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Background: Pseudomeningocele is a considerable morbidity after posterior fossa surgery. Its incidence and optimal management strategies are quite unclear. Hence the objective of this study is to define the risk factors and evaluate the management strategies and to study the incidence and morbidity of postoperative posterior fossa pseudomeningocele.Methods: A retrospective study of 33 patients undergone posterior fossa surgery for variety of diseases in the department of neurosurgery, Saveetha Medical College and Hospital from January 2015 to December 2018 with emphasis on incidence of pseudomeningocele,its morbidity and treatment strategies.Results: Out of 33 posterior fossa surgeries performed, 9 developed pseudomeningocele. Hence the incidence of pseudomeningocele in hospital is 27.27%. Out of 9 patients who developed pseudomeningocele, 6 patients were symptomatic, and aspiration was done to 5 patients and one patient underwent resurgery. That one patient underwent subgaleal-peritoneal shunt, excision of recurrent tumor was performed after which the symptoms subsided.Conclusions: Psudomeningocele is a well-known complication of posterior fossa surgery. The risk factors for pseudomeningocele formation after posterior fossa surgery has been evaluated. Age, sex and type of surgery are found to be a risk factors in our study. Conservative management is effective in most cases to reduce the symptoms. Surgical intervention is advocated, only when conservative treatment fails. Preventive measures like careful perioperative planning, strict adherence to aseptic techniques, usage of autologous pericranium with dural sealant augmentation, polyethylene glycol hydrogel dural sealant can be adopted.
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OBJECTIVE: Many surgeons advocate for watertight dural reconstruction after posterior fossa surgery given the significant risk of cerebrospinal fluid (CSF) leak. Little evidence exists for posterior fossa dural reconstruction utilizing monolayer collagen matrix onlay graft in a non-watertight fashion. Our objective was to report the results of using collagen matrix in a non-watertight fashion for posterior fossa dural reconstruction. METHODS: We conducted a retrospective review of operations performed by the senior author from 2004-2011 identified collagen matrix (DuraGen) use in 84 posterior fossa operations. Wound complications such as CSF leak, infection, pseudomeningocele, and aseptic meningitis were noted. Fisher's exact test was performed to assess risk factor association with specific complications. RESULTS: Incisional CSF leak rate was 8.3% and non-incisional CSF leak rate was 3.6%. Incidence of aseptic meningitis was 7.1% and all cases resolved with steroids alone. Incidence of palpable and symptomatic pseudomeningocele in follow-up was 10.7% and 3.6% respectively. Postoperative infection rate was 4.8%. Previous surgery was associated with pseudomeningocele development (p<0.05). CONCLUSION: When primary dural closure after posterior fossa surgery is undesirable or not feasible, non-watertight dural reconstruction with collagen matrix resulted in incisional CSF leak in 8.3%. Incidence of pseudomeningocele, aseptic meningitis, and wound infection were within acceptable range. Data from this study may be used to compare alternative methods of dural reconstruction in posterior fossa surgery.
Subject(s)
Cerebrospinal Fluid , Collagen , Follow-Up Studies , Incidence , Inlays , Meningitis, Aseptic , Retrospective Studies , Risk Factors , Steroids , Transplants , Wound Infection , Wounds and InjuriesABSTRACT
Objetivo: Describir y analizar un caso de Chiari I con edema medular y aumento de la siringomielia (SM), luego de una descompresión cráneo espinal (DCE). Descripción: una mujer de 57 años consultó por cefaleas agravadas por maniobras de Valsalva, hipo, disfagia e hipoestesia distal del miembro superior izquierdo. La Resonancia Magnética (RM) mostró una malformación de Chiari tipo I con SM. Intervención: en abril del 2009 se efectuó una DCE (occipital + atlas) con plástica meníngea (dura artificial). En el postoperatorio inmediato notó aumento de su cefalea, y además se produjo una fístula de LCR que se trató con un drenaje lumbar externo. Como sus síntomas pre y postoperatorios mejoraron fue externada. En la RM realizada a los 15 días se observó un pseudomeningocele (PM) con edema medular. Los controles posteriores mostraron la desaparición del edema y el PM, con un aumento en el tamaño de la SM. En marzo del 2011 se hizo una laminectomía del axis sin reducción de la SM. Luego de un acceso de tos apareció un dolor neuropático en el brazo izquierdo. La nueva RM mostró que la SM no se había reducido y que la plástica meníngea se había retraído obstruyendo la cisterna magna. En diciembre del 2011 se realizó una nueva plástica meníngea con periostio y la RM de marzo del 2012 mostró una desaparición de la SM. Conclusión: en este caso, el edema medular y el PM se redujeron espontáneamente pero la SM no mejoró hasta eliminar todas las causas de obstrucción en la circulación del LCR a nivel del foramen magno.
Objective: To describe and analyze a Chiari I malformation with spinal cord edema and syrinx increase after craneospinal decompression (CED).Description: a 57 years-old female referred a history of headaches after Valsalva maneuvers, hiccup, dysphagia and left distal upper limb hypoesthesia. Magnetic Resonance Imaging (MRI) showed a Chiari I malformation with syringomyelia.Intervention: during April 2009 a CED (occipital + atlas) with a non autologous duraplasty were performed. In the immediate postoperative period headaches increased and also appeared an external CSF fistula that was treated successfully with an external lumbar drainage. As the pre and postoperative symptoms improved she was discharged. After 15 days MRI revealed a pseudomeningocele (PMC) with spinal cord edema. Further controls showed the disappearance of the PMC and the edema with syrinx increase. In March 2011 a laminectomy of the axis was performed without reduction of the syrinx. A few months later and after a cough attack a neuropathic pain developed in the left upper limb. MRI showed a larger syrinx with retraction of the duraplasty. In December 2011 a new duraplasty with autologous pericranium was performed. Three months latter a postoperative MRI showed syrinx resolution. Conclusion: in this case the spinal cord edema and PMC resolved spontaneously but syringomyelia improved only after removing all the causes that obstructed the normal CSF circulation at the foramen magnum.
Subject(s)
Humans , Arnold-Chiari Malformation , Decompression , Edema , Meningocele , SyringomyeliaABSTRACT
Upward migration of the peritoneal catheter of a subgaleo-peritoneal (SP) shunt and coiling into the subgaleal space is an extremely rare complication of a SP shunt. A 32-year-old male patient visited our hospital presenting with a large skull defect due to a prior craniectomy performed elsewhere. The patient underwent a cranioplasty with methylmetacrylate, but subsequently developed progressive pseudomeningocele and subgaleal cerebrospinal fluid (CSF) collection. The patient underwent CSF diversion via a SP shunt. After SP shunting, the pseudomeningocele disappeared completely. Six months later, the patient presented with progressive scalp swelling. Skull X-ray showed migration and coiling of the distal catheter of the SP shunt. The patient was treated by removing the entire shunt catheter and the dura was covered with a subgaleal flap. We would like to report our experience with a very rare complication of subgaleo-peritoneal shunting.
Subject(s)
Adult , Humans , Male , Catheters , Cerebrospinal Fluid , Scalp , SkullABSTRACT
ObjectiveTo evaluate the value of MR imaging(MRI)in diagosing of obstetrical brachial plexus.MethodsBetween September 2006 to September 2011,eighteen cases (12 males and 6 females)of obstetrical brachial plexus injury had being used for investigation,aging from 2 month to 3 years, average of 10.6 month. Eight left side and 10 right side. Tassin Ⅰ was 4 cases,Tassin Ⅱ was 6 eases, Tassin Ⅲwas 5 eases, Tassin Ⅳ was 4 cases. All cases were performed to MRI test before operating and the result compare with finding during operating. ResultsFindings of MRI:pseudomeningocele was in 13 of the 18cases while 10 of the 15 patients had multiple pseudomeningoceles. Displacement of spinal cord was in 6 cases; Normal was 2 cases; thickening of nerve root was in 2 cases.ConclusionMR imaging is an effective tool for demonstrating lesions of the brachial plexus worthy of surgical exploration.
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Pseudomeningocele is rare complication after lumbar discectomy. Most pseudomeningoceles are asymptomatic, but sometimes can cause headaches, infection, back pain, and radicular pain. Treatment modalities include conservative management, epidural blood patch, lumbar subarachnoid drainage, and surgery. We report a successful treatment of pseudomeningocele with epidural blood and fibrin glue patch, which did not treated with conservative management and epidural blood patch alone.
Subject(s)
Back Pain , Blood Patch, Epidural , Diskectomy , Drainage , Fibrin , Fibrin Tissue Adhesive , HeadacheABSTRACT
Postlaminectomy syndrome is characterized by persistent low back pain and radiculopathy of the legs after surgery of the spine. Pseudomeningocele is an uncommon cause of postlaminectomy syndrome; it is characterized by an extradural collection of cerebrospinal fluid (CSF) without dural covering, resulting from unrecognized dural tears at the time of lumbar surgery. In most cases, surgery to repair a pseudomeningocele is recommended. However if surgical treatment does not yield symptomatic relief, then conservative treatment should be considered. We treated a patient with a pseudomeningocele after spine surgery in which selective transforaminal epidural block produced long-term relief of symptoms. Here we describe the management of this patient.
Subject(s)
Humans , Cerebrospinal Fluid , Leg , Low Back Pain , Pain Management , Radiculopathy , SpineABSTRACT
Pseudomeningocele after spine surgery can cause various symptoms, but it can also be silent. We experienced 3 cases of pseudomeningocele with different symptoms and we analyzed the characteristics of each case. A small pseudomeningocele without connection to the subarachnoidal space can show no symptoms. A pseudomeningocele with a small dural tear and it's abutted on the duramater at a small portion can produce sciatica and limitations of straight leg raising due to adhesion of the cauda equina around the dural tear. In addition, a large pseudomeningocele with a big dural and lamina defect can produce back tenderness furthermore, a patient with such a lesion can have low back pain and leg pain that are aggravated by an increment of abdominal pressure or by impact to the body and even by walking. Pseudomeningocele should be suspected when symptoms recur after spine surgery and especially in the case of dural tear during an operation
Subject(s)
Humans , Cauda Equina , Leg , Low Back Pain , Sciatica , Spine , WalkingABSTRACT
Two unique cases of delayed nerve root herniation and entrapment into the pseudomeningocele through an unrepaired dural laceration at lumbar laminectomy were reported. Both patients presented with recurred radiculopathy, 3 and 6 years after first operation respectively. Lumbar myelography showed an extradural pseudomeningocele pouch in case 1 while showing no abnormality in case 2. Lumbar MRI in case 1 showed tangled herniated nerve root in the pouch of pseudomeningocele. Lumbar myelographic CT of case 2 showd delayed partial filling of the pseudomeningocele pouch only. Herniation through dural defect and entrapment of nerve root in the pseudomeningocele was nosted during surgery. Surgical correction of the herniated nerve root and dural repair was performed and this correction completely relieved the pain in both patients. These cases demonstrate even a small tear in the spinal dura during laminectomies requires surgical closure to prevent late nerve root herniation. Finally, the possible mechanism of this condition was also discussed.
Subject(s)
Humans , Diskectomy , Lacerations , Laminectomy , Magnetic Resonance Imaging , Myelography , RadiculopathyABSTRACT
Two unique cases of delayed nerve root herniation and entrapment into the pseudomeningocele through an unrepaired dural laceration at lumbar laminectomy were reported. Both patients presented with recurred radiculopathy, 3 and 6 years after first operation respectively. Lumbar myelography showed an extradural pseudomeningocele pouch in case 1 while showing no abnormality in case 2. Lumbar MRI in case 1 showed tangled herniated nerve root in the pouch of pseudomeningocele. Lumbar myelographic CT of case 2 showd delayed partial filling of the pseudomeningocele pouch only. Herniation through dural defect and entrapment of nerve root in the pseudomeningocele was nosted during surgery. Surgical correction of the herniated nerve root and dural repair was performed and this correction completely relieved the pain in both patients. These cases demonstrate even a small tear in the spinal dura during laminectomies requires surgical closure to prevent late nerve root herniation. Finally, the possible mechanism of this condition was also discussed.
Subject(s)
Humans , Diskectomy , Lacerations , Laminectomy , Magnetic Resonance Imaging , Myelography , RadiculopathyABSTRACT
The author reviewed a series of 48patients who underwent lumbo-peritoneal shunt operation at Taegu Catholic University Hospital during recent five years. Among them, 10 cases were excluded in this study because of their poor neurologic status which was not adequate to estimate the operative result. In our series, lumbo-peritoneal shunt was done in 34 cases of communicating hydrocephalus due to aneurysmal subarachnoid hemorrhage, head injury, spontaneous intracerebral hemorrhage with/without intraventicular hemorrhage and brain tumor, 2 cases of pseudomeningocele and 2 cases of normal pressure hydrocephalus. The results of this review demonstrate clinical improvement in 28 cases(73.7%), 10 cases(26.7%) of no clinical improvement. There were 9 complications including 8 shunt dysfunction and 1 infection. Among the 8 cases of shunt dysfunction, 5 cases showed postoperative early clinical improvement but revealed shunt dysfunction of delayed onset. In conclusion, lumbo-peritoneal shunt was considered as a good initial CSF diversion procedure in the treatment of communicating hydrocephalus and pseudomeningocele.
Subject(s)
Brain Neoplasms , Cerebral Hemorrhage , Craniocerebral Trauma , Hemorrhage , Hydrocephalus , Hydrocephalus, Normal Pressure , Subarachnoid HemorrhageABSTRACT
A 27-year-old woman with a clavicular fracture and post-traumatic hydrocephalus developed a subclavicular pseudomeningocele which was successfully treated by lumboperitoneal shunt. A brief review of the neurosurgical literature on the management of pseudomeningocele is presented.