case_images: PMC6051269_01
case_images: Schematic of DuraSeal dural sealant system assembly. Note. Omit step 7 as the spray tip is not needed for percutaneous injection of the hydrogel sealant. Instead attach the applicator directly to the Tuohy needle hub using the Luer lock mechanism.
case_images: CRIA2018-4189518.001.jpg
case_images: PMC6051269_01_CRIA2018-4189518.001.jpg
case_images: fig1
case_images: T10-T11 and T11-T12 was planned. The hydrogel sealant was prepared according to package insert instructions (Figure 1).
case_images: CT-guided image displaying the Tuohy needle trajectory to achieve right-sided transforaminal epidural placement for the injection of hydrogel sealant.
case_images: CRIA2018-4189518.002.jpg
case_images: PMC6051269_01_CRIA2018-4189518.002.jpg
case_images: fig2
case_images: Tuohy needle was used for transforaminal placement of the sealant at T10-T11 with the goal volume of 5 ml. The final needle tip location was placed slightly more ventral (Figure 2) compared to the initial injection at T11-12 as the dural defect had previously been identified to be more ventral in location.
case_images: Axial T2 postinjection MRI demonstrating extradural hydrogel sealant deposition with leftward displacement of the thecal sac and spinal cord at T10-11.
case_images: CRIA2018-4189518.003.jpg
case_images: PMC6051269_01_CRIA2018-4189518.003.jpg
case_images: fig3
case_images: T10-T11 level with normal cord signal (Figure 3). The patient subsequently developed signs and symptoms consistent with a concordant right-sided dermatomal thoracic neuralgia, presumably due to mass effect on the lower thoracic spinal nerve roots, but did not demonstrate any myelopathy.