Bradaschia Leonardo, Lacatena Filippo, Vincitorio Francesca, Titolo Paolo, Battiston Bruno, Garbossa Diego, Cofano Fabio
Department of Neuroscience "Rita Levi Montalcini", University of Turin, 10126 Turin, Italy.
Neurosurgery Unit, Department of Neuroscience "Rita Levi Montalcini", A.O.U. Città della Salute e della Scienza Torino University of Turin, 10126 Turin, Italy.
Neurol Int. 2024 Dec 6;16(6):1742-1749. doi: 10.3390/neurolint16060126.
Post-traumatic pseudomeningoceles are common findings after a brachial or lumbar plexus trauma, in particular after nerve root avulsion. Unlike meningoceles, pseudomeningoceles are CSF full-filled cysts confined by the paraspinous soft tissue, along the normal nerve course, in communication with the spinal subarachnoid spaces. Normally no more than a radiological finding at MRI, in rare instances they might be symptomatic due to their size or might constitute an obstacle during a reconstructive surgery.
A review of the literature was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines in a time span ranging from November 1972 to May 2024. A total of five articles were found meeting the inclusion criteria. A case report at our institution was added to the case history.
A 30-year-old man with complete right brachial plexus nerve roots avulsion and a voluminous pseudomeningocele at the C6-C7 level after a motorcycle incident in January 2023. The pseudomeningocele covered the entirety of the injured brachial plexus. Pre-operative external lumbar drainage was utilized to prevent relapse or worsening of the already existing cerebral spinal fluid collection, with good results at 6 months. The full case report is reported in detail.
To date, no clear guidelines about the management of post-traumatic pseudomeningoceles are reported in the literature. The lack of symptoms or signs related to them does not usually require any surgical intervention. If not, a possible management strategy with the use of an external lumbar drainage is proposed, a solution already in use in other surgical contexts with successful results in preventing CSF fistula or its relapse.
创伤后假性脑脊膜膨出是臂丛或腰骶丛创伤后常见的表现，尤其是在神经根撕脱后。与脑脊膜膨出不同，假性脑脊膜膨出是由椎旁软组织限制的充满脑脊液的囊肿，沿正常神经走行，与脊髓蛛网膜下腔相通。通常在MRI上只是一种影像学表现，在极少数情况下，它们可能因其大小而出现症状，或者在重建手术中构成障碍。
按照系统评价和Meta分析的首选报告项目（PRISMA）指南，对1972年11月至2024年5月期间的文献进行了回顾。共发现5篇符合纳入标准的文章。将我们机构的1例病例报告补充到病例史中。
一名30岁男性，在2023年1月发生摩托车事故后，出现右侧臂丛神经根完全撕脱，并在C6-C7水平有一个巨大的假性脑脊膜膨出。假性脑脊膜膨出覆盖了整个受损的臂丛神经。术前采用外部腰大池引流以防止已有的脑脊液积聚复发或恶化，6个月时效果良好。详细报告了完整的病例报告。
迄今为止，文献中未报道关于创伤后假性脑脊膜膨出管理的明确指南。缺乏与之相关的症状或体征通常不需要任何手术干预。如果需要，建议采用外部腰大池引流的可能管理策略，这一解决方案已在其他手术中使用，在预防脑脊液漏或其复发方面取得了成功结果。
