• Eduardo Augusto Iunes, Enrico Affonso Barletta, Fernando Seiji Suzuki, Telmo Augusto Barba Belsuzarri, Daniel de Araújo Paz, Fabio Veiga de Castro Sparapani, Franz Jooji Onishi, Sergio Cavalheiro, Thiago Salati, Vinicius de Meldau Benites, Guilherme Riechelmann, and Andrei Fernandes Joaquim.
• Federal University of São Paulo, Medical School, Neurosurgery Department, São Paulo, Brazil.
• World Neurosurg. 2020 Jul 1; 139: 592-602.

BackgroundIdiopathic ventral spinal cord herniation (ISCH) is a rare disease; however, it is an important differential diagnosis. Its treatment presents some controversies.Case DescriptionWe report on a 55-year-old woman who had been presenting with relevant back pain and leg weakness for the past 3 years and urinary incontinence for the past 3 months. Clinical examination disclosed paresis on the right inferior limb and right foot, as well as a T6-level painful hypoesthesia. Magnetic resonance imaging disclosed a T4/T5 ISCH. The patient underwent surgical decompression. During the procedure, we opened the arachnoid and cut the dentate ligaments of the spine, which considerably improved the mobility and safety of the procedure. In the early follow-up, our patient presented a partial improvement regarding the paresis grades and hypoesthesia pain relief on the left side. A video showing the surgical procedure and case evolution is presented. We also assembled literature reviews to compare our case with others. ISCH is becoming a more recognized cause of progressive thoracic myelopathy. However, this condition is still frequently misdiagnosed. Magnetic resonance imaging is the key for diagnosis. The objective of surgical treatment is to prevent myelopathy progression. The technique presented in this report is an appropriate surgical option, once it is a safer way to identify and treat the defect. The neurologic condition usually improves greatly after surgical treatment, especially when the patient presents positive predictive factors.ConclusionsISCH is being more recognized. The technique presented is an appropriate surgical option.Copyright © 2020 Elsevier Inc. All rights reserved.

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