107
views
0
recommends
+1 Recommend
0 collections
    6
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

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

      case-report

      Read this article at

      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          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.

          Related collections

          Most cited references8

          • Record: found
          • Abstract: found
          • Article: not found

          Treatment of dural tears associated with spinal surgery.

          We reviewed the cases of five consecutive patients with tears of the spinal dura with postoperative leaks of cerebrospinal fluid. Problems in cluded the persistence of cerebrospinal-fluid fistulas in four patients and a late symptomatic pseudomeningocele in one, all requiring reoperation and meticulous closure of the dura. Dural tears should be repaired at the time of the original operation either directly or utilizing a fascial graft or a tissue-plug technique. When the leak is first noted in the postoperative period, reoperation for repair of the dura is recommended.
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            Spinal pseudomeningoceles and cerebrospinal fluid fistulas.

            Spinal pseudomeningoceles and cerebrospinal fluid (CSF) fistulas are rare extradural collections of CSF that result following a breach in the dural-arachnoid layer. They may occur due to an incidental durotomy, during intradural surgery, or from trauma or congenital abnormality. The majority are iatrogenic and occur in the posterior lumbar region following surgery. Although they are often asymptomatic, they may cause low-back pain, headaches, and even nerve root entrapment. Leakage of CSF from the wound may cause a fistulous tract, which is a conduit for infection and should be repaired immediately. Diagnosis can be confirmed on clinical examination or imaging studies including magnetic resonance imaging, computerized tomography myelography, and radionuclide myelography. Treatment must be specific to each patient because the timing, size, symptoms, and location of the dural breach all affect the choice of therapy. Nonsurgical methods may be used, but more frequently operative repair is required. In this article, the authors review the diagnosis and treatment of spinal pseudomeningoceles and CSF fistulas.
              Bookmark
              • Record: found
              • Abstract: found
              • Article: found
              Is Open Access

              Management of giant pseudomeningoceles after spinal surgery

              Background Pseudomeningoceles are a rare complication after spinal surgery, and studies on these complex formations are few. Methods Between 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. Results All 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. Conclusions We 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.
                Bookmark

                Author and article information

                Journal
                Indian J Orthop
                Indian J Orthop
                IJOrtho
                Indian Journal of Orthopaedics
                Medknow Publications & Media Pvt Ltd (India )
                0019-5413
                1998-3727
                Jul-Aug 2013
                : 47
                : 4
                : 417-421
                Affiliations
                [1]Department of Orthopaedics, Spinal Disorder Surgery Unit, Christian Medical College, Vellore, Tamil Nadu, India
                Author notes
                Address for correspondence: Dr. Vijay Sekharappa, Department of Orthopaedics, Spinal Disorder Surgery Unit, Christian Medical College, Vellore - 632 004, Tamil Nadu, India. E-mail: vijays_sdumc@ 123456yahoo.co.in
                Article
                IJOrtho-47-417
                10.4103/0019-5413.114937
                3745699
                23960289
                05d105bd-73cd-4b81-9028-81a8c53ea8c5
                Copyright: © Indian Journal of Orthopaedics

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Categories
                Case Report

                Orthopedics
                giant pseudomeningocele,large pseudomeningocele,spontaneous resolution
                Orthopedics
                giant pseudomeningocele, large pseudomeningocele, spontaneous resolution

                Comments

                Comment on this article