Intradural Lumbar Migration of Intracranial Neurosurgical Hemostatic Clip Associated with Lumbosciatic Pain.

Background: Clips implanted during intracranial neurosurgical procedures sometimes migrate intradurally with rare cases of spinal migration. The appearance of radicular symptoms of topography concordant with the position of the foreign body leads to discussion about the optimal therapeutic strategy.
Case Description: We report the case of a 52-year-old woman suffering from L5 radicular pain resistant to medical treatment in the presence of L4L5 lumbar stenosis and a neurosurgical clip migrated to the L5S1 level. This clip had been implanted 19 years earlier during a surgical procedure in the posterior fossa, for resection of a juvenile astrocytoma. The imputability of this clip was deemed low given its location and history. A laminarthrectomy associated with circumferential arthrodesis of the L4L5 level was performed allowing complete improvement of radiculopathy. Surgical removal of the clip was not performed.
Conclusion: Craniospinal migrations of neurosurgical clips are rare. Their imputability in the appearance of root symptoms is random and is based on a bundle of clinical, radiologic, and neurophysiologic arguments. Surgical removal should not be the standard treatment, especially if there is another cause of root compression.
(Copyright © 2018 Elsevier Inc. All rights reserved.)