Large Compressive Pseudomeningocele Causing Early Major Neurologic Deficit After Spinal Surgery

Abstract

Study Design:Retrospective review.Objectives:Large compressive pseudomeningocele causing a major neurologic deficit is a very rare complication that is not well described in the existing literature.Methods:Institutional review board consent was obtained to study 2552 consecutive extradural spinal surgical cases performed by a single senior spinal surgeon during a 10-year period. The surgeon’s database for the decade was retrospectively reviewed and 3 cases involving postoperative major neurologic deficits caused by large compressive pseudomeningocele were identified.Results:The incidence of postoperative compressive pseudomeningocele causing major neurologic deficit was 0.12% (3/2552) per decade of spinal surgery with approximately 1.3% of cases incurring incidental durotomy. Average age of the patients was 57 years (range 45-78). One patient had posterior cervical spine surgery, and 2 patients had posterior lumbar surgery. All 3 patients had intraoperative incidental durotomy repaired during their index procedure. Large compressive pseudomeningocele causing major neurologic deficit occurred in the early 2-week postoperative period in all patients and was clearly identified on postoperative magnetic resonance imaging. All 3 patients were treated with emergent decompression and repair of the dural defect. All patients recovered neurologic function after revision surgery.Conclusions:Incidental durotomy and repair causing a large compressive pseudomeningocele after spine surgery is a rare and potentially devastating event. Early postoperative magnetic resonance imaging assists in the diagnosis. Emergent decompression combined with revision dural repair surgery may result in improved outcomes. Surgeons should be cognizant of this rare cause of early postoperative major neurologic deficit in patients who had previous dural repair.

Giant dorsolumbar pseudomeningocele: Unusual evolution of traumatic dural tiny tear

“…Pseudomeningoceles with a size of more than eight centimeters in diameter has been reported previously in only 22 cases [1,2]. Pseudomeningoceles are usually asymptomatic being embedded in the posterior paraspinal soft tissue.…”

“…The postoperative etiology is the most frequent. The defect can be also traumatic or congenital [1].…”

Late-Onset Cervical Pseudomeningocele Following Ossification of the Posterior Longitudinal Ligament Surgery Successfully Treated With a Lumboperitoneal Shunt

“…A pseudomeningocele can cause symptoms related to CSF hypotension, such as blurry vision, dizziness, postural headaches, diplopia, headaches, tinnitus, back pain, radicular symptoms, nausea, and vomiting, as well as neurologic deficit mainly resulting from herniation of neural tissue through the dural defect [ 17 , 18 ]. In our case, although there was no herniation of the spinal cord, the patient presented with a worsening of his clinical condition.…”

Postoperative Bildgebung der Wirbelsäule

“…5 ; [ 39 ]). Kommt es im Operations- oder Zugangsgebiet zu einer extraduralen Kollektion von Liquor innerhalb einer Pseudokapsel, liegt eine Pseudomeningozele vor, die palpabel sein kann [ 38 ]. Typischerweise zeigt sich eine liquorisointense, zystische Formation mit Verbindung zum Duralsack.…”