Efficacy of endoscopic assistance in dural closure for a patient with superficial siderosis

Superficial siderosis (SS) is a rare disease in which hemosiderin is deposited on the surface of the brain and spinal cord because of chronic repeated bleeding into the subarachnoid space. Ventral spinal dural defect has been associated with SS and surgical defect closure has been recognized as an effective treatment.We describe a patient with SS in whom endoscopic assistance was required to identify and repair the dural defect. The patient presented with progressive hearing loss and ataxia. Magnetic resonance imaging (MRI) demonstrated SS and a ventral spinal epidural fluid collection extending from T5 to T8. Computed tomography myelography showed ventral epidural leakage of contrast medium at T8. Thoracic osteoplastic laminotomy for dural closure was performed. Endoscopic inspection of the ventral dura revealed a communication between the epidural and subarachnoid spaces through a dural defect without manipulating the spinal cord. Finally, the dural defect could be successfully closed under a microscope with minimal spinal cord manipulation. The patient experienced no further neurological deterioration. Follow-up MRI showed disappearance of the epidural fluid collection.Endoscopic assistance was useful in our patient because it enabled visualization and repair of the responsible ventral dural defect with minimal spinal cord manipulation.