Management of giant pseudomeningoceles after spinal surgery

Abstract

BackgroundPseudomeningoceles are a rare complication after spinal surgery, and studies on these complex formations are few.MethodsBetween October 2000 and March 2008, 11 patients who developed symptomatic pseudomeningoceles after spinal surgery were recruited. In this retrospective study, we reported our experiences in the management of these complex, symptomatic pseudomeningoceles after spinal surgery. A giant pseudomeningocele was defined as a pseudomeningocele >8 cm in length. We also evaluated the risk factors for the formation of giant pseudomeningoceles.ResultsAll patients were treated successfully with a combined treatment protocol of open revision surgery for extirpation of the pseudomeningoceles, repair of dural tears, and implantation of a subarachnoid catheter for drainage. Surgery-related complications were not observed. Recurrence of pseudomeningocele was not observed for any patient at a mean follow-up of 16.5 months. This result was confirmed by magnetic resonance imaging.ConclusionsWe conclude that a combined treatment protocol involving open revision surgery for extirpation of pseudomeningoceles, repair of dural tears, and implantation of a subarachnoid catheter for drainage is safe and effective to treat giant pseudomeningoceles.

Remote Cervical Pseudomeningocele Following Anterior Cervical Corpectomy and Fusion: Report of a Case and Review of the Literature

“…If the layers of the cervical incision are not closed tightly, CSF will leak through the surgical incision. [11][12][13][14][15][16][17] However, removal of the osteophytes in cervical spondylotic myelopathy may result in micro tears which are not immediately evident. But can lead to low flow cerebrospinal fluid fistula with very gradual expansion and ultimately chronic formation of a pseudomeningocele as was demonstrated in the present case.…”

“…[4][5][6][7][8][9][10] But, in rare occasions, iatrogenic cervical pseudomeningoceles may occur after anterior cervical procedures mainly after ACCF rather than ACDF as a consequence of an inadvertent tear of the dura mater and pia arachnoid breach or a lack of closure of the dural tear with resultant CSF leakage into the anterior compartment of the neck. [11][12][13][14][15][16][17] A chronic case which is the consequence of microdural tear, a pseudomeningocele develops from a month and later after surgery where time permits the surrounding tissue to react with formation of fibrous capsule around the CSF collection. The most striking, clinical feature of a chronic one might be only a unilateral soft palpable mass seen on the anterior aspect of the neck.…”

“…[15][16][17] Surprisingly, all these reported cases were acute ones and in careful review of the literature, we could not find even a single case of chronic spinal pseudomeningocele following anterior spinal surgeries.…”

Post-operative Pseudomeningocele after Spine Surgery: Rare Cause of Failed Back Syndrome

“…The lumbar spine has a higher intraspinal pressure in erect posture, and hence there is a greater incidence of pseudomeningocele formation noted at this level. Giant pseudomeningocele is a pathology where the size of the lesion is ≥ 8 cm in diameter (9). It is a very rare entity and only 22 cases have been reported in literature so far (10)(11)(12)(13)(14).…”

Traumatic anterior cervical pseudomeningocele causing intracranial hypotension successfully treated with blood patch: case report

“…In more rare cases, pseudomeningoceles can be caused by trauma. 2,5,6,11,12 We present the case of a relatively uncommon posttraumatic anterior cervical pseudomeningocele, with symptoms of intracranial hypotension, successfully treated with a blood patch.…”