Beckman Scott P, Proctor Carlie, Toms Jamie B
Medicine, Louisiana State University (LSU) Health Shreveport, Shreveport, USA.
Neurosurgery, Louisiana State University (LSU) Health Shreveport, Shreveport, USA.
Cureus. 2023 Feb 28;15(2):e35600. doi: 10.7759/cureus.35600. eCollection 2023 Feb.
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.
假性脑脊膜膨出是脊柱和颅脑手术后一种众所周知的潜在并发症，可发生于腰椎减压术和后颅窝手术后。它们通常由意外的硬脊膜切开术引起，但也可能是诊断性检查期间硬脊膜穿刺的结果。本报告描述了一名59岁男性，在因严重腰椎管狭窄行L4椎板切除术后出现复发性假性脑脊膜膨出，最终采用硬膜外血贴（EBP）治疗。他的术前状况有了很大改善，但出现了假性脑脊膜膨出，冰敷和轻度按压后未消退。患者随后接受了伤口探查，未发现硬脊膜缺损。在这次探查中，用硬脊膜补片和密封剂加强了硬脊膜。不幸的是，患者在短时间内又出现了假性脑脊膜膨出。当时怀疑椎板切除术后部位为之前CT脊髓造影时硬脊膜穿刺导致脑脊液（CSF）漏出提供了空间。患者随后接受了超声（US）引导下假性脑脊膜膨出抽吸术，并在术前脊髓造影的水平进行了EBP注射。EBP的成功表明之前的CT脊髓造影可能是假性脑脊膜膨出的原因。无意外硬脊膜切开证据的复发性脊柱假性脑脊膜膨出可能由脊髓造影时的硬脊膜穿刺引起。在这种情况下，对之前进行脊髓造影的区域进行EBP可解决假性脑脊膜膨出问题。
