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

Abstract

Pseudomeningocele is an extradural cerebrospinal fluid collection arising from a dural defect, that may be congenital, traumatic, or more commonly as a result of postoperative complication. Majority of the postoperative pseudomeningoceles occurring after lumbar spine surgeries are small and resolve spontaneously. However, large pseudomeningoceles are rare and spontaneous resolution of such pseudomeningoceles has not been described. We report four cases of postoperative large lumbar pseudomeningoceles that presented as asymptomatic soft fluctuant swelling over the back which resolved spontaneously. We also reviewed the related literatures and operative records of these patients to find the possible mechanism of occurrence, their management, prevention, and reasons for spontaneous resolution. We conclude that nonoperative management under close observation can be employed for asymptomatic postoperative large lumbar pseudomeningoceles. Surgical exploration and repair should be reserved for symptomatic cases presenting with clinical features of intracranial hypotension, worsening neurology, external fistula or infection, thereby avoiding morbidity and potential complications associated with surgical treatment.

Spinal Cord Stimulator Paddle Lead Surgery Complicated by Cerebrospinal Fluid Leak and Fistula Formation

“…Complications of dural tears include spinal fluid leaks, post-dural puncture headache (PDPH), and meningitis [14]. Although pseudomeningoceles have been reported to resolve spontaneously, management is required for symptomatic patients [13]. This patient presented with pain and tenderness at the site of the pseudomeningocele.…”

“…Pseudomeningocele etiology is based on a dural opening, which leaks cerebrospinal fluid and subsequently forms a fluid-filled pocket. Pseudomeningoceles are extradural collections of cerebrospinal fluid that result from a dural defect and violation of subarachnoid space [13]. Sequelae of pseudomeningoceles include intracranial hypotension, site pain, nerve compression, external fistula tract formation, and meningitis [13].…”

“…Pseudomeningoceles are extradural collections of cerebrospinal fluid that result from a dural defect and violation of subarachnoid space [13]. Sequelae of pseudomeningoceles include intracranial hypotension, site pain, nerve compression, external fistula tract formation, and meningitis [13]. A congenital dural defect, traumatic puncture, or iatrogenic durotomy are all possible causes of the pathologic dural opening found in pseudomeningoceles.…”

“…A congenital dural defect, traumatic puncture, or iatrogenic durotomy are all possible causes of the pathologic dural opening found in pseudomeningoceles. Postoperative pseudomeningoceles are most likely caused by dural tears due to unintentional durotomy without complete closure or dural puncture by sharp bone edges post-laminectomy [13].…”

Spontaneous pseudomeningocele associated with lumbar spondylolisthesis: A case report and review of the literature

“…The most common are iatrogenic, resulting from unintended dural tear during surgery. [ 4 6 ] Scarcer iatrogenic causes include dural puncture for epidural catheter placement. There are a few reported cases of traumatic pseudomeningocele associated with spina bifida occulta or in conjunction with congenital diseases such as Marfan syndrome and neurofibromatosis.…”