A hospital-based analysis of pseudomeningoceles after elective craniotomy in children: what predicts need for intervention?

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>In pediatric patients, the development of a postoperative pseudomeningocele after an elective craniotomy is not unusual. Most will resolve with time, but some may require intervention. In this study, the authors analyzed patients who required intervention for a postoperative pseudomeningocele following an elective craniotomy or craniectomy and identified factors associated with the need for intervention.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>An institutional operative database of elective craniotomies and craniectomies was queried to identify all surgeries associated with development of a postoperative pseudomeningocele from January 1, 2010, to December 31, 2017. Demographic and surgical data were collected, as were details regarding postoperative events and interventions during either the initial admission or upon readmission. A bivariate analysis was performed to compare patients who underwent observation with those who required intervention.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>Following 1648 elective craniotomies or craniectomies, 84 (5.1%) clinically significant pseudomeningoceles were identified in 82 unique patients. Of these, 58 (69%) of the pseudomeningoceles were diagnosed during the index admission (8 of which persisted and resulted in readmission), and 26 (31%) were diagnosed upon readmission. Forty-nine patients (59.8% of those with a pseudomeningocele) required one or more interventions, such as lumbar puncture(s), lumbar drain placement, wound exploration, or shunt placement or revision. Only race (p &lt; 0.01) and duraplasty (p = 0.03, OR 3.0) were associated with the need for pseudomeningocele treatment.</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>Clinically relevant pseudomeningoceles developed in 5% of patients undergoing an elective craniotomy, with 60% of these pseudomeningoceles needing some form of intervention. The need for intervention was associated with race and whether a duraplasty was performed.</jats:p></jats:sec>

Supraorbital Keyhole Craniotomy in Pediatric Neurosurgery: A Systematic Review of Clinical Outcomes and Cosmetic Outcomes

“…54 In pediatric patients undergoing elective craniotomy surgery not specific to supraorbital keyhole approach, one study reported 84 pseudomeningoceles in 82 (5%) J o u r n a l P r e -p r o o f patients out of a total of 1648 craniotomies, with 60% of these lesions found to require some form of intervention. 55 This review found 5 cases of subgaleal CSF collection, all from the same series, 44 which resolved within 2 weeks through combined medical therapy and bandaging.…”

Management of pseudomeningocele following posterior fossa tumor surgery with absence of hydrocephalus: A case report

“…How long should a surgeon endure conservative treatment? Some surgeons perform conservative therapy for 7–14 days before exploring a posterior fossa pseudomeningocele following tumor resection [1] , [3] . However, there are other factors that must be considered including the burden on the patient while the pseudomeningocele is present, as well as its evolution.…”

“…Pseudomeningocele is the abnormal extradural accumulation of CSF at the operative site following cranial or spinal surgery [1] , [2] , [3] . It may be due to poor surgical closure of the dura or when CSF fills the potential space created during the surgery [2] .…”

“…A small portion of the pseudomeningocele becomes persistent or recurrent and poses the risk of wound dehiscence, CSF fistula formation, intracranial hypotension, meningitis, and rarely death [2] , [6] . Although pseudomeningocele is not an uncommon complication, there is currently no consensus or standard protocol regarding the type and timing of treatment [1] , [2] , [4] , [6] . There has been little literature which reported the uses of puncture techniques as a conservative treatment.…”