Cauda equina entrapment in a pseudomeningocele after lumbar Schwannoma extirpation

Incidental or intentional durotomy causing cerebrospinal fluid (CSF) leakage, leading to the formation of a pseudomeningocele is a known complication in spinal surgery. Herniation of nerve roots into such a pseudomeningocele is very rare, but can occur up to years after initial durotomy and has been described to cause permanent neurologic deficit. However, cauda equina fiber herniation and entrapment into a pseudomeningocele has not been reported before. Here, we present a case of symptomatic transdural cauda equina herniation and incarceration into a pseudomeningocele, 3 months after extirpation of a lumbar Schwannoma. A 59-year-old man, who previously underwent intradural Schwannoma extirpation presented 3 months after surgery with back pain, sciatica and loss of bladder filling sensation caused by cauda equina fiber entrapment into a defect in the wall of a pseudomeningocele, diagnosed with magnetic resonance imaging. On re-operation, the pseudomeningocele was resected and the herniated and entrapped cauda fibers were released and replaced intradurally. The dura defect was closed and the patient recovered completely. In conclusion, CSF leakage can cause neurological deficit up to years after durotomy by transdural nerve root herniation and subsequent entrapment. Clinicians should be aware of the possibility of this potentially devastating complication. The present case also underlines the importance of meticulous dura closure in spinal surgery

Monitoring und Qualitätssicherung von Prävention und Gesundheitsförderung auf Bundesebene

Das Monitoring und die Qualitätssicherung zur Ermittlung des Bedarfs und der Wirksamkeit von Präventions- und Gesundheitsförderungsmaßnahmen gewinnen zunehmend an Bedeutung. Der vorliegende Beitrag stellt exemplarisch diesbezügliche Aktivitäten auf Bundesebene vor, die von der Bundeszentrale für gesundheitliche Aufklärung und vom Robert Koch-Institut durchgeführt werden. Als Beispiele wurden die Präventionsthemen „HIV/Aids“, „Ernährung und Bewegung“ sowie „Kindergesundheit“ ausgewählt. Sie veranschaulichen die Rolle der epidemiologischen Surveillance, der Gesundheitsberichterstattung, der Evaluation und der Interventionsberichterstattung. Das Robert Koch-Institut und die Bundeszentrale für gesundheitliche Aufklärung liefern sich ergänzende Informationen zur Gesundheits- und Interventionsberichterstattung auf Bundesebene. Mit ihren Berichten stellen sie der Politik Entscheidungsgrundlagen zur Verfügung, um nationale Gesundheitsziele und Aktionspläne evidenzbasiert zu formulieren, umzusetzen und zu evaluieren.Monitoring and quality assurance are gaining in importance for the identification of needs and the effectiveness of prevention and health promotion activities. This paper presents examples of activities of monitoring and quality assurance at the federal level, carried out by the Federal Centre for Health Education and the Robert Koch Institute. Examples include the prevention issues “HIV/AIDS”, “nutrition and physical activity” and “child health”. They illustrate the roles of epidemiological surveillance, health monitoring, evaluation, and intervention reporting. The Robert Koch Institute and the Federal Centre for Health Education provide complementary information on health and intervention reporting at the federal level. With their reports, they provide essential information for health policy to formulate, to implement and to evaluate evidence-based national health goals and action plans