Rare Image of Epidural Catheter Fracture in Lumbar Analgesia

Objective. Accidental fracture of epidural analgesia catheters has a very low incidence of 2.5 per 100,000 anesthesia. A rare image of the fracture is reported. Methods. A 42-year-old female patient was attending a cesarean section eight years earlier to her consult. In the cesarean section, she received regional epidural anesthesia, and the main complaint was low back pain, specifically between the spinous processes L2 and L3. The somatic pain had been presenting intermittently for eight years. The sagittal section of magnetic resonance imaging of the lumbar spine showed a “golf club” image from the midline to the laminae of L2 and L3 with the subcutaneous tissue. Results. A small right hemilaminectomy was performed to remove the complete catheter, which did not adhere, but was coiled in the S-shape. The catheter was trapped between the left facets of L2 and L3 laterally than through the midline. Several risk factors and therapeutic procedures have been proposed. Conclusion. In a systematic review, 24 articles were reported on this specific issue. No surgical procedure and follow-up were informed by 8 authors. Surgical remotion by laminectomy was used in 9 articles, surgical explanation by skin incision was reported by 4 authors, and remotion by endoscopy was reported in 1 article. Two articles not reported solution

A special case of intramedullary teratoma in an adult. Literature review

Spinal teratomas that occur in adulthood are rare. The most accepted theory is that of a disembryogenic origin, but in this case we present the theory of misplaced germ cells.We present a 54-year-old male with saddle hypoesthesia, 3/5 paraesthesia of the lower extremities, urinary incontinence, loss of anal sphincter tone, and patellar and achilles hyporeflexia, of 10 months’ evolution. The MRI showed a heterogeneous, cystic and solid intramedullary lesion with defined edges. Laminoplasty surgery of L2 to L4 and complete resection of the lesion was performed. The histopathological study found a mature teratoma.The incidence of intraspinal teratomas is very low. There are two theories: the disembryogenic theory (most accepted) and the misplaced germ cell theory (our case). This pathogenesis of teratoma formation involves a niche of pluripotent cells from the primitive knot or a caudal cell mass that may precede the formation of a dysraphism. In this modified theory, teratoma growth sometimes causes disruption of the development field and dysraphism. Resumen: Los teratomas espinales, son raros que se presenten en edad adulta. La teoría más aceptada es disembriogénica, pero en este caso exponemos la teoría de células germinales del fuera de lugar.Presentamos un masculino de 54 años, de 10 meses de evolución con hipoestesia en silla de montar, parestesia miembros pélvicos 3/5, incontinencia urinaria, tono de esfínter anal ausente, hiporeflexia patelar y aquilea. RMN lumbar muestra lesión tumoral heterogénea intramedular, quística y solida, bordes definidos. Se realiza cirugía de laminoplastia de L2-L4 y resección total de lesión tumoral, con resultado del estudio histopatológico de Teratoma maduro. La incidencia de teratomas intraespinales es muy baja. Existen 2 teorías: teoría disembiogénica (más aceptada) y teoría de células germinales fuera de lugar (nuestro caso). Esta patogénesis de formación de teratoma tiene nicho de células pluripotentes a partir de nodos de Hensen o masa celular caudal que puede preceder a la formación de disrafismo. Esta teoría modificada, del crecimiento de teratoma a veces causa interrupción del campo del desarrollo y disrafismo. Keywords: Teratoma, Spinal tumour, Mollaret's meningitis, Aseptic meningitis, Intradural, Misplaced germ cell theory, Palabras clave: Teratoma, Tumour espinal, Meningitis Mollaret, Meningitis aséptica, Intradural, Teoría de las células germinales fuera de luga