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van Staalduinen EK, Massoud TF. Imaging Anatomy of the Cerebrospinal Fluid Spaces. Neuroimaging Clin N Am 2025; 35:1-13. [PMID: 39521518 DOI: 10.1016/j.nic.2024.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2024]
Abstract
The cerebrospinal fluid spaces of the spine and brain are an intricate network of tissues with complex anatomic relationships. Understanding the normal imaging anatomy and variants of these spaces is crucial for accessing the spinal subarachnoid space and evaluating patients with suspected CSF leaks. This article reviews the imaging anatomy of the cerebrospinal fluid spaces in the spine and brain with emphasis on clinically relevant anatomy for percutaneous needle access to the spinal subarachnoid space and management of patients with CSF leak.
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Affiliation(s)
- Eric K van Staalduinen
- Division of Neuroimaging and Neurointervention, Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA.
| | - Tarik F Massoud
- Division of Neuroimaging and Neurointervention, Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
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2
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Signorelli F, Santi S, Leone A, Visocchi M. Iatrogenic intracranial hypotension secondary to subarachnoid-pleural fistula after transthoracic surgery for the treatment of lateral thoracic meningocele. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2024; 15:375-379. [PMID: 39483828 PMCID: PMC11524558 DOI: 10.4103/jcvjs.jcvjs_39_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Accepted: 04/09/2024] [Indexed: 11/03/2024] Open
Abstract
Subarachnoid-pleural fistula (SPF), a rare complication following transthoracic spinal surgery, results in the accumulation of cerebrospinal fluid (CSF) in the pleural space. Hindered spontaneous closure, attributed to negative pleural pressure, gives rise to CSF hypotension and subdural blood collections. Despite numerous reported cases, achieving consensus on management remains elusive. Treatment options encompass conservative measures, surgical repair, epidural blood patch, and diverse approaches such as multilayer dural closure or meningocele resection. Presented herein is a distinctive case following lateral thoracic meningocele surgery, where SPF-induced CSF hypotension found successful resolution through the innovative use of titanium hemostatic clips to occlude the meningocele. This novel approach, emphasizing the utility of titanium clips, deviates from conventional strategies. Surgical SPF exclusion, particularly leveraging titanium clips, emerges as a potential solution, effectively alleviating symptoms of CSF hypotension. The article also aims to present a personal experience, contributing an effective and alternative approach for the etiological treatment of thoracic meningocele.
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Affiliation(s)
- Francesco Signorelli
- Department of Neurosurgery, Gemelli University Polyclinic Foundation I.R.C.C.S, Rome, Italy
| | - Samuele Santi
- Department of Neurosurgery, Gemelli University Polyclinic Foundation I.R.C.C.S, Rome, Italy
| | - Antonio Leone
- Radiology Department, Gemelli University Polyclinic Foundation I.R.C.C.S, Rome, Italy
| | - Massimiliano Visocchi
- Department of Neurosurgery, Gemelli University Polyclinic Foundation I.R.C.C.S, Rome, Italy
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Sun S, Luo H, Wang Y, Xi Y, Fang K, Wu T. Artificial spinal dura mater made of gelatin microfibers and bioadhesive for preventing cerebrospinal fluid leakage. Chem Commun (Camb) 2024; 60:2353-2356. [PMID: 38323482 DOI: 10.1039/d3cc06278c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Artificial spinal dura mater was designed by combining solution blow-spun gelatin microfibers and dopamine-capped polyurethane bioadhesive. Notably, the gelatin microfibers had a special pore structure, good water adsorption capability, and excellent burst pressure resistance. The bioadhesive layer contributed to the excellent sealing performance in the wet state. This material provides a promising alternative as an artificial spinal dura mater to prevent cerebrospinal fluid leakage.
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Affiliation(s)
- Shengdong Sun
- Shandong Key Laboratory of Medical and Health Textile Materials, College of Textiles and Clothing, Qingdao University, Qingdao, 266071, China.
- Collaborative Innovation Center for Eco-Textiles of Shandong Province and the Ministry of Education, Qingdao University, Qingdao, 266071, China
| | - Hao Luo
- Affiliated Hospital of Qingdao University, Qingdao Medical College, Qingdao University, Qingdao, 266071, China.
| | - Yuanfei Wang
- Shandong Key Laboratory of Medical and Health Textile Materials, College of Textiles and Clothing, Qingdao University, Qingdao, 266071, China.
- Qingdao Stomatological Hospital Affiliated to Qingdao University, Qingdao, 266001, China
| | - Yongming Xi
- Affiliated Hospital of Qingdao University, Qingdao Medical College, Qingdao University, Qingdao, 266071, China.
| | - Kuanjun Fang
- Shandong Key Laboratory of Medical and Health Textile Materials, College of Textiles and Clothing, Qingdao University, Qingdao, 266071, China.
- Collaborative Innovation Center for Eco-Textiles of Shandong Province and the Ministry of Education, Qingdao University, Qingdao, 266071, China
- Laboratory for Manufacturing Low Carbon and Functionalized Textiles in the Universities of Shandong Province, Qingdao, 266071, China
- State Key Laboratory for Biofibers and Eco-textiles, 308 Ningxia Road, Qingdao 266071, China
| | - Tong Wu
- Shandong Key Laboratory of Medical and Health Textile Materials, College of Textiles and Clothing, Qingdao University, Qingdao, 266071, China.
- Collaborative Innovation Center for Eco-Textiles of Shandong Province and the Ministry of Education, Qingdao University, Qingdao, 266071, China
- Affiliated Hospital of Qingdao University, Qingdao Medical College, Qingdao University, Qingdao, 266071, China.
- Institute of Neuroregeneration & Neurorehabilitation, Department of Pathophysiology, School of Basic Medicine, Qingdao University, Qingdao, 266071, China
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Schartz DA, Ismail RF, Rahman AA, Bender MT, Westesson PL, Mesfin A, Kessler A. Management of postoperative cervical pseudomeningocele with percutaneous aspiration and epidural blood patch. Interv Neuroradiol 2024; 30:137-142. [PMID: 35818726 PMCID: PMC10956454 DOI: 10.1177/15910199221113714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 06/27/2022] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION While epidural blood patch can be an effective management option in lumbar pseudomeningoceles in certain clinical settings, its utility in the cervical spine is unclear. The aim of this study was to evaluate the safety and effectiveness of percutaneous aspiration and autologous blood patch for post-operative durotomy related pseudomeningoceles within the cervical spine. METHODS A single institution retrospective review detailing 3 patients with durotomy related pseudomeningocele following posterior cervical spine surgery was completed. RESULTS In all three cases, aspiration with subsequent injection of autologous epidural blood patch successfully treated each pseudomeningocele. One patient required more than one intervention, while the other two were successfully treated after one procedure. All three patients improved clinically without need for additional surgery. CONCLUSION Percutaneous aspiration and epidural blood patch can be used to safely manage post-operative pseudomeningoceles within the posterior cervical spine.
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Affiliation(s)
- Derrek A Schartz
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Rahim F Ismail
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Akm A Rahman
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Matthew T Bender
- Department of Neurosurgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Per-Lennart Westesson
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Addisu Mesfin
- Department of Orthopedic Surgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Alex Kessler
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY, USA
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Rodrigues A, Antunes D, Pereira DJ, Jesus-Ribeiro J. Giant lumbar postoperative pseudomeningocele inducing positional syncope. BMJ Case Rep 2024; 17:e259235. [PMID: 38290984 PMCID: PMC10828859 DOI: 10.1136/bcr-2023-259235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2024] [Indexed: 02/01/2024] Open
Affiliation(s)
- Ana Rodrigues
- Internal Medicine, Centro Hospitalar Leiria EPE, Leiria, Portugal
| | - Daniela Antunes
- Internal Medicine, Centro Hospitalar Leiria EPE, Leiria, Portugal
| | - Daniela Jardim Pereira
- Neuroradiology Functional Unit, Medical Imaging Service, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
- Diaton MRI Unit, Centro Hospitalar Leiria EPE, Leiria, Portugal
| | - Joana Jesus-Ribeiro
- Neurology, Centro Hospitalar Leiria EPE, Leiria, Portugal
- Coimbra Institute for Clinical and Biomedical Research (iCBR) and Center of Investigation in Environment, Genetics and Oncobiology (CIMAGO), University of Coimbra Faculty of Medicine, Coimbra, Portugal
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Khan DZ, Tariq K, Lee KS, Dyson EW, Russo V, Watkins LD, Russo A. Patient-specific automated cerebrospinal fluid pressure control to augment spinal wound closure: a case series using the LiquoGuard®. Br J Neurosurg 2024:1-9. [PMID: 38174716 PMCID: PMC11013023 DOI: 10.1080/02688697.2023.2290101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 11/26/2023] [Indexed: 01/05/2024]
Abstract
OBJECTIVE Spinal cerebrospinal fluid (CSF) leaks are common, and their management is heterogeneous. For high-flow leaks, numerous studies advocate for primary dural repair and CSF diversion. The LiquoGuard7® allows automated and precise pressure and volume control, and calculation of patient-specific CSF production rate (prCSF), which is hypothesized to be increased in the context of durotomies and CSF leaks. METHODS This single-centre illustrative case series included patients undergoing complex spinal surgery where: 1) a high flow intra-operative and/or post-operative CSF leak was expected and 2) lumbar CSF drainage was performed using a LiquoGuard7®. CSF diversion was tailored to prCSF for each patient, combined with layered spinal wound closure. RESULTS Three patients were included, with a variety of pathologies: T7/T8 disc prolapse, T8-T9 meningioma, and T4-T5 metastatic spinal cord compression. The first two patients underwent CSF diversion to prevent post-op CSF leak, whilst the third required this in response to post-op CSF leak. CSF hyperproduction was evident in all cases (mean >/=140ml/hr). With patient-specific CSF diversion regimes, no cases required further intervention for CSF fistulae repair (including for pleural CSF effusion), wound breakdown or infection. CONCLUSIONS Patient-specific cerebrospinal fluid drainage may be a useful tool in the management of high-flow intra-operative and post-operative CSF leaks during complex spinal surgery. These systems may reduce post-operative CSF leakage from the wound or into adjacent body cavities. Further larger studies are needed to evaluate the comparative benefits and cost-effectiveness of this approach.
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Affiliation(s)
- Danyal Z. Khan
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
| | - Kanza Tariq
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
- Department of Brain Repair & Rehabilitation, UCL Queen Square Institute of Neurology, London, UK
| | - Keng Siang Lee
- Bristol Medical School, Faculty of Health Sciences, University of Bristol, Bristol, UK
| | - Edward W Dyson
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
- Department of Brain Repair & Rehabilitation, UCL Queen Square Institute of Neurology, London, UK
| | - Vittorio Russo
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - Laurence D Watkins
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
- Department of Brain Repair & Rehabilitation, UCL Queen Square Institute of Neurology, London, UK
| | - Antonino Russo
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
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Soler-Rico M, Di Santo M, Vaz G, Joris V, Fomekong E, Guillaume S, Van Boven M, Raftopoulos C. How to reduce the complication rate of multiple burr holes surgery in moyamoya angiopathy. Acta Neurochir (Wien) 2023; 165:3613-3622. [PMID: 37993630 DOI: 10.1007/s00701-023-05876-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 10/16/2023] [Indexed: 11/24/2023]
Abstract
PURPOSE This study is aimed at analyzing clinical outcome, absence of stroke recurrence, revascularization, and complications and long-term follow-up in the surgical treatment of moyamoya angiopathy (MMA) using the multiple burr holes (MBH) technique with dura opening and arachnoid preservation as a single procedure. To the best of our knowledge, this is the first to describe an MBH technique with arachnoid preservation. METHOD We retrospectively reviewed all patients operated from June 2001 to March 2021, for a symptomatic and progressive MMA operated with opening of the dura but arachnoid preservation. Clinical examinations were obtained in all patients, and radiological monitoring was performed by cerebral 3D-magnetic resonance angiography (MRA) with perfusion or single-photon emission computed tomography (SPECT) with acetazolamide. RESULTS In total, 21 consecutive patients (6 children and 15 adults) were included with a mean age of 7.4 years in the pediatric group and 36.9 years in the adult group. Initial presentation was permanent ischemic stroke in 15 cases, transient ischemic attack (TIA) in 5 cases, and cerebral hemorrhage in one case. The MBH with dura opening and arachnoid preservation was performed bilaterally in 9 cases (43%) and unilaterally in 12 cases (57%). One patient died due to intraoperative bilateral ischemic stroke. Of the 20 other patients, 30% demonstrated clinical stability and 70% showed partial or complete recovery. Although one patient experienced a perioperative stroke, we did not observe any pseudomeningocele or postoperative ischemic stroke (IS) recurrence in all surviving cases during the average follow-up period of 55.5 months (range: 1-195). These outcomes emphasize the importance of preoperative monitoring to ensure the effectiveness and safety of the intervention. Postoperative angiography studies showed revascularization in 96.3% of treated hemispheres (100% in the adult group vs 80% in the pediatric group). CONCLUSIONS Our results on this small cohort suggest that the MBH technique with opening of the dura and arachnoids preservation can prevent recurrent strokes and reduce the risk of pseudomeningocele.
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Affiliation(s)
- M Soler-Rico
- Neurosurgery Department, St-Luc Hospital, Université Catholique de Louvain, Brussels, Belgium
| | - M Di Santo
- Neurosurgery Department, St-Luc Hospital, Université Catholique de Louvain, Brussels, Belgium
| | - G Vaz
- Neurosurgery Department, St-Luc Hospital, Université Catholique de Louvain, Brussels, Belgium
| | - V Joris
- Neurosurgery Department, St-Luc Hospital, Université Catholique de Louvain, Brussels, Belgium
| | - E Fomekong
- Neurosurgery Department, St-Luc Hospital, Université Catholique de Louvain, Brussels, Belgium
| | - S Guillaume
- Medical Imaging Department, St-Luc Hospital, Université Catholique de Louvain, Brussels, Belgium
| | - M Van Boven
- Anesthesiology Department, St-Luc Hospital, Université Catholique de Louvain, Brussels, Belgium
| | - C Raftopoulos
- Neurosurgery Department, St-Luc Hospital, Université Catholique de Louvain, Brussels, Belgium.
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Xu C, Dong RP, Cheng XL, Zhao JW. Late presentation of dural tears: Two case reports and review of literature. World J Clin Cases 2023; 11:2464-2473. [PMID: 37123324 PMCID: PMC10130997 DOI: 10.12998/wjcc.v11.i11.2464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/23/2023] [Accepted: 03/21/2023] [Indexed: 04/06/2023] Open
Abstract
BACKGROUND The late presentation of dural tears (LPDT) has a low incidence rate and hidden symptoms and is easily ignored in clinical practice. If the disease is not treated in time, a series of complications may occur, including low intracranial pressure headache, infection, pseudodural cyst formation, and sinus formation. Here, we describe two cases of LPDT. CASE SUMMARY Two patients had sudden fever 1 wk after lumbar surgery. Physical examination showed obvious tenderness in the operation area. The patients were confirmed as having LPDT by lumbar magnetic resonance imaging and surgical exploration. One case was caused by continuous negative pressure suction and malnutrition, and the other was caused by decreased dural ductility and low postoperative nutritional status. The first symptom of both patients was fever, with occasional headache. Both patients underwent secondary surgery to treat the LPDT. Dural defects were observed and dural sealants were used to seal the dural defects, then drainage tubes were retained for drainage. After the operation, the patients were treated with antibiotics and the patients' surgical incisions healed well, without fever or incision tenderness. Both recovered and were discharged 1 wk after the operation. CONCLUSION LPDT is a rare complication of spinal surgery or neurosurgery that has hidden symptoms and can easily be overlooked. Since it may cause a series of complications, LPDT needs to be actively addressed in clinical practice.
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Affiliation(s)
- Chang Xu
- Department of Orthopedics, Jilin Provincial Armed Police Corps Hospital, Changchun 130000, Jilin Province, China
| | - Rong-Peng Dong
- Department of Spinal Surgery, The Second Hospital of Jilin University, Changchun 130012, Jilin Province, China
| | - Xue-Liang Cheng
- Department of Spinal Surgery, The Second Hospital of Jilin University, Changchun 130012, Jilin Province, China
| | - Jian-Wu Zhao
- Department of Spinal Surgery, The Second Hospital of Jilin University, Changchun 130012, Jilin Province, China
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Kasper BE, Perera IR, Moriarty SE, Rawlins F. Lumbar Laminectomy Precedes Positional Headache and MRI-Confirmed Pseudomeningocele With Duro-Cutaneous Fistula. Cureus 2023; 15:e37946. [PMID: 37220438 PMCID: PMC10200271 DOI: 10.7759/cureus.37946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2023] [Indexed: 05/25/2023] Open
Abstract
Pseudomeningoceles (PMs) are collections of cerebrospinal fluid (CSF) occurring as a direct result of a dural rent. This article presents a well-documented case of a 68-year-old male presenting to the emergency department with postoperative lumbar PM with a duro-cutaneous fistula. It was initially recognized on palpation of the patient's postoperative incision site and later diagnosed with magnetic resonance imaging (MRI). Incidental durotomies (IDs) leading to PMs are a rare complication of laminectomies and other spinal surgeries. A thorough physical exam, diagnostic imaging, and lumbar drainage to survey the integrity of the dura mater are important aspects of postoperative care.
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Affiliation(s)
- Bradley E Kasper
- Medical School, HOLO Labs - Simulation and Educational Technology, Edward Via College of Osteopathic Medicine, Blacksburg, USA
| | - Ishan R Perera
- Medical School, HOLO Labs - Simulation and Educational Technology, Edward Via College of Osteopathic Medicine, Blacksburg, USA
| | - Sydney E Moriarty
- Medical School, HOLO Labs - Simulation and Educational Technology, Edward Via College of Osteopathic Medicine, Blacksburg, USA
| | - Frederic Rawlins
- Emergency Medicine, HOLO Labs - Simulation and Educational Technology, Edward Via College of Osteopathic Medicine, Blacksburg, USA
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Beckman SP, Proctor C, Toms JB. The Management of Recurrent Post-myelography Lumbar Pseudomeningocele With Epidural Blood Patch. Cureus 2023; 15:e35600. [PMID: 37007384 PMCID: PMC10063238 DOI: 10.7759/cureus.35600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2023] [Indexed: 03/04/2023] Open
Abstract
Pseudomeningoceles are a well-known potential postoperative complication of spinal and cranial surgeries that can occur after lumbar decompression and posterior fossa surgeries. They are often caused by incidental durotomies but may also occur as a result of dural puncture during diagnostic testing. This report describes a 59-year-old male that developed a recurrent pseudomeningocele after an L4 laminectomy for severe lumbar spinal stenosis that was ultimately treated with an epidural blood patch (EBP). His preoperative condition greatly improved, but he developed a pseudomeningocele that did not resolve after applying ice and light pressure. The patient subsequently underwent a wound exploration where no dural defect was identified. During this exploration, the dura was reinforced with dural onlays and sealant. Unfortunately, the patient developed another pseudomeningocele within a short interval. It was then suspected that the post-laminectomy site provided a space for the dural punctures from previous CT myelography to leak cerebrospinal fluid (CSF) into. The patient subsequently underwent ultrasound (US)-guided aspiration of the pseudomeningocele and EBP injections at the levels where his preoperative myelography was performed. The success of the EBP indicates that the previous CT myelography was the likely cause of the pseudomeningocele. Recurrent spinal pseudomeningoceles with no evidence of incidental durotomy may be caused by dural puncture from myelography. In such cases, EBP to the area that the previous myelography was performed can resolve the pseudomeningocele.
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Ng JJ, Blum JD, Cho DY, Cheung L, Romeo DJ, Low DW, Taylor JA, Heuer GG, Swanson JW, Flanders TM. Spinal pseudomeningocele closure: capsulofascial interposition technique. Childs Nerv Syst 2023; 39:1045-1049. [PMID: 36790495 DOI: 10.1007/s00381-023-05849-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 01/14/2023] [Indexed: 02/16/2023]
Abstract
INTRODUCTION The development of a spinal pseudomeningocele is a complication of dural repair or reconstruction that carries significant morbidity for pediatric patients. In addition to cerebrospinal fluid (CSF) hypotension and positional headaches, CSF leaking into the extradural space increases the risk for incisional breakdown, meningitis, and cosmetic deformity. Spinal pseudomeningocele management is challenging, and reported techniques range from local wound revisions/exploration to shunt placement for permanent CSF diversion. METHODS At our institution, we have recently implemented a multidisciplinary approach of capsulofascial interposition for the surgical repair of the symptomatic spinal pseudomeningocele with a combined neurosurgery-plastic surgery team. To our knowledge, this technique has not previously been characterized, and we describe the technical aspects of this surgery here. RESULTS Among 10 patients treated with this technique, none required reoperation or developed infections following pseudomeningocele closure; 2 patients received postoperative transfusions; and 2 patients underwent CSF diversion procedures. CONCLUSION We propose that this capsulofascial interposition technique should be employed in the surgical treatment of symptomatic spinal pseudomeningoceles.
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Affiliation(s)
- Jinggang J Ng
- The Childrens Hospital of Philadelphia, Division of Plastic Surgery, Philadelphia, PA, 19104, USA
| | - Jessica D Blum
- The Childrens Hospital of Philadelphia, Division of Plastic Surgery, Philadelphia, PA, 19104, USA
| | - Daniel Y Cho
- The Childrens Hospital of Philadelphia, Division of Plastic Surgery, Philadelphia, PA, 19104, USA
| | - Liana Cheung
- The Childrens Hospital of Philadelphia, Division of Plastic Surgery, Philadelphia, PA, 19104, USA
| | - Dominic J Romeo
- The Childrens Hospital of Philadelphia, Division of Plastic Surgery, Philadelphia, PA, 19104, USA
| | - David W Low
- The Childrens Hospital of Philadelphia, Division of Plastic Surgery, Philadelphia, PA, 19104, USA
| | - Jesse A Taylor
- The Childrens Hospital of Philadelphia, Division of Plastic Surgery, Philadelphia, PA, 19104, USA
| | - Gregory G Heuer
- The Childrens Hospital of Philadelphia, Division of Neurosurgery, Philadelphia, PA, 19104, USA
| | - Jordan W Swanson
- The Childrens Hospital of Philadelphia, Division of Plastic Surgery, Philadelphia, PA, 19104, USA
| | - Tracy M Flanders
- The Childrens Hospital of Philadelphia, Division of Neurosurgery, Philadelphia, PA, 19104, USA.
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Tzerefos C, Paterakis K, Bouramas D, Fotakopoulos G, Brotis A, Fountas K. Late-Onset Cervical Pseudomeningocele Following Ossification of the Posterior Longitudinal Ligament Surgery Successfully Treated With a Lumboperitoneal Shunt. Cureus 2022; 14:e30744. [DOI: 10.7759/cureus.30744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2022] [Indexed: 11/07/2022] Open
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Yeh KL, Wu SH, Fuh CS, Huang YH, Chen CS, Wu SS. Cauda equina syndrome caused by the application of DuraSeal TM in a microlaminectomy surgery: A case report. World J Clin Cases 2022; 10:11178-11184. [PMID: 36338214 PMCID: PMC9631147 DOI: 10.12998/wjcc.v10.i30.11178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/29/2022] [Accepted: 09/22/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The management of dural tears is important. While a massive dura can be repaired with absorbable suture lines, cerebrospinal fluid leakage can be attenuated by dural sealant when an unintended tiny durotomy occurs intraoperatively. DuraSeal is often used because it can expand to seal tears. This case emphasizes the need for caution when DuraSeal is used as high expansion can cause complications following microlaminectomy.
CASE SUMMARY A 77-year-old woman presented with L2/3 and L3/4 lateral recess stenosis. She underwent microlaminectomy, foraminal decompression, and disk height restoration using an IntraSPINE® device. A tiny incident durotomy occurred intraoperatively and was sealed using DuraSealTM. However, decreased muscle power, urinary incontinence, and absence of anal reflexes were observed postoperatively. Emergent magnetic resonance imaging revealed fluid collection causing thecal sac indentation and central canal compression. Surgical exploration revealed that the gel-like DuraSeal had entrapped the hematoma and, consequently, compressed the thecal sac and nerve roots. While we removed all DuraSealTM and exposed the nerve root, the patient’s neurological function did not recover postoperatively.
CONCLUSION DuraSeal expansion must not be underestimated. Changes in neurological status require investigation for cauda equina syndrome due to expansion.
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Affiliation(s)
- Kuei-Lin Yeh
- Department of Orthopaedics, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi City 600, Taiwan
- Department of Computer Science and Information Engineering, National Taiwan University, Taipei 10617, Taiwan
- Department of Long-Term Care and Management, WuFeng University, Chiayi County 621303, Taiwan
| | - Szu-Hsien Wu
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei 11217, Taiwan
| | - Chiou-Shann Fuh
- Department of Computer Science and Information Engineering, National Taiwan University, Taipei 10617, Taiwan
| | - Yi-Hung Huang
- Department of Orthopaedics, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi City 600, Taiwan
| | - Chu-Song Chen
- Department of Computer Science and Information Engineering, National Taiwan University, Taipei 10617, Taiwan
| | - Shing-Sheng Wu
- Department of Orthopaedics, Shin Kong Wu-Ho Su Memorial Hospital, Taiepi 111, Taiwan
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Cunha B, Rodrigues A, Gonçalves J, Conceição C. Imaging of intraspinal cystic lesions: A review. J Neuroimaging 2022; 32:1044-1061. [PMID: 35942824 DOI: 10.1111/jon.13037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 07/21/2022] [Accepted: 07/28/2022] [Indexed: 11/29/2022] Open
Abstract
Several distinct conditions present as cystic or pseudocystic lesions within the spinal canal. Some of the most common spinal cystic lesions include spinal meningeal cysts, juxtafacet cysts, dermoid/epidermoid cysts, nerve sheath tumors, and syringohydromyelia. Clinical presentation is usually nonspecific and imaging characteristics are frequently overlapping, which may pose a challenging presurgical diagnosis. We provide a pictorial review of cystic intraspinal lesions and discuss the main imaging features that can aid the neuroradiologist in the differential diagnosis. First, we propose a categorization of the lesions according to their location as extradural, intradural extramedullary, and intramedullary. This is a crucial initial step in the diagnostic workup and surgical planning. Second, for each of these locations, we organize the lesions according to their etiology: congenital and developmental disorders, degenerative disorders, traumatic or postsurgical collections, infectious conditions, neoplastic lesions, and other miscellaneous disorders. Finally, we summarize the clinical highlights and MR features that provide important insights for the differential diagnosis. MR is the technique of choice in presurgical evaluation and postsurgery follow-up. It provides accurate lesion localization and characterization and, most of the times, it will allow a confident differential diagnosis. High-resolution three-dimensional T2-weighted sequences and diffusion-weighted imaging can provide important hints in specific cases. Signal correlation with T1-weighted and fat-saturated sequences allows to differentiate true cystic lesions from hemorrhage or fat tissue.
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Affiliation(s)
- Bruno Cunha
- Neuroradiology Department, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal.,NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Alexandra Rodrigues
- Neuroradiology Department, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal.,NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal.,Unidade de Neurorradiologia, Hospital Central do Funchal, Funchal, Portugal
| | - João Gonçalves
- Neuroradiology Department, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal.,NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal.,Unidade de Neurorradiologia, Hospital Central do Funchal, Funchal, Portugal
| | - Carla Conceição
- Neuroradiology Department, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
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15
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Can Cervical and Lumbar Epidural Blood Patches Help Avoid Revision Surgery for Symptomatic Postoperative Dural Tears? World Neurosurg 2022; 164:e877-e883. [PMID: 35605941 DOI: 10.1016/j.wneu.2022.05.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 05/13/2022] [Accepted: 05/14/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Incidental durotomies resulting in symptomatic postoperative cerebrospinal fluid (CSF) leaks can be treated with bedrest, subarachnoid lumbar drain, and surgical re-exploration. Another option is an epidural blood patch, which forms a clot over the dural tear in a minimally invasive manner. Our objective was to describe our center's outcomes and complications following epidural blood patches for symptomatic postoperative durotomies. METHODS Patients undergoing spine surgeries at one institution from 2012-2020 were included. Patient charts were reviewed for demographic information, surgical data, rate of dural tear, type of repair, and use of blood patches postoperatively. RESULTS A total of 1392 patients (726 male, 666 female, average age: 56.3 ± 15.4 years), including 436 cervical and 956 posterior thoracolumbar/lumbar spine surgeries were screened. There were 6 (1.4%) cervical, 64 (6.7%) lumbar, and a total of 70 (5.0%) patients with incidental dural tears/blebs. Of these patients, we identified 2 cervical and 8 lumbar spine patients with persistent CSF leaks who received epidural blood patches postoperatively. Nine of 10 (90%) had resolution of symptoms. One lumbar patient failed both an initial blood patch and subsequent surgical re-exploration, but had successful relief after a second blood patch. CONCLUSIONS The incidence of dural tears/blebs was 1.4% in cervical, 6.7% in lumbar, and 5.0% in all spine surgeries. Of the 10 patients with symptomatic CSF leaks, 9 were successfully treated with blood patches. Targeted epidural blood patch is effective in treating symptomatic CSF leaks and minimizes the morbidity of surgical re-exploration.
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16
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Pereira AI, Fernandes DL, Amorim A, Nunes S. Cerebrospinal fluid fistula after combined spinal-epidural block. BMJ Case Rep 2022; 15:e247598. [PMID: 35241447 PMCID: PMC8895927 DOI: 10.1136/bcr-2021-247598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2022] [Indexed: 11/03/2022] Open
Abstract
Neuraxial anaesthesia is an essential technique in obstetric anaesthesia practice. Cerebrospinal fluid (CSF) fistula is a rare complication and there is no consensus about its clinical approach. We present a case of a 28-year-old nulliparous woman that developed a cutaneous CSF fistula following combined spinal and epidural block for caesarean delivery. After multidisciplinary discussion it was decided that hydration, absolute bed-rest and compressive dressing with abdominal binder was the best option and the patient fully recovered without any sequelae.Based on literature, symptoms of intracranial hypotension and leakage of clear fluid surrounding the puncture site usually motivate referral to anaesthesia. Management strategies can be both conservative and invasive, including direct suture of the skin puncture site and epidural blood patch.Regarding the anaesthesia practice on this topic, most of the available evidence is based on case reports, rendering the decision-making process challenging.
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Affiliation(s)
- Ana Isabel Pereira
- Anaesthesia Department, Centro Hospitalar do Funchal, Funchal, Madeira, Portugal
| | | | - Ana Amorim
- Anaesthesia Department, Centro Hospitalar do Funchal, Funchal, Madeira, Portugal
| | - Sara Nunes
- Anaesthesia Department, Centro Hospitalar do Funchal, Funchal, Madeira, Portugal
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17
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Sonawane K, Baskaran A, Thampi R, Balavenkatasubramanian J. Therapeutic intervention for iatrogenic thoracolumbar pseudomeningocele using ultrasound-guided aspiration and ultrasound-assisted epidural blood patch - A case report. J Clin Anesth 2021; 75:110508. [PMID: 34560445 DOI: 10.1016/j.jclinane.2021.110508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 08/30/2021] [Accepted: 09/04/2021] [Indexed: 11/18/2022]
Abstract
Cerebrospinal fluid (CSF) leakage causing a pseudomeningocele is a well-recognized complication after spine surgery. It presents as a recurrence of low-back pain, radiculopathy, subcutaneous swelling, symptoms of intracranial hypotension, and delayed myelopathy. Definitive surgical repair is needed if not resolved spontaneously or with minimally invasive measures like lumbar subarachnoid drainage and an epidural blood patch (EBP). We report a case of iatrogenic thoracic pseudomeningocele, successfully treated with dual therapeutic intervention (CSF aspiration and EBP) using an ultrasound. This minimally-invasive intervention helped our patient resolve symptoms, avoid radiation, and make it cost-effective by avoiding surgical intervention and polypharmacy of general anesthesia.
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Affiliation(s)
- Kartik Sonawane
- Dept. of Anesthesiology, Ganga Medical Centre & Hospitals, Pvt. Ltd., Coimbatore, Tamil Nadu, India.
| | - Aswani Baskaran
- Dept. of Anesthesiology, Ganga Medical Centre & Hospitals, Pvt. Ltd., Coimbatore, Tamil Nadu, India
| | - Ranjith Thampi
- Dept. of Anesthesiology, Ganga Medical Centre & Hospitals, Pvt. Ltd., Coimbatore, Tamil Nadu, India
| | - J Balavenkatasubramanian
- Dept. of Anesthesiology, Ganga Medical Centre & Hospitals, Pvt. Ltd., Coimbatore, Tamil Nadu, India
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18
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Roytman M, Ulrich CT, Chazen JL. Post-dural puncture pseudomeningocele ("arachnoid bleb"): An underrecognized etiology of spontaneous intracranial hypotension symptomatology. Clin Imaging 2021; 80:377-381. [PMID: 34517304 DOI: 10.1016/j.clinimag.2021.08.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/17/2021] [Accepted: 08/30/2021] [Indexed: 10/20/2022]
Abstract
Spontaneous intracranial hypotension (SIH) is an important secondary cause of a persistent headache syndrome, classically presenting as sudden onset debilitating positional headaches related to reduced intracranial cerebrospinal fluid (CSF) volume. Current understanding of SIH pathogenesis recognizes three underlying etiologies: dural tear, meningeal diverticulum, and CSF-venous fistula, with a fourth broad category of indeterminate/unknown etiologies. Post-dural puncture headache (PDPH) is a well-known and common complication of dural puncture, typically remitting spontaneously within two weeks of onset or with autologous epidural blood patch, though with some patients developing complex and difficult to manage chronic PDPH. Herein, we present a case of chronic PDPH resulting in SIH symptomatology secondary to a post-dural puncture pseudomeningocele, or "arachnoid bleb," successfully treated with curative surgical intervention. Increasing awareness of additional potential etiologies of SIH symptomatology will allow for improved detection for targeted definitive therapy, ultimately improving patient outcomes including quality of life in this debilitating and difficult to manage secondary headache syndrome.
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Affiliation(s)
- Michelle Roytman
- Department of Radiology, New York-Presbyterian Hospital/Weill Cornell Medicine, United States of America
| | | | - J Levi Chazen
- Department of Radiology, Hospital for Special Surgery, United States of America.
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19
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Wang L, Yang X, Wang H, Chen Z, Sun C, Li W. Pseudomeningocele-a rare complication following thoracic spinal decompression surgery: clinical features, treatment guidelines, technical notes, and evaluation of results. INTERNATIONAL ORTHOPAEDICS 2021; 45:2609-2618. [PMID: 34398291 DOI: 10.1007/s00264-021-05156-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 07/17/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Pseudomeningocele (PMC) is a rare complication following thoracic spinal decompression surgery. The aim of this study is to assess the clinical features and treatment of PMC and provide the technical notes with revision surgery. METHODS Between January 2010 and December 2019, patients who developed PMC after posterior thoracic surgery were enrolled. An additional 25 patients who suffered cerebrospinal fluid leakage (CSFL) but did not develop PMC in the same period were randomly selected. General data, intra-operative factors, CSFL position, cost, modified Japanese Orthopaedic Association (mJOA) scores, patient satisfaction, and clinical features were recorded and compared between the two groups. RESULTS Eighteen patients were diagnosed with PMC after thoracic spinal surgery. The average length, width, and depth were 16.25 ± 5.73 cm, 6.96 ± 3.61 cm and 4.39 ± 2.2 cm, respectively. The most common symptom was neurological deficits following incision problems and headache. Compared with the control group, the PMC group showed a longer duration of initial surgery, greater estimated blood loss, an increased rate of CSFL on the ventral side, reduced mJOA scores, and lower patient satisfaction at the final follow-up. CONCLUSION PMC is a rare complication of thoracic surgery with an incidence of 1.12%. PMC typically occurs at the upper and lower thoracic spine, resulting in increased health care costs, poorer neurological recovery, and a lower rate of patient satisfaction. The management of PMC should be individualized depending on diagnosis time and symptoms.
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Affiliation(s)
- Longjie Wang
- Department of Orthopaedics, Peking University Third Hospital, Haidian District, 49 North Garden Road, Beijing, 100191, China
- Engineering Research Center of Bone and Joint Precision Medicine, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
| | - Xiaoxi Yang
- Department of Orthopaedics, Peking University Third Hospital, Haidian District, 49 North Garden Road, Beijing, 100191, China
- Engineering Research Center of Bone and Joint Precision Medicine, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
| | - Hui Wang
- Department of Orthopaedics, Peking University Third Hospital, Haidian District, 49 North Garden Road, Beijing, 100191, China
- Engineering Research Center of Bone and Joint Precision Medicine, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
| | - Zhongqiang Chen
- Department of Orthopaedics, Peking University Third Hospital, Haidian District, 49 North Garden Road, Beijing, 100191, China
- Engineering Research Center of Bone and Joint Precision Medicine, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
| | - Chuiguo Sun
- Department of Orthopaedics, Peking University Third Hospital, Haidian District, 49 North Garden Road, Beijing, 100191, China
- Engineering Research Center of Bone and Joint Precision Medicine, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
| | - Weishi Li
- Department of Orthopaedics, Peking University Third Hospital, Haidian District, 49 North Garden Road, Beijing, 100191, China.
- Engineering Research Center of Bone and Joint Precision Medicine, Beijing, China.
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China.
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20
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Tran DDT, Dinh TPH, Nguyen QB, Mai DT, Truong VT. Spontaneous Resolution of Postoperative Giant Frontal Pseudomeningocele. Asian J Neurosurg 2021; 16:372-375. [PMID: 34268167 PMCID: PMC8244681 DOI: 10.4103/ajns.ajns_18_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 03/01/2021] [Indexed: 11/18/2022] Open
Abstract
Cranial pseudomeningoceles are abnormal extradural collections of cerebrospinal fluid. Postoperative giant cranial pseudomeningoceles have been rarely reported in the literature and have no specific treatment guidelines. The optimal management strategy for this condition differs among authors, varying from conservative approach to surgical intervention. A spontaneous resolution of postoperative giant frontal pseudomeningocele is reported. A 41-year-old female presented a pseudomeningocele 3 weeks after a right frontal meningioma surgical resection. The pseudomeningocele progressed during the first 1.5-month postoperatively despite percutaneous aspiration and compressive bandage, it then shrank spontaneously and was completely resolved at the 15th month since the surgery. Nonoperative treatment with a close follow-up could be a good option for asymptomatic giant pseudomeningoceles, resulting in a spontaneous resolution.
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Affiliation(s)
- Duc Duy Tri Tran
- Department of Neurosurgery, Hue University Hospital, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam.,Department of Neurosurgery, Xuyen A Hospital, Ho Chi Minh City, Vietnam
| | - Thi Phuong Hoai Dinh
- Department of Neurosurgery, Hue University Hospital, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Quoc Bao Nguyen
- Department of Neurosurgery, Hue University Hospital, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Dang Thi Mai
- Department of Neurosurgery, Hue University Hospital, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Van Tri Truong
- Department of Neurosurgery, Hue University Hospital, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam.,Division of Orthopedics, Central Hospital of University of Montreal, University of Montreal, Montreal, Canada
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21
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Wang ZW, Fan XW, Wang Z, Du PY, Gao XD, Ding WY, Yang DL. Repair of Delayed Meningeal Cyst after Spinal Surgery with Paraspinal Muscle Flap under Microscope. J INVEST SURG 2021; 35:723-730. [PMID: 34039249 DOI: 10.1080/08941939.2021.1924899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Delayed meningeal cyst (DMC) is a rare complication after spinal surgery that is often ignored by clinicians, and its in-depth research is infrequent. In particular, no consensus has been reached about its surgical treatment. We found that patients with a DMC failed after conservative treatment, epidural blood patch, subarachnoid drainage, and initial attempts to eliminate the meningeal cyst. Therefore, we introduce the application of a paraspinal muscle flap repair under a microscope for the treatment of DMC. METHODS In this study, 13 patients who were repaired by a paraspinal muscle flap under a microscope for DMC from January 2007 to January 2017 were retrospectively reviewed. Their ages were 18-68 years old (mean age 48.7 years). The course of the disease ranged from 3 weeks to 28 months after the operation for the primary disease, with an average of 10.6 months. Length >5 cm was called a large DMC and length >8 was called a giant DMC. By analyzing the effect of surgical treatment, we summarized the treatment experience of DMC and evaluated the risk factors for the formation of DMC. RESULTS All patients were treated with paraspinal muscle flap repair under a microscope, and they healed well after the operation. There was no cerebrospinal fluid leakage or other operation-related complication. The mean follow-up was 16.5 months. Reexamination of the spine MRI showed no recurrence of the DMC. CONCLUSIONS The application of paraspinal muscle flap under a microscope combined with glue, bedrest, and CSF drain, was an effective option for the patients with DMC.
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Affiliation(s)
- Zhi-Wei Wang
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, PR China
| | - Xi-Wen Fan
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, PR China
| | - Zheng Wang
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, PR China
| | - Pei-Yu Du
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, PR China
| | - Xian-Da Gao
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, PR China
| | - Wen-Yuan Ding
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, PR China.,Hebei Provincial Key Laboratory of Orthopaedic Biomechanics, Shijiazhuang, PR China
| | - Da-Long Yang
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, PR China
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22
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Compressive cervicothoracic pseudomeningocele as a rare manifestation of idiopathic intrathecal hypotension after past trauma: a review. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 30:1451-1459. [PMID: 33620574 DOI: 10.1007/s00586-021-06766-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 09/03/2020] [Accepted: 02/04/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE Spontaneous intracranial or intrathecal hypotension (SIH) is an underdiagnosed phenomenon predominantly presenting with low cerebrospinal fluid (CSF) pressure and postural headache in the setting of CSF leak. Extrathecal CSF collections causing compression of the spinal cord or nerve roots present an even rarer subset of this disease. We aim to describe this pathology in a comprehensive manner while illustrating with a case of our own. METHODS We present a literature review on spinal idiopathic pseudomeningoceles and their neurological implications illustrated with a case of an anterior compressive pseudomeningocele between C2 and D7. Further investigations through a myelography and myelo-CT were able to postulate a CSF leak through a discogenic osteophytic microspur at the level C5-C6. RESULTS Spinal manifestations are uncommon in cases of idiopathic or spontaneous CSF leak, occurring in about 6% of patients, but myelopathy and radiculopathy involving all spinal segments do occur. In contrast to the cranial complaints, the spinal manifestations usually are not positional and are caused by mass effect from an extradural CSF collection. CONCLUSION The utility of multiple imaging modalities such as dynamic myelography and the use of epidural blood patches and fibrin glue polymers should be explored, and surgery is an option if the symptoms persist despite other measures.
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23
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Mishinov S, Samokhin A, Panchenko A, Stupak V. A titanium implant for Chiari malformation Type 1 surgery. Surg Neurol Int 2021; 12:72. [PMID: 33767876 PMCID: PMC7982118 DOI: 10.25259/sni_960_2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 01/21/2021] [Indexed: 11/04/2022] Open
Abstract
Background Concepts of Chiari malformation Type 1 (CM1) surgery in the present time significantly different. The most common complications are pseudomeningocele (12%) and postoperative CSF leak (5%). The development of pseudomeningocele may be associated with inappropriate restoration of bone and muscles relations. Methods The pilot study involved 11 patients aged 24-64 years with a diagnosis of CM1 who had indications for surgical treatment. Special titanium implant enabling fixation of the occipital and cervical muscles at the projections of their normal attachments was developed, it was placed to occipital bone on the final stages of surgical intervention. Surgical technique promoted tightened wound closure neutralizing formation of "dead space" at the place of occipital craniectomy and between muscle layers. The implant was produced by direct metal laser sintering method for each patient individually. Results There were no complications during the hospitalization and follow-up period. Postoperative MRI demonstrated adequate formation of the cisterna magna and the absence of pseudomeningocele. During follow-up period there were no signs of pseudomeningocele, CSF leak, surgical scar complications, implant-associated infections, and other complications. Conclusion In the study group, no pseudomeningocele cases as long as any other complications associated with surgery had been revealed. The efficacy of the proposed surgical technique using the developed implant should be evaluated in clinical trials with larger patient samples. To simplify preoperative planning and manufacturing of the implant for each patient individually, a set of implants with different specified sizes was developed.
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Affiliation(s)
- Sergey Mishinov
- Department of Neurosurgery, Novosibirsk Scientific Research Institute of Traumatology and Orthopedics, Ya.L. Tsivyan, Russian Federation
| | - Alexander Samokhin
- Department of Experimental, Novosibirsk Scientific Research Institute of Traumatology and Orthopedics, Ya.L. Tsivyan, Russian Federation
| | - Andrey Panchenko
- Department of 3D Printing, LLC Logeeks MS, Novosibirsk, Russian Federation
| | - Vyacheslav Stupak
- Department of Neurosurgery, Novosibirsk Scientific Research Institute of Traumatology and Orthopedics, Ya.L. Tsivyan, Russian Federation
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24
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Al Jammal OM, Wali AR, Lewis CS, Zaldana MV, Suliman AS, Pham MH. Management of Giant Sacral Pseudomeningocele in Revision Spine Surgery. Int J Spine Surg 2020; 14:778-784. [PMID: 33097586 DOI: 10.14444/7111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Giant pseudomeningoceles are an uncommon complication of spine surgery. Surgical management and extirpation can be difficult, and guidelines remain unclear. METHODS Here, we present a 56-year-old female patient with a history of grade III L5-S1 spondylolisthesis who was treated with 2 prior spine surgeries. The patient was treated with bone grafting for pseudarthrosis and instrumentation from L4 to ilium. After unsuccessful intraoperative and postoperative cerebrospinal fluid drainage and dural repair, the patient presented to the emergency room with debilitating positional headaches. RESULTS The patient underwent dural repair with bovine pericardial patch inlay sutured with 7-0 prolene, blood patch, and a dural sealant. Plastic surgery performed a layered closure, using acellular dermal matrix over the dural closure. The bilateral paraspinal flaps were advanced medially to cover the entirety of the acellular dermal matrix, and the fasciocutaneous flaps were then advanced to the midline for a watertight closure. At 3-month follow-up, the patient was headache free and had returned to her activities of daily living. CONCLUSIONS We conclude that early consultation with plastic surgery can be greatly beneficial to effectively extirpate dead space and resolve giant sacral pseudomeningoceles, especially if there is concern of persistent cerebrospinal fluid leakage due to relatively immobile avascular soft tissue as a result of prior revision surgery.
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Affiliation(s)
- Omar M Al Jammal
- Department of Neurosurgery, University of California San Diego School of Medicine, San Diego, California
| | - Arvin R Wali
- Department of Neurosurgery, University of California San Diego School of Medicine, San Diego, California
| | - Courtney S Lewis
- Department of Neurosurgery, University of California San Diego School of Medicine, San Diego, California
| | - Michelle V Zaldana
- Department of Plastic Surgery, University of California San Diego School of Medicine, San Diego, California
| | - Ahmed S Suliman
- Department of Plastic Surgery, University of California San Diego School of Medicine, San Diego, California
| | - Martin H Pham
- Department of Neurosurgery, University of California San Diego School of Medicine, San Diego, California
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25
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Alotaibi NH, AlShehri AJ, Alshankiti OH, AlThubaiti I. Surgical management of a retropharyngeal pseudomeningocele: Case report. Int J Surg Case Rep 2020; 76:331-334. [PMID: 33074131 PMCID: PMC7569257 DOI: 10.1016/j.ijscr.2020.09.191] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 09/28/2020] [Accepted: 09/28/2020] [Indexed: 11/30/2022] Open
Abstract
Retropharyngeal pseudomeningocele is a rare condition, which is usually detected weeks after trauma. Early recognition and accurate diagnosis might help avoiding management delay and late intervention. As surgical management is considered to be the definitive management, multidisciplinary management involving a team of Otolaryngology and Neurosurgery skull base surgeons is essential to achieve optimal outcomes. Introduction Retropharyngeal pseudomeningocele is a very rare form of pseudomeningocele, that is known to be associated with cervical trauma. Identifying such pathology can be challenging leading to delayed management. Case presentation We report a case of post-traumatic retropharyngeal pseudomeningocele that was managed surgically in a 21-year-old gentleman with poly-trauma injuries due to a motor vehicle accident. After 10 weeks since the traumatic event, magnetic resonance imaging (MRI) and computerised tomography (CT) scan showed evidence of bilateral atlanto-occipital dislocation and a fluid collection of 8 × 4 × 2 cm in the retropharyngeal space. The patient was found to have dysphagia and muffled voice with difficult visualisation of the vocal cords upon examination. After a multidisciplinary team decision, the patient underwent cerebrospinal fluid (CSF) leak management, pseudomeningocele resection and dural defect repair with shunting conducted by the Neurosurgery and Otolaryngology. Postoperative assessments and patient's symptoms, at 9 months follow-up, were satisfactory and reassuring. Discussion It’s believed that conservative management with bed rest, elevation of bed head and acetazolamide is the initial step in management. As an alternative measure, shunting of the CSF had led to resolution of the collection. However, surgical removal of the collection and direct dural defect repair have been suggested in the literature but needed to be properly studied. Conclusion Early recognition of this condition is important to avoid management delay. With a multidisciplinary approach, surgical management can be safe and an acceptable option for retropharyngeal pseudomeningocele.
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Affiliation(s)
- Naif H Alotaibi
- Department of Otolaryngology, Dr. Suliman Al Habib Medical Group, Riyadh, Saudi Arabia; College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | | | - Osamah H Alshankiti
- Department of Anaesthesia, Dr. Suliman Al Habib Medical Group, Riyadh, Saudi Arabia
| | - Ibrahim AlThubaiti
- Department of Neurosurgery, Dr. Suliman Al Habib Medical Group, Riyadh, Saudi Arabia
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26
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Banerjee C, Cross B, Rumley J, Devine J, Ritter E, Vender J. Multiple-Layer Lumbosacral Pseudomeningocele Repair with Bilateral Paraspinous Muscle Flaps and Literature Review. World Neurosurg 2020; 144:e693-e700. [PMID: 32942058 DOI: 10.1016/j.wneu.2020.09.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 09/09/2020] [Accepted: 09/09/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Pseudomeningocele is an uncommon but widely recognized complication of spinal surgery that can be challenging to correct. When conservative measures fail, patients frequently require reoperation to attempt primary closure of the durotomy, yet attempts at true watertight closures of the dura or fascia sometimes fall short. We describe a technique of lumbosacral pseudomeningocele repair involving a 2-layer pants-over-vest closure of the pseudomeningocele coupled with mobilization of bilateral paraspinal musculature to create a Z-plasty, or a Z-shaped flap. We have demonstrated a high success rate with our small series. METHODS The technique used meticulous manipulation of the pseudomeningocele to make a 2-layer pants-over-vest closure. This closure coupled with wide mobilization and importation of paraspinous muscle into the wound effectively obliterated dead space with simultaneous tamponade of the dural tear. The lateral row perforators were left intact, providing excellent vascularity with adequate mobility to the patient. RESULTS This technique was incorporated into the care of 10 patients between 2004 and July 2019. All wounds were closed in a single stage after careful flap section based on the wound's needs. We demonstrated successful pseudomeningocele resolution in all 10 patients with no observed clinical recurrence of symptomatic pseudomeningocele after at least 6 months of follow-up. CONCLUSIONS This technique provides a straightforward option for the spine surgeon to manage these challenging spinal wounds with minimal, if any, need for further laminectomy as well as a high fistula control rate with minimal morbidity.
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Affiliation(s)
- Christopher Banerjee
- Department of Neurological Surgery, Medical College of Georgia at Augusta University, Augusta, Georgia, USA.
| | - Brandy Cross
- Department of General Surgery, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - Jacob Rumley
- Department of Orthopedic Surgery, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - John Devine
- Department of Orthopedic Surgery, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - Edmond Ritter
- Department of Plastic Surgery, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - John Vender
- Department of Neurological Surgery, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
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Ghodasara N, Yi PH, Clark K, Fishman EK, Farshad M, Fritz J. Postoperative Spinal CT: What the Radiologist Needs to Know. Radiographics 2020; 39:1840-1861. [PMID: 31589573 DOI: 10.1148/rg.2019190050] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
During the past 2 decades, the number of spinal surgeries performed annually has been steadily increasing, and these procedures are being accompanied by a growing number of postoperative imaging studies to interpret. CT is accurate for identifying the location and integrity of implants, assessing the success of decompression and intervertebral arthrodesis procedures, and detecting and characterizing related complications. Although postoperative spinal CT is often limited owing to artifacts caused by metallic implants, parameter optimization and advanced metal artifact reduction techniques, including iterative reconstruction and monoenergetic extrapolation methods, can be used to reduce metal artifact severity and improve image quality substantially. Commonly used and recently available spinal implants and prostheses include screws and wires, static and extendable rods, bone grafts and biologic materials, interbody cages, and intervertebral disk prostheses. CT assessment and the spectrum of complications that can occur after spinal surgery and intervertebral arthroplasty include those related to the position and integrity of implants and prostheses, adjacent segment degeneration, collections, fistulas, pseudomeningoceles, cerebrospinal fluid leaks, and surgical site infections. Knowledge of the numerous spinal surgery techniques and devices aids in differentiating expected postoperative findings from complications. The various types of spinal surgery instrumentation and commonly used spinal implants are reviewed. The authors also describe and illustrate normal postoperative spine findings, signs of successful surgery, and the broad spectrum of postoperative complications that can aid radiologists in generating reports that address issues that the surgeon needs to know for optimal patient management.©RSNA, 2019.
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Affiliation(s)
- Nevil Ghodasara
- From the Russell H. Morgan Department of Radiology and Radiologic Science (N.G., P.H.Y., K.C.), Sections of Body CT (E.K.F.) and Musculoskeletal Radiology (J.F.), Johns Hopkins Hospital, 601 N Caroline St, Room 3014, Baltimore, MD 21287; and Spine Division, Department of Orthopedics, Balgrist University Hospital Zurich, Zurich, Switzerland (M.F.)
| | - Paul H Yi
- From the Russell H. Morgan Department of Radiology and Radiologic Science (N.G., P.H.Y., K.C.), Sections of Body CT (E.K.F.) and Musculoskeletal Radiology (J.F.), Johns Hopkins Hospital, 601 N Caroline St, Room 3014, Baltimore, MD 21287; and Spine Division, Department of Orthopedics, Balgrist University Hospital Zurich, Zurich, Switzerland (M.F.)
| | - Karen Clark
- From the Russell H. Morgan Department of Radiology and Radiologic Science (N.G., P.H.Y., K.C.), Sections of Body CT (E.K.F.) and Musculoskeletal Radiology (J.F.), Johns Hopkins Hospital, 601 N Caroline St, Room 3014, Baltimore, MD 21287; and Spine Division, Department of Orthopedics, Balgrist University Hospital Zurich, Zurich, Switzerland (M.F.)
| | - Elliot K Fishman
- From the Russell H. Morgan Department of Radiology and Radiologic Science (N.G., P.H.Y., K.C.), Sections of Body CT (E.K.F.) and Musculoskeletal Radiology (J.F.), Johns Hopkins Hospital, 601 N Caroline St, Room 3014, Baltimore, MD 21287; and Spine Division, Department of Orthopedics, Balgrist University Hospital Zurich, Zurich, Switzerland (M.F.)
| | - Mazda Farshad
- From the Russell H. Morgan Department of Radiology and Radiologic Science (N.G., P.H.Y., K.C.), Sections of Body CT (E.K.F.) and Musculoskeletal Radiology (J.F.), Johns Hopkins Hospital, 601 N Caroline St, Room 3014, Baltimore, MD 21287; and Spine Division, Department of Orthopedics, Balgrist University Hospital Zurich, Zurich, Switzerland (M.F.)
| | - Jan Fritz
- From the Russell H. Morgan Department of Radiology and Radiologic Science (N.G., P.H.Y., K.C.), Sections of Body CT (E.K.F.) and Musculoskeletal Radiology (J.F.), Johns Hopkins Hospital, 601 N Caroline St, Room 3014, Baltimore, MD 21287; and Spine Division, Department of Orthopedics, Balgrist University Hospital Zurich, Zurich, Switzerland (M.F.)
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Han HJ, Jeong JH, Kim JW, Seung WB. Postoperative Thecal Sac Compression Induced by Hydrogel Dural Sealant after Spinal Schwannoma Removal. Korean J Neurotrauma 2020; 16:99-104. [PMID: 32395458 PMCID: PMC7192801 DOI: 10.13004/kjnt.2020.16.e10] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 03/23/2020] [Accepted: 04/07/2020] [Indexed: 11/15/2022] Open
Abstract
Cerebrospinal fluid (CSF) leak is a common complication of spinal and cranial surgery, and patients undergoing spinal tumor surgery are probably particularly predisposed due to the presence of an intradural tumor and many other factors. Furthermore, a meticulous dural closure technique does not always result in watertight closure. A number of adjunctive methods have been used to assist with dural closure. Synthetic, absorbable polyethylene glycol hydrogel dural sealants are widely used and have been approved for use as adjuncts for cranial applications requiring sutured dural closure. We report a case of thecal sac compression by DuraSeal® Dural Sealant used to repair the CSF leak after intentional durotomy during lumbar schwannoma extirpation.
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Affiliation(s)
- Hong Joon Han
- Department of Neurosurgery, Dongguk University Gyeongju Hospital, Dongguk University College of Medicine, Gyeongju, Korea
| | - Ju Ho Jeong
- Department of Neurosurgery, Dongguk University Gyeongju Hospital, Dongguk University College of Medicine, Gyeongju, Korea
| | - Jin Wook Kim
- Department of Neurosurgery, Dongguk University Gyeongju Hospital, Dongguk University College of Medicine, Gyeongju, Korea
| | - Won Bae Seung
- Department of Neurosurgery, Dongguk University Gyeongju Hospital, Dongguk University College of Medicine, Gyeongju, Korea
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Kang SS, Kim JE, Choi DJ, Park EJ. Pseudomeningocele after biportal endoscopic spine surgery: A case report. J Orthop 2019; 18:1-4. [PMID: 32189874 DOI: 10.1016/j.jor.2019.10.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 10/19/2019] [Indexed: 11/24/2022] Open
Abstract
Background Biportal endoscopic spinal surgery (BESS) was recently introduced and became prevalent fast. Incidental dural tear (IDT) could happen as one of the common complications even in endoscopic spine surgery. Case description A 45-year old male underwent discectomy by BESS. IDT sized about 15mm at the dorsal surface of dura occurred during the laminotomy procedure with an osteotome. Revision surgery was planned for assuming that the IDT is small enough to be sealed with a patch. Conclusion Revision surgery using BESS for a small-sized IDT could be reasonable alternative treatment to preserve the soft tissue, the primary purpose of MISS.
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Affiliation(s)
- Sang-Su Kang
- Department of Orthopaedic Surgery, Leaders Hospital, Seoul, South Korea
| | - Ju-Eun Kim
- Department of Orthopaedic Surgery, Himnaera Hospital, Pusan, South Korea
| | - Dae-Jung Choi
- Department of Orthopaedic Surgery, Himnaera Hospital, Pusan, South Korea
| | - Eugene J Park
- Department of Orthopaedic Surgery, Chungnam National University School of Medicine, Daejeon, Republic of Korea
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Suter A, Spirig JM, Fornaciari P, Bachmann E, Götschi T, Klein K, Farshad M. Watertightness of wound closure in lumbar spine-a comparison of different techniques. JOURNAL OF SPINE SURGERY (HONG KONG) 2019; 5:358-364. [PMID: 31663047 PMCID: PMC6787369 DOI: 10.21037/jss.2019.08.01] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 07/19/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Since a primary watertight dural suture after incidental durotomies has a failure rate of 5-10%, a watertight closure technique of the overlying layers (fascia, subcutis and skin) is essential. The purpose of this cadaveric study was to find the most watertight closure technique for fascia, subcutis and skin. METHODS Different suturing techniques were tested for each layer in a sheep cadaveric model by measuring the leakage pressure. The specimens were mounted on a pressure chamber connected to a manometer and a water tube system. Subsequently, the leakage was over-sewed with a cross stitch and the experiment was repeated. RESULTS Cross stitch suturing [median =180 mbar (43; 660)] performed best compared to continuous [median =16 mbar (6; 52)] (P=0.003) but not to single knot [median =118 mbar (21; 387)] (P=1.0) or locking stitch suturing [median =109 mbar (3; 149)] (P=0.93) for fascia closure. Continuous suture [median =9 mbar (3; 14)] resulted in a higher leakage pressure than single knot [median =1 mbar (1; 6)] (P=0.017) for subcutaneous closure. No significant differences were found between intracutaneous, Donati-continuous, single knot and locking stitch for skin closures (P=0.075). However, the Donati-continuous stitch closure resulted in higher pressures in tendency. Over-sewing increased median leakage pressure from 8.0 to 11.0 mbar (P=0.068) and from 4.0 to 13.0 mbar (P=0.042) for single knot and for locking stitch skin closures, respectively. CONCLUSIONS Cross stitches for the fascia, continuous suturing technique for the subcutis and Donati-continuous stitch for the skin resulted in the most watertight closure within this experimental setting. If leakage occurs, over-sewing might relevantly improve the watertightness of the wound.
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Affiliation(s)
- Aline Suter
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - José Miguel Spirig
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Paolo Fornaciari
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Elias Bachmann
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- Switzerland Laboratory for Orthopedic Biomechanics, Swiss Federal Institute of Technology in Zurich (ETHZ), Zurich, Switzerland
| | - Tobias Götschi
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- Switzerland Laboratory for Orthopedic Biomechanics, Swiss Federal Institute of Technology in Zurich (ETHZ), Zurich, Switzerland
| | - Karina Klein
- Vetsuisse, Musculoskeletal Research Unit (MSRU), University of Zurich, Zurich, Switzerland
| | - Mazda Farshad
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
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Sarfraz M, Mustansir F, Khan N, Darbar A. Acute Orbital Pseudomeningocele Due to Traumatic Fracture in an Infant. Neuroophthalmology 2019; 44:339-343. [PMID: 33012925 DOI: 10.1080/01658107.2019.1611881] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Paediatric orbital trauma is uncommon, but it can be associated with significant morbidity. Traumatic pseudomeningocele is an infrequent complication of orbital trauma; it occurs due to an extradural collection of cerebrospinal fluid (CSF) that develops after a dural tear. Herein, we report a case of a seven-month-old male child who presented with eye swelling and suspicion of orbital cellulitis, along with a history of a road traffic accident. He was later diagnosed with traumatic orbital pseudomeningocele and underwent a left frontal craniotomy and duroplasty along with repair of medial orbital pseudomeningocele. Postoperatively, the child remained stable and resolution of proptosis was observed.
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Affiliation(s)
- Maryam Sarfraz
- Department of Surgery, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Fatima Mustansir
- Department of Surgery, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Natasha Khan
- Department of Surgery, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Aneela Darbar
- Department of Surgery, The Aga Khan University, Karachi, Sindh, Pakistan
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Barber SM, Fridley JS, Konakondla S, Nakhla J, Oyelese AA, Telfeian AE, Gokaslan ZL. Cerebrospinal fluid leaks after spine tumor resection: avoidance, recognition and management. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:217. [PMID: 31297382 DOI: 10.21037/atm.2019.01.04] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Post-operative CSF leaks are a known complication of spine surgery in general, and patients undergoing surgical intervention for spinal tumors may be particularly predisposed due to the presence of intradural tumor and a number of other factors. Post-operative CSF leaks increase morbidity, lengthen hospital stays, prolong immobilization and subject patients to a number of associated complications. Intraoperative identification of unintended durotomies and effective primary repair of dural defects is an important first step in the prevention of post-operative CSF leaks, but in patients who develop post-operative pseudomeningoceles, durocutaneous fistulae or other CSF-leak-related sequelae, early recognition and secondary intervention are paramount to preventing further CSF-leak-related complications and achieving the best patient outcomes possible. In this article, the incidence, risk factors and complications of CSF leaks after spine tumor surgery are reviewed, with an emphasis on avoidance of post-operative CSF leaks, early post-operative identification and effective secondary intervention.
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Affiliation(s)
- Sean M Barber
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School at Brown University, Providence, RI, USA
| | - Jared S Fridley
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School at Brown University, Providence, RI, USA
| | - Sanjay Konakondla
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School at Brown University, Providence, RI, USA
| | - Jonathan Nakhla
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School at Brown University, Providence, RI, USA
| | - Adetokunbo A Oyelese
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School at Brown University, Providence, RI, USA
| | - Albert E Telfeian
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School at Brown University, Providence, RI, USA
| | - Ziya L Gokaslan
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School at Brown University, Providence, RI, USA
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Kim KD, Ramanathan D, Highsmith J, Lavelle W, Gerszten P, Vale F, Wright N. DuraSeal Exact Is a Safe Adjunctive Treatment for Durotomy in Spine: Postapproval Study. Global Spine J 2019; 9:272-278. [PMID: 31192094 PMCID: PMC6542171 DOI: 10.1177/2192568218791150] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN A nonrandomized, two-armed prospective study. OBJECTIVE Water-tight dural closure is paramount to the prevention of cerebrospinal fluid (CSF) leakage and associated complications. Synthetic polyethylene glycol (PEG) hydrogel has been used as an adjunct to sutured dural repair; however, its expansion postoperatively is a concern for neurological complications. A low-swell formulation of PEG sealant was introduced as DuraSeal Exact Spine Sealant System (DESS). A Post-Approval Study was performed primarily to evaluate the safety and efficacy of DESS for spinal dural repair compared to current alternatives, in a large patient population, reflecting a real-world practice. METHODS A total of 36 sites in the United States enrolled 429 patients treated with DESS as an adjunct to dural repair in the spinal sealant group and 406 patients treated with all other modalities in the control arm, from October 2011 to June 2016. The primary endpoint was the incidence of CSF leak within 90 days of operation. The secondary endpoints evaluated were deep surgical site infection and neurological serious adverse events. RESULTS The CSF leakage in the DESS group (6.6%) was not significantly different from the control group (6.5%) (p = .83), and there was no significant difference in the time to first leak. The two groups had no significant differences in deep surgical site infection (1.6% versus control 2.1%, p = .61) or proportion of subjects with neurological serious adverse events (2.9% versus control 1.6%, p = .516). CONCLUSIONS DuraSeal Exact Spinal Sealant is safe when compared to current alternatives for spinal dural repair.
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Affiliation(s)
- Kee D. Kim
- University of California–Davis, Sacramento, CA, USA,Kee D. Kim, MD, Department of Neurosurgery, University of California–Davis, 4860 Y Street, Suite 3740, Sacramento, CA 95817, USA.
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Clifton WE, Stone JJ, Kumar N, Marek T, Spinner RJ. Delayed Myelopathy in Patients with Traumatic Preganglionic Brachial Plexus Avulsion Injuries. World Neurosurg 2019; 122:e1562-e1569. [DOI: 10.1016/j.wneu.2018.11.102] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Revised: 11/11/2018] [Accepted: 11/12/2018] [Indexed: 10/27/2022]
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Cerebrospinal Fluid Leak and Symptomatic Pseudomeningocele After Intradural Spine Surgery. World Neurosurg 2018; 120:e497-e502. [DOI: 10.1016/j.wneu.2018.08.112] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 08/13/2018] [Accepted: 08/14/2018] [Indexed: 11/24/2022]
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Lim J, Berkman R. Profound Finger Extension Weakness 21 Years After a Traumatic Lumbar Spine Pseudomeningocele. World Neurosurg 2018; 120:244-248. [PMID: 30165213 DOI: 10.1016/j.wneu.2018.08.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Revised: 08/17/2018] [Accepted: 08/18/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND We present a case report of traumatic pseudomeningocele and a review of the literature and discussion of the neuro-cytoarchitecture to address the disproportionate weakness of extensor neurons seen in the case. CASE DESCRIPTION A 42-year old man developed profound hand weakness 21 years after a lumbar spinal fracture. An examination revealed bilateral hand weakness affecting the extensors of the hands. Imaging studies revealed an extensive ventral epidural pseudomeningocele extending from the area of the lumbar spinal fracture to the cervical spine posteriorly displacing the spinal cord and the ventral motor roots. CONCLUSIONS The patient was successfully treated with a subarachnoid-peritoneal shunt, which completely resolved the epidural pseudomeningocele and resulted in improvement but not resolution of his neurologic deficits.
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Affiliation(s)
- Jaims Lim
- Department of Neurosurgery, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York at Buffalo, Buffalo, New York, USA.
| | - Richard Berkman
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Clinical and Magnetic Resonance Imaging Characteristics of Postfenestration Optic Nerve Sheath Pseudomeningoceles. Ophthalmic Plast Reconstr Surg 2018; 35:159-164. [PMID: 30134388 DOI: 10.1097/iop.0000000000001194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The clinical significance of postoperative pseudomeningocele formation following optic nerve sheath fenestration (ONSF) has not been fully characterized. A literature review identifies 9 previously published cases the authors believe demonstrate pseudomeningocele formation and approximately 19 other similar findings that were either transient or less defined blebs. This study was undertaken to more clearly define the clinical, radiographic, and histopathologic features associated with this entity. METHODS Sixteen-year, single-center, retrospective chart review of all ONSF cases performed by 2 surgeons. Clinical data, intracranial pressure, radiographic imaging, and histopathology of clinically detected pseudomeningoceles after ONSF were reviewed. RESULTS Eighty-six eyes in 57 patients underwent ONSF (28 unilateral, 12 bilateral sequential, 17 bilateral simultaneous). Forty-nine of 57 patients had elevated intracranial pressure preoperatively (41 idiopathic intracranial hypertension, 4 venous thrombosis, 2 meningitis, 1 arteriovenous malformation, and 1 sarcoid). In 32 patients undergoing postoperative imaging, 4 eyes (4.7%) in 4 patients developed well-defined pseudomeningoceles, of which 3 were symptomatic and 2 required surgical revision. Each pseudomeningocele developed in the setting of elevated preoperative intracranial pressure (350, 360, 430, 500 mm H20). Magnetic resonance imaging and/or computed tomography revealed sharply demarcated fluid-filled sacs adjacent to the optic nerve. The contents of these sacs were hypointense on T1-weighted imaging, hyperintense on T2-weighting, variably enhanced with contrast, and hypointense on fluid attenuated inversion recovery, and were thus consistent with cerebrospinal fluid. Histopathologic analysis of one of these outpouchings demonstrated an acellular, fibrocollagenized lining consistent with pseudomeningocele. Three eyes in 3 additional patients had less well-defined findings on imaging interpreted as bleb-like or cyst-like change. CONCLUSIONS Pseudomeningoceles following ONSF may be asymptomatic or may cause symptomatic orbital mass effect and rarely visual loss, amendable to surgical excision. Post-ONSF pseudomeningoceles are identified on computed tomography or magnetic resonance imaging to occur at the locations of fenestration sites and contain cerebrospinal fluid communicating with the subdural space that may act as a "filtration" bleb in some cases. Imaging findings may represent a spectrum spanning intraorbital cerebrospinal fluid leakage, partial walling off of bleb, or fully developed cysts. Resection of optic nerve pseudomeningoceles is considered in symptomatic cysts or eyes with papilledema that fails to improve.
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Bradford VA, Falcon RJ, Petersen TR, Soneru CN. Delayed Post Caudal Catheter Placement Pseudomeningocele: A Case Report. A A Pract 2018; 10:258-260. [PMID: 29757794 DOI: 10.1213/xaa.0000000000000679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We present a rare case of a 7-month-old infant who developed a pseudomeningocele 16 days after an uneventful caudal catheter placement. The patient did not exhibit neurological deficits or signs of infection, and the mass increased in size with Valsalva maneuver. Pseudomeningocele, an abnormal collection of cerebrospinal fluid around an opening in the dura mater, can be iatrogenic or traumatic. Regional anesthesia is rarely the cause. Recognizing diagnostic features such as the lack of infectious signs and mass compressibility can prevent misdiagnosis and inappropriate invasive treatment.
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Affiliation(s)
- Victoria A Bradford
- From the Department of Anesthesiology, University of Kentucky, Lexington, Kentucky
| | - Ricardo J Falcon
- Department of Anesthesiology and Critical Care, University of New Mexico, Albuquerque, New Mexico
| | - Timothy R Petersen
- Department of Anesthesiology and Critical Care, University of New Mexico, Albuquerque, New Mexico
| | - Codruta N Soneru
- Department of Anesthesiology and Critical Care, University of New Mexico, Albuquerque, New Mexico
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Pitskhelauri D, Kudieva E, Moshchev D, Ananev E, Shifrin M, Danilov G, Melnikova-Pitskhelauri T, Kachkov I, Bykanov A, Sanikidze A. Cisterna magna arachnoid membrane suturing decreases incidence of pseudomeningocele formation and incisional CSF leakage. Acta Neurochir (Wien) 2018; 160:1079-1087. [PMID: 29557532 DOI: 10.1007/s00701-018-3507-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 02/27/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVE A pseudomeningocele and an incisional cerebrospinal fluid leak are considered frequent complications following neurosurgical operations. The rate of these complications especially increases following neurosurgical procedures on the posterior cranial fossae. According to some publications, the rate of pseudomeningoceles has been reported as high as 40%, whereas that of incisional cerebrospinal fluid leaks is up to 17%. For the purposes of reducing the risk of these complications after a midline suboccipital craniotomy, we propose suturing the arachnoid membrane of the cisterna magna. In this paper, we present a retrospective analysis of arachnoid membrane suturing. METHODS Seventy patients underwent midline suboccipital craniotomy by the first author between 2012 and 2016 at Burdenko Neurosurgery Institute. In this group was included a consecutive group of patients with posterior fossae tumors where the approach was performed through the cisterna magna arachnoid membrane following midline suboccipital craniotomy and dural opening. The patients were divided into two groups. Group 1 included 38 patients to whom cisterna magna arachnoid membrane suturing was performed with monofilament nonabsorbable suture 7.0., and additionally, the suture was sealed with fibrin adhesive sealant TachoComb®. Group 2 included 32 patients without arachnoid membrane suturing. There was no other significant difference in terms of clinical signs and surgical procedures between these groups. In the postoperative period, the frequency of developing a pseudomeningocele and an incisional cerebrospinal fluid leak was assessed in these two groups. The results were evaluated on the basis of clinical, CT, and MRI data performed in the postoperative period. RESULTS In the patients who underwent arachnoid membrane suturing (group I), pseudomeningocele formation was observed in one (2.6%) and CSF leak in one (2.6%) of the 38 patients. In group II, in which patients had no arachnoid membrane suturing, we observed pseudomeningocele formation in 11 (34.4%) patients and a CSF leak in 7 (25.0%) out of 28 patients with known follow-up. Statistical analysis of the data indicates a significantly higher risk of postoperative pseudomeningocele formation and/or an incisional cerebrospinal fluid leak in a group of patients who did not undergo arachnoid membrane suturing (p < 0.05). CONCLUSIONS Suturing of the arachnoid membrane of the cisterna magna and its further sealing with fibrin adhesive sealant TachoComb® create an additional barrier for preventing cerebrospinal fluid collection in the extradural space. This technique significantly reduces the risk of postoperative pseudomeningocele formation and/or an incisional cerebrospinal fluid leak in patients with midline suboccipital craniotomy.
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Rudrappa S, Govindasamy R, Tukkapuram VR, Gopal S. Lumbar pseudomeningocele presenting as decerebrate rigidity-A rare case entity. Int J Surg Case Rep 2018; 47:41-44. [PMID: 29709844 PMCID: PMC5994805 DOI: 10.1016/j.ijscr.2018.04.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 03/14/2018] [Accepted: 04/15/2018] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Spinal pseudomeningoceles are extradural collections of cerebrospinal fluid that result following a breach in the dural-arachnoid layer and is reported as one of the complications of lumbar disc surgery. Although they are often self subsiding and asymptomatic, they may occasionally cause low-back pain, headaches, and even nerve root entrapment. The purpose of this case report is to present an unreported presentation of pseudomeningocele PRESENTATION OF CASE: A 34 year obese male presented one month post lumbar discectomy with symptoms suggestive of raised intra cranial pressure presenting as repetitive decerebrate rigidity and altered sensorium lasting for few minutes when there is pressure on the pseudomeningocele sac and subsiding with change in position of the patient. He underwent surgical repair of the dural tear and was improved symptomatically with no recurrence of symptoms at five years follow up. DISCUSSION Radiological investigation helped in ruling out the other causes of decerebrate rigidity and the possible mechanism of development of such symptom in pseudomeningocele is discussed. CONCLUSION To the best of our knowledge, this is the first reported case of pseudomeningooele presenting as decerebrate rigidity. Spinal pseudomeningocele can present in varied ways and earliest detection is the key to avoid such complications.
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Affiliation(s)
- Satish Rudrappa
- Department of Neurological Sciences, Sakra World Hospital, Bangalore, India.
| | | | | | - Swaroop Gopal
- Department of Neurological Sciences, Sakra World Hospital, Bangalore, India.
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Ganaha S, Lara-Velazquez M, Yoon JW, Akinduro OO, Clendenen SR, Murray PM, Pichelmann MA, Quinones-Hinojosa A, Deen HG. Challenges of Managing Patients with Symptomatic Large Traumatic Cervical Pseudomeningoceles. World Neurosurg 2018; 115:128-133. [PMID: 29654960 DOI: 10.1016/j.wneu.2018.04.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 04/02/2018] [Accepted: 04/03/2018] [Indexed: 01/30/2023]
Abstract
BACKGROUND Traumatic cervical pseudomeningoceles (TCPs) occur secondary to traction of the cervical nerve roots resulting in violation of the dura. Surgical repair is not necessary in most cases because pseudomeningoceles have a high propensity to spontaneously resolve with conservative management alone. Currently, there are a limited number of cases of large TCPs (large is defined as ≥6 cm in greatest diameter), and there is no established guideline for the management of such lesions. CASE DESCRIPTION We describe the cases of 2 young men in their 20s who were involved in a motor vehicle accident. Both patients suffered a brachial plexus injury and developed large TCPs. Patient 1 was treated surgically for TCP using a combined intra-/extradural approach using a fascia lata graft. Patient 2 was ultimately treated nonsurgically because a spontaneous resolution of the pseudomeningocele was achieved over the period of 7 months after the accident. Both patients underwent brachial plexus repair surgery consisting of spinal accessory nerve transfer to the suprascapular nerve and intercostal nerve transfer to the musculocutaneous nerve. CONCLUSIONS Disease progression of TCPs is a dynamic process, and even large lesions may spontaneously resolve without surgical intervention. When surgery is indicated, a definitive dural repair using a fascia lata graft to cover the dural tear intra- and extradurally is an effective method. Surgery must be planned carefully on a case-by-case basis, and close follow-up with thorough physical examination and serial imaging is critical to monitor disease progression.
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Affiliation(s)
- Sara Ganaha
- Department of Neurosurgery, Mayo Clinic, Jacksonville, Florida, USA
| | | | - Jang W Yoon
- Department of Neurosurgery, Mayo Clinic, Jacksonville, Florida, USA
| | | | | | - Peter M Murray
- Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | | | | | - H Gordon Deen
- Department of Neurosurgery, Mayo Clinic, Jacksonville, Florida, USA.
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Lee JW, Kang H, Choi ES, Seol JW, Shin S. Spinal anesthesia in a patient with postoperative iatrogenic pseudomeningocele - A case report -. Anesth Pain Med (Seoul) 2018. [DOI: 10.17085/apm.2018.13.1.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Jae-woo Lee
- Department of Anesthesiology and Pain Medicine, Nowon Eulji Medical Center, Eulji University College of Medicine, Seoul, Korea
| | - Hyoseok Kang
- Department of Anesthesiology and Pain Medicine, Nowon Eulji Medical Center, Eulji University College of Medicine, Seoul, Korea
| | - Eun-Su Choi
- Department of Anesthesiology and Pain Medicine, Nowon Eulji Medical Center, Eulji University College of Medicine, Seoul, Korea
| | - Jin Wook Seol
- Department of Anesthesiology and Pain Medicine, Nowon Eulji Medical Center, Eulji University College of Medicine, Seoul, Korea
| | - Sojin Shin
- Department of Anesthesiology and Pain Medicine, Nowon Eulji Medical Center, Eulji University College of Medicine, Seoul, Korea
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Intraosseous pseudomeningocele of the mobile spine: a case report and review of the literature. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2018; 27:472-476. [DOI: 10.1007/s00586-018-5498-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 01/04/2018] [Accepted: 01/24/2018] [Indexed: 10/18/2022]
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Engel L, Manch M. The Life and Trials of a Pseudomeningocoele. AUSTRALASIAN JOURNAL OF NEUROSCIENCE 2018. [DOI: 10.21307/ajon-2017-124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Ailon T, Smith JS, Nassr A, Smith ZA, Hsu WK, Fehlings MG, Fish DE, Wang JC, Hilibrand AS, Mummaneni PV, Chou D, Sasso RC, Traynelis VC, Arnold PM, Mroz TE, Buser Z, Lord EL, Massicotte EM, Sebastian AS, Than KD, Steinmetz MP, Smith GA, Pace J, Corriveau M, Lee S, Riew KD, Shaffrey C. Rare Complications of Cervical Spine Surgery: Pseudomeningocoele. Global Spine J 2017; 7:109S-114S. [PMID: 28451481 PMCID: PMC5400191 DOI: 10.1177/2192568216687769] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
STUDY DESIGN This study was a retrospective, multicenter cohort study. OBJECTIVES Rare complications of cervical spine surgery are inherently difficult to investigate. Pseudomeningocoele (PMC), an abnormal collection of cerebrospinal fluid that communicates with the subarachnoid space, is one such complication. In order to evaluate and better understand the incidence, presentation, treatment, and outcome of PMC following cervical spine surgery, we conducted a multicenter study to pool our collective experience. METHODS This study was a retrospective, multicenter cohort study of patients who underwent cervical spine surgery at any level(s) from C2 to C7, inclusive; were over 18 years of age; and experienced a postoperative PMC. RESULTS Thirteen patients (0.08%) developed a postoperative PMC, 6 (46.2%) of whom were female. They had an average age of 48.2 years and stayed in hospital a mean of 11.2 days. Three patients were current smokers, 3 previous smokers, 5 had never smoked, and 2 had unknown smoking status. The majority, 10 (76.9%), were associated with posterior surgery, whereas 3 (23.1%) occurred after an anterior procedure. Myelopathy was the most common indication for operations that were complicated by PMC (46%). Seven patients (53%) required a surgical procedure to address the PMC, whereas the remaining 6 were treated conservatively. All PMCs ultimately resolved or were successfully treated with no residual effects. CONCLUSIONS PMC is a rare complication of cervical surgery with an incidence of less than 0.1%. They prolong hospital stay. PMCs occurred more frequently in association with posterior approaches. Approximately half of PMCs required surgery and all ultimately resolved without residual neurologic or other long-term effects.
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Affiliation(s)
- Tamir Ailon
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Justin S. Smith
- University of Virginia, Charlottesville, VA, USA,Justin S. Smith, University of Virginia, PO Box 800212, Charlottesville, VA 22908, USA.
| | | | - Zachary A. Smith
- Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Wellington K. Hsu
- Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | | | | | | | - Alan S. Hilibrand
- Jefferson Medical College, The Rothman Institute, Philadelphia, PA, USA
| | | | - Dean Chou
- University of California San Francisco, CA, USA
| | | | | | | | | | - Zorica Buser
- University of Southern California, Los Angeles, CA, USA
| | | | - Eric M. Massicotte
- Toronto Western Hospital, Toronto, Ontario, Canada,University of Toronto, Toronto, Ontario, Canada
| | | | - Khoi D. Than
- Oregon Health & Science University, Portland, OR, USA
| | | | | | - Jonathan Pace
- University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Mark Corriveau
- University of Wisconsin Hospital and Clinics, Madison, WI, USA
| | - Sungho Lee
- University Hospitals Case Medical Center, Cleveland, OH, USA
| | - K. Daniel Riew
- Columbia University, New York, NY, USA,New York-Presbyterian/The Allen Hospital, New York, NY, USA
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Rahimizadeh A, Soufiani H, Rahimizadeh S. Remote Cervical Pseudomeningocele Following Anterior Cervical Corpectomy and Fusion: Report of a Case and Review of the Literature. Int J Spine Surg 2016; 10:36. [PMID: 27909657 DOI: 10.14444/3036] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Iatrogenic cervical pseudomeningocele is a rare event and majority are located posteriorly as a delayed complication of inadvertent dural tear after decompressive laminectomy. However, iatrogenic anterior cervical pseudomeningocele subsequent to discectomy or corpectomy is a rare pathology. The time necessary for formation of pseudomeningocele varies and depend on the width of the dural tear and the flow of cerebrospinal fluid leakage. Large tears with high CSF flow usually result in early collection of the cerebrospinal fluid in anterior compartment of the neck designated acute pseudomeningoceles. Micro-tears of dura mater, with low flow of cerebrospinal fluid may lead to late formation of a pseudomeningocele known as chronic ones. Herein a 49- year-old woman in whom cervical pseudomeningocele appeared clinically as a mass on the anterior aspect of the neck, six months after anterior cervical corpectomy for cervical spondylotic myelopathy is presented. Otherwise, she was neurologically stable. Cystoperitoneal shunt was proposed which she refused. Surprisingly, at 2-year follow-up, the cyst had remained of the same size. To the best of our knowledge, this is the first example of post-operative chronic cervical pseudomeningocele in the literature, the event that might propose the self-limited natural course of this rare pathology in chronic cases.
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CT-guided epidural blood patch for treatment of CSF leak and pseudomeningocele following tethered cord release in a 3-year-old. Clin Imaging 2016; 40:1191-1194. [PMID: 27596235 DOI: 10.1016/j.clinimag.2016.08.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 08/03/2016] [Accepted: 08/12/2016] [Indexed: 11/23/2022]
Abstract
An epidural blood patch (EBP) has become standard of care for management of postdural puncture headache, and in recent years, attempts have been made to expand its applicability. Its utility in the management of postsurgical pseudomeningocele remains poorly defined, and few reports describe its use in children. In this case, we report the successful management of lumbar pseudomeningocele via EBP in a 3-year-old after tethered cord release, thereby obviating the need for surgical repair and its potential morbidity.
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Jens W, Bacharach R, Savaliya S, Kaur D. Pseudomenigiocele masquerading as monomelic amyotrophy. INTERDISCIPLINARY NEUROSURGERY 2016. [DOI: 10.1016/j.inat.2016.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Posterior Trans-Dural Repair of Iatrogenic Spinal Cord Herniation after Resection of Ossification of Posterior Longitudinal Ligament. Asian Spine J 2016; 10:355-9. [PMID: 27114779 PMCID: PMC4843075 DOI: 10.4184/asj.2016.10.2.355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 09/21/2015] [Accepted: 09/24/2015] [Indexed: 11/23/2022] Open
Abstract
Iatrogenic spinal cord herniation is a rare complication following spinal surgery. We introduce a posterior trans-dural repair technique used in a case of thoracic spinal cord herniation through a ventral dural defect following resection of ossification of the posterior longitudinal ligament (OPLL) in the cervicothoracic spine. A 51-year-old female was suffering from paraplegia after laminectomy alone for cervicothoracic OPLL. Magnetic resonance imaging revealed a severely compressed spinal cord with pseudomeningocele identified postoperatively. Cerebrospinal fluid leak and iatrogenic spinal cord herniation persisted despite several operations with duroplasty and sealing agent. Finally, the problems were treated by repair of the ventral dural defect with posterior trans-dural duroplasty. Several months after surgery, the patient could walk independently. This surgical technique can be applied to treat ventral dural defect and spinal cord herniation.
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