Spontaneous resolution of postoperative giant frontal pseudomeningocele

Tran, Dinh Binh; Hoai, Dinh Thi Phuong; Nguyen, Quoc Bao; Thi, Dang; Truong, Van Tri

doi:10.4103/ajns.ajns_18_21

Cited by 6 publications

(4 citation statements)

References 22 publications

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“…Although there have been previous reports of spontaneous resolution of giant cranial and spinal pseudomeningoceles [ 22 – 24 ], the exact mechanism behind the spontaneous reduction of the pseudomeningocele in this case is not clear. It can be hypothesised that the same inflammatory- and/or haemorrhage-driven process that resulted in ossification of the pseudomeningocele also resulted in later closure of the dural defect and CSF leak [ 22 , 24 ]. A reduction in CSF pressure and flow through the dural defect following the ETV, however, also likely played a key role.…”

Section: Discussionmentioning

confidence: 74%

Rapid ossification of a giant post-operative occipital pseudomeningocele following posterior fossa surgery

2023

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Pseudomeningocele formation following posterior fossa surgery is a well-recognised complication, occurring in up to 33% of operated cases in some series. Ossification of a cranial pseudomeningocele is, however, an exceptionally rare event with only three prior reported cases. We present the unique case of a paediatric patient who developed rapid ossification of a giant occipital pseudomeningocele following posterior fossa surgery. An 8-year-old female patient underwent a midline posterior fossa craniotomy for resection of an exophytic brainstem low-grade glioma. Post-surgery, the patient developed pan-ventricular hydrocephalus and a large occipital pseudomeningocele, which initially increased in size despite a successful endoscopic third ventriculostomy (ETV) being performed. At approximately 3 months post-surgery, reduction of the pseudomeningocele was observed with associated prominent ossification of the pseudomeningocele wall on computed tomography (CT) imaging. Surgical excision was subsequently undertaken, and intra-operatively, a large ossified pseudomeningocele was found. Follow-up MRI 1 month later demonstrated almost complete resolution of the pseudomeningocele with an associated reduction in the degree of pan-ventricular ventriculomegaly. This case highlights that ossification of even giant pseudomeningoceles can occur over a time period of just a few months and clinicians should consider ossification whenever a change in size or consistency of a post-operative pseudomeningocele is encountered.

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Section: Discussionmentioning

confidence: 74%

Rapid ossification of a giant post-operative occipital pseudomeningocele following posterior fossa surgery

2023

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“…Small dural defects heal almost spontaneously, whereas large dural defects, inadequate soft tissue coverage, scar tissue, previous irradiation, infection, nutritional deficiencies, steroids, and elevated CSF pressure may delay dural defect recovery. 13 As the CSF water hammer effect is also associated with tissue detachment, cyst formation, and cyst enlargement, 9 it is, therefore, necessary to completely prevent CSF leakage by using various sealants (e.g., fibrin glue) and the Valsalva maneuver during dural suture, as well as protective brain manipulation during the operation. Additionally, if a pseudomeningocele occurs, they often improve with conservative treatments, such as compression dressings, and rest to keep the head elevated but intractable cases may require needle aspiration or lumbar drainage.…”

Section: Discussionmentioning

confidence: 99%

Symptomatic Cerebellar Cyst Formation after Foramen Magnum Meningioma Removal: A Case Report

Hanai,

Yanaka,

Onuma

et al. 2024

Asian J Neurosurg

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Background Symptomatic cerebellar cyst formation after surgery is rare and the mechanism remains unknown. We describe a cerebellar cyst that gradually expanded, becoming symptomatic, after the removal of a foramen magnum meningioma and discuss the mechanism of cyst formation. Case Description A 76-year-old woman with a tumor at the foramen magnum was treated by posterior fossa craniotomy and C1 hemilaminectomy. The patient suddenly developed cerebellar symptoms and consciousness disturbance approximately 1 week into an otherwise good postoperative course. Imaging showed a subcutaneous pseudomeningocele in the occipital region and cerebellar cyst formation. After resolution by fenestration of the cerebellar cyst and duraplasty, the patient's symptoms gradually improved. No tumor or cerebellar cyst recurrence has been detected in over 5 years since the surgery. Conclusion Postoperative pseudomeningocele appeared crucial for cerebellar cyst formation. Postoperative development of symptomatic cerebellar cysts is rare but should be recognized as a serious, sometimes life-threatening, postoperative complication of posterior fossa surgery.

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“…On the other hand, diffusion-weighted imaging shows the lesion as hypointense and can be used to differentiate from epidermoid cysts, which appear as high signal intensity [9-11]. Intradiploic arachnoid cyst can be differentiated, in contrast to OIP, by the evident arachnoid lining [12]. Moreover, MRI can identify the coexistence of promoting factors such as hydrocephalus, cysts, or edema in the posterior cranial fossa.…”

Section: Discussionmentioning

confidence: 99%

“…Intradiploic arachnoid cyst can be differentiated, in contrast to OIP, by the evident arachnoid lining [12]. Moreover, MRI can identify the coexistence of promoting factors such as hydrocephalus, cysts, or edema in the posterior cranial fossa.…”

Section: Color Version Available Onlinementioning

confidence: 99%

Occipital Intradiploic Pseudomeningocele – A Rare Complication of Pediatric Posterior Cranial Fossa Surgery: Case Report and Review of the Literature

et al. 2022

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Introduction: Intradiploic pseudomeningoceles, also called intradiploic cerebrospinal fluid (CSF) fistulas, are abnormal CSF collection between the two bony tables of the calvaria resulting from post-surgical CSF leakage. To date, only six cases of intradiploic pseudomeningocele have been reported, all occurring in the occipital area. In this paper, we report the seventh case of late-onset occipital intradiploic pseudomeningocele (OIP) occurring in a young female patient who underwent surgery for the removal of a cerebellar pilocytic astrocytoma. At this regard, we also review the literature on the few recognized cases of OIP. Case presentation: The case of an 18-year-old female patient known to our institute for an operation 12 years earlier to remove a pilocytic astrocytoma is illustrated. At admission the patient complained only of occasional orthostatic headache. Brain imaging demonstrated a pseudomeningocele extended intradiploically from the occipital squama to the condylar and clivus regions, thinning both occipital bone tables and dilating the CSF-filled diploe. Watertight duroplasty and cranioplasty were effectively performed. Conclusion: Pediatric patients undergoing posterior cranial fossa craniotomy/craniectomy may postoperatively develop OIP. In this setting, treatment of any dural CSF fistula should be considered because of the risk of progressive extension and bone erosion.

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Spontaneous resolution of postoperative giant frontal pseudomeningocele

Cited by 6 publications

References 22 publications

Rapid ossification of a giant post-operative occipital pseudomeningocele following posterior fossa surgery

Rapid ossification of a giant post-operative occipital pseudomeningocele following posterior fossa surgery

Symptomatic Cerebellar Cyst Formation after Foramen Magnum Meningioma Removal: A Case Report

Occipital Intradiploic Pseudomeningocele – A Rare Complication of Pediatric Posterior Cranial Fossa Surgery: Case Report and Review of the Literature

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