Case Report. Subarachnoid Drainage of an Established or Chronic Pseudomeningocele

Stambough, Jeffery L.; Templin, Cary R.; Collins, John J.

doi:10.1097/00002517-200002000-00008

Cited by 24 publications

(11 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…4,21,39 Lumbar subarachnoid drains have also been used, primarily in the management of postoperative CSF leak and pseudomeningocele. 11,19,23,34 We do not routinely use drains for MISS cases, and thus no subfascial or lumbar drains were placed in any of the patients in this series. We believe that one of the benefits of MISS in the setting of durotomy is the decreased dead space resulting from a smaller incision and muscle-splitting approach.…”

Section: Discussionmentioning

confidence: 99%

“…4,8,9,19,39 However, serious complications, such as neurological deficit, pseudomeningocele, meningitis, and intracranial hemorrhage, have been reported. 4,5,7,11,14,20,[23][24][25][26][27][28]34,42 In addition, rates of persistent CSF wound leak and pseudomeningocele formation have been reported to be as high as 17.6%. 15 In our series of patients with a mean follow-up of 310 days, there were no complications referable to durotomy, which compares favorably with the current literature on durotomies after open cases.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Management of incidental durotomy in minimally invasive spine surgery

Ruban

O’Toole²

2011

FOC

View full text Add to dashboard Cite

Object Unintended durotomy is one of the most common complications in spine surgery that may lead to serious complications if not recognized or treated properly. There are few reports on the management of durotomies incurred during minimally invasive spine surgery (MISS). The authors describe their experience in a series of consecutive MISS patients with unintended durotomies. Methods All patients who underwent MISS by the senior author between August 2006 and February 2011 were retrospectively reviewed, and cases with unintended durotomies were identified. A case-control study was carried out comparing patient demographics and perioperative data between patients with and without durotomy. Surgical technique, including a proposed algorithm for management of durotomies, is described. Results Unintended durotomy occurred in 53 (9.4%) of 563 patients. The mean age at surgery was 60.7 years (range 30–85 years). Previous surgery at the same level was performed in 5 patients (9.4%). Two patients underwent posterior cervical surgery, and 51 patients underwent posterior lumbar surgery. Decompression alone was performed in 32 patients (60.4%), and fusion was performed in 21 patients (39.6%). The mean operative time was 105 minutes in the decompression group and 310 minutes in the fusion group (p < 0.001). Estimated blood loss was 60 ml in the decompression group and 381 ml in the fusion group (p < 0.001). The hospital length of stay was 52 hours in the decompression group and 106 hours in the fusion group (p < 0.001). The mean follow-up was 310 days, and there were no cases of cutaneous CSF fistula, pseudomeningocele, or other complications referable to durotomy in either group. Risk factors identified for durotomy included previous operation at the same level (p = 0.019) and operation in the lumbar spine region (p = 0.001). Conclusions In the authors' consecutive series of patients undergoing MISS, an unintended durotomy was associated with fewer complications than previously reported for open spinal surgery. The authors propose a simple management algorithm that includes early mobilization and results in excellent clinical outcomes with no incidence of postoperative cutaneous CSF fistula or other complications.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Management of incidental durotomy in minimally invasive spine surgery

Ruban

O’Toole²

2011

FOC

View full text Add to dashboard Cite

show abstract

“…Stambough et al, 20 reported the case of a chronic pseudomeningocele which was successfully managed without surgical repair. They use a subarachnoid drain.…”

Section: Discussionmentioning

confidence: 99%

Management of Incidental Lumbar Durotomy with Lumbar Drain and Fat Grafts

Soliman¹

2015

Egyptian Spine Journal

View full text Add to dashboard Cite

Background: Although dural tears (DTs) are known potential intraoperative complications of spine surgery, there is a relative lack of information about the true incidence of this common occurrence. Various studies have reported incidences ranging from 1.6%-17.4%. The literature on iatrogenic DT during spine surgery is surprisingly sparse; and the management is controversial. Purpose: To evaluate the use of lumbar drain and fat graft following incidental durotomy in prevention of early CSF leak and pseudomeningocele formation later on. Study Design: Prospective clinical case study. Patients and Methods: 343 patients were included in this study with degenerative spinal diseases indicated for decompression (lumbar disc, canal stenosis, degenerative spondylolisthesis or revision surgery). We excluded trauma cases and ventral tears not repaired. Patients with incidental dural tear had direct primary closure and then patients were divided into two groups: group A; a lumbar drains were inserted, and group B; a fat graft was used without drain. Both groups were followed-up for CSF leak control and pseudomeningocele formation. Results: We had 38 patients with DTs from 343 patients undergoing lumbar surgery with incidence of (11%). High incidence of DT occurred in revision surgeries (21.8%). In group (A), 85% of cases were free, 15% showed transient CSF leak managed conservatively, while in group (B), 72.2% were free, 27.7% showed transient CSF leak and 16.6% required repair for pseudomeningocele later on. Conclusion: Incidental durotomy is a well-known complication of spine surgery, and it occurs even among experienced spine surgeons. The use of lumbar drain was more efficient than fat graft in minimizing the postoperative CSF leak and pseudomeningocele formation. (2015ESJ078)

show abstract

“…3,20,23 The presence of the subcutaneous fluctuant collection serves as an indication of the degree of response to this treatment. If the lesion forms immediately after surgery due to a repaired or unrecognized durotomy or following intradural procedures requiring durotomy, immediate subarachnoid CSF drainage is suggested.…”

Section: Discussionmentioning

confidence: 99%

Lumbar myofascial flap for pseudomeningocele repair

Misra

Morgan

Sedler

2003

FOC

View full text Add to dashboard Cite

Object Initial management for lumbar pseudomeningoceles entails the closed external drainage of cerebrospinal fluid (CSF) with or without blood patch application. The presence of longstanding pseudomeningoceles and those associated with nonmicroscopic dural tears can be more problematic. Additionally the failure of nonoperative measures may necessitate surgery. Ideally the procedure should involve repairing the dural defect, removing the encapsulated cavity of the pseudomeningocele, and obliterating the extraspinal dead space to minimize the recurrence of the problem. Methods The authors describe a technique performed in 12 patients with large (> 5-cm-diameter) pseudomeningoceles referred for management following the failure of less aggressive measures. Diagnosis was based on symptoms of lumbar wound swelling, postural headaches, back and leg pain, and was confirmed by imaging studies. In all patients subarachnoid CSF drainage and initial operative attempts to obliterate the pseudomeningocele had failed. They were treated between July 1990 and July 1998. The cause of the pseudomeningoceles was lumbar discectomy (four patients), lumbar decompression (one patient), lumbar decompression and placement of instrumentation (five patients), and intradural procedures (two patients). Their mean age was 47.9 years (range 20–67 years), and they presented at a mean of 5.5 months postoperatively (range 3 weeks–37 months). In all cases there was a satisfactory repair of the pseudomeningocele, dead space obliteration, and long-term symptomatic resolution. Conclusions Lumbar myofascial advancement for this problem is a useful technique in cases of symptomatic pseudomeningoceles. This technique requires the medial advancement of the musculofascial units of the paravertebral muscles for a layered closure over the exposed spinal canal with obliteration of the pseudomeningocele.

show abstract

Case Report. Subarachnoid Drainage of an Established or Chronic Pseudomeningocele

Cited by 24 publications

References 8 publications

Management of incidental durotomy in minimally invasive spine surgery

Management of incidental durotomy in minimally invasive spine surgery

Management of Incidental Lumbar Durotomy with Lumbar Drain and Fat Grafts

Lumbar myofascial flap for pseudomeningocele repair

Contact Info

Product

Resources

About