Al Jammal Omar M, Wali Arvin R, Lewis Courtney S, Zaldana Michelle V, Suliman Ahmed S, Pham Martin H
Department of Neurosurgery, University of California San Diego School of Medicine, San Diego, California.
Department of Plastic Surgery, University of California San Diego School of Medicine, San Diego, California.
Int J Spine Surg. 2020 Oct;14(5):778-784. doi: 10.14444/7111. Epub 2020 Oct 23.
Giant pseudomeningoceles are an uncommon complication of spine surgery. Surgical management and extirpation can be difficult, and guidelines remain unclear.
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.
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.
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.
巨大假性脑脊膜膨出是脊柱手术一种罕见的并发症。手术处理和切除可能具有挑战性，且相关指南仍不明确。
在此，我们报告一名56岁女性患者，有III度L5 - S1椎体滑脱病史，曾接受过2次脊柱手术。患者因假关节形成接受了从L4至髂骨的植骨和内固定治疗。术中及术后脑脊液引流和硬脑膜修复均未成功，患者因严重的体位性头痛就诊于急诊室。
患者接受了硬脑膜修复，使用牛心包补片用7 - 0普理灵缝线镶嵌缝合、血液补片和硬脑膜封闭剂。整形外科进行了分层缝合，在硬脑膜缝合处上方使用无细胞真皮基质。双侧椎旁皮瓣向内侧推进以覆盖整个无细胞真皮基质，然后将筋膜皮瓣推进至中线以实现水密缝合。在3个月的随访中，患者头痛消失，已恢复日常生活活动。
我们得出结论，早期咨询整形外科对于有效消除死腔和解决巨大骶部假性脑脊膜膨出可能非常有益，特别是如果由于既往翻修手术导致相对固定的无血管软组织而担心存在持续性脑脊液漏时。
