Neurological recovery after surgical treatment of giant cervical pseudomeningoceles extending to lumbar spine associated with previous brachial plexus injury

Abstract

The authors describe a case of 28-year-old man who presented with cervical myelopathy and lumbar radiculopathy due to the giant cervical pseudomeningocele extending to the lumbar spine at 10 years after previous brachial plexus injury. To evaluate the communicating tract between pseudomeningocele and subarachnoidal space, the multidetector-row helical CT with simultaneous myelography was performed preoperatively. The surgical treatment in the cervical spine included the resection of pseudomeningocele and the repair of dural defects communicating into the cyst following multi-level laminoplasty and foraminotomies. At 6 years after surgery, the significant neurologic recovery and complete obliteration of cysts in the whole spine area were maintained. This serves as the first report describing the significant neurologic recovery after the surgical treatment of giant cervical pseudomeningocele extending to the lumbar spine after previous brachial plexus injury.

Cervical vertebral fusion with anterior meningocele

“…There is a growing number of case reports of anterior cervical meningocele associated with trauma; either atlanto-occipital dislocation 17 or brachial plexus injury. 18 The imaging in this case did not show any evidence of these traumatic processes.…”

A Giant Lumbar Pseudomeningocele in a Patient with Neurofibromatosis Type 1: A Case Report

“…When discovered, immediate surgical repair has been recommended especially for large pseudomeningoceles with the goal to prevent fistulous tract and infections [ 11 ]. Various treatment options like close observation for spontaneous resolution of small lesions, epidural blood patch, lumbar subarachnoid drainage and synthetic dural patch have been described in the literature for management of pseudomeningoceles with good results [ 12 – 14 ]. It is well known that the presence of dystrophic features in patients with type 1 neurofibromatosis increases the risk of relapse of pseudomeningocele after surgery [ 15 ].…”

Spontaneous resolution of postoperative lumbar pseudomeningoceles: A report of four cases

“…Various treatment options like close observation for spontaneous resolution, conservative measures such as bed rest, and application of an epidural blood patch, lumbar subarachnoid drainage, and definitive surgical repair have been described in the literature for management of postoperative pseudomeningoceles depending on their size and patient's symptoms 1. Immediate surgical repair has been recommended in the literature for large pseudomeningoceles to prevent fistulous tract formation which is a conduit for infection 285. The same was advised in all our patients, except in case1 where a dural repair was already attempted.…”