Solomon Prince, Sekharappa Vijay, Krishnan Venkatesh, David Kenny Samuel
Department of Orthopaedics, Spinal Disorder Surgery Unit, Christian Medical College, Vellore, Tamil Nadu, India.
Indian J Orthop. 2013 Jul;47(4):417-21. doi: 10.4103/0019-5413.114937.
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.
假性脑脊膜膨出是一种源于硬脑膜缺损的硬膜外脑脊液聚集，可能是先天性、创伤性的，或更常见于术后并发症。腰椎手术后发生的大多数术后假性脑脊膜膨出较小，可自行消退。然而，大型假性脑脊膜膨出很少见，且此类假性脑脊膜膨出的自发消退尚未见报道。我们报告了4例术后大型腰椎假性脑脊膜膨出病例，表现为背部无症状的柔软波动性肿胀，且均自行消退。我们还回顾了这些患者的相关文献和手术记录，以找出可能的发生机制、治疗方法、预防措施以及自发消退的原因。我们得出结论，对于无症状的术后大型腰椎假性脑脊膜膨出，可在密切观察下采用非手术治疗。对于出现颅内低压、神经功能恶化、外瘘或感染等临床特征的有症状病例，应进行手术探查和修复，从而避免与手术治疗相关的发病率和潜在并发症。
