Iatrogenic giant pseudomeningocele of the cervical spine: A case report

BACKGROUND

Only a few cases of giant pseudomeningoceles have been reported in the literature. Herein, we report a giant pseudomeningocele of the cervical spine that was found after cervical laminectomy for an epidural hematoma following epidural blockade.

CASE SUMMARY

A 47-year-old man presented with recurrent neck pain and posterior neck swelling after spinal surgery. Magnetic resonance imaging of the cervical spine revealed fluid collection (5.6 cm × 6.6 cm × 11.2 cm) at the C3-6 level; this proved to be a pseudomeningocele. Symptoms related to the pseudomeningocele resolved following dural repair and fat graft transplantation.

CONCLUSION

Although rare, pseudomeningocele is a possibility in patients with recurrent back pain, radicular pain, or a persistent headache following spinal surgery. Continuous attention should be paid throughout the spinal procedure, whether conservative or non-conservative.

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

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