto-temporal constitue une démence associée à l’hyper-somnolence, à des changements de personnalité ainsi qu’à des traits d’hypotension intracrânienne mis en évidence par l’imagerie par résonnance magnétique (IRM). Peu d’écrits ont abordé les options de traitement. Qui plus est, nombreux sont les patients atteints dont la condition ira en se dégradant. Nous voulons présenter ici un cas à propos duquel ce type d’affaissement a bien répondu à une chirurgie réductrice du sac dural. Des examens postopératoires par IRM ont en effet indiqué une normalisation de l’affaissement fronto-temporal et de la pression lombaire intrathécale. Bien qu’aucune preuve de fuite de liquide cérébro-spinal n’ait été observée, une dure-mère extrêmement mince a été notée peropératoirement, ce qui suggère qu’une dure-mère amincie et inefficace pourrait résulter de ce syndrome d’hypotension. Les médecins cliniciens confrontés à un tel syndrome devraient du coup envisager la chirurgie réductrice du sac dural à titre de stratégie thérapeutique.

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Copyright
Corresponding author
Correspondence to: Valerie L. Sim, Centre for Prions and Protein Folding Diseases, 204 Brain & Aging Research Building, University of Alberta, 8710-112 St, Edmonton, AB, Canada T6G 2M8. Email: valerie.sim@ualberta.ca
References
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8. Schievink, WI, Rosner, HL, Louy, C. A wearable epidural catheter infusion system for patients with intractable spontaneous intracranial hypotension. Reg Anesth Pain Med. 2015;40:49-51.
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Canadian Journal of Neurological Sciences
  • ISSN: 0317-1671
  • EISSN: 2057-0155
  • URL: /core/journals/canadian-journal-of-neurological-sciences
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