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Abstract

Pseudomeningoceles (PMs) are collections of cerebrospinal fluid (CSF) occurring as a direct result of a dural rent1. This article presents the case of a rare PM initially recognized on palpation of the patient’s postoperative incision site and later diagnosed with magnetic resonance imaging (MRI). A well-documented case of a 68-year-old male presenting to emergency department with postoperative lumbar PM with a duro-cutaneous fistula was reported. Incidental durotomies leading to PMs are a rare complication of laminectomies and other spinal surgeries1. A thorough physical exam, intentional imaging, and lumbar drainage to survey the integrity of the dura mater are important aspects of postoperative care. Pseudomeningoceles (PM) are extradural collections of cerebrospinal fluid (CSF) which form after the dura mater is torn1. These rare complications of spinal surgery occur after approximately 0.7% to 2% of laminectomies or discectomies1. Determining factors for PM formation include the size of the dural defect, strength of the surrounding musculature and structures, and pressure due to inflowing CSF2. A trial following 553 patients after lumbar laminectomies found 70 patients experienced incidental durotomies (ID) – 3 of these cases presented with PMs3. This study also found incidence of ID to be highest in reoperative surgeries following findings of PMs, and nonspecific CSF leaks3. These are rarely diagnosed in clinical practice, specifically during the immediate postoperative course, due to their commonly asymptomatic nature1. We present a rare case of a symptomatic PM initially recognized upon palpation of the postoperative incision site and diagnosed with lumbosacral magnetic resonance imaging (MRI). Our goal is to emphasize the importance of a thorough physical examination, postoperative imaging, and placement of a lumbar drainage device after spinal surgery.

References

1. Hawk MW, Kim KD. Review of spinal PMs and cerebrospinal fluid fistulas. FOC. 2000;9(1):1-8. doi:10.3171/foc.2000.9.1.5

2. David KS, Rao RD, Fischgrund JS. CHAPTER 105 – Postoperative Pseudomeningocele, Hematoma, and Seroma. Interventional Spine an algorithmic approach. 2008:1147-1153. doi:10.1016/B978-0-7216-2872-1.50110-2

3. Kalevski SK, Peev NA, Haritonov DG. Incidental Dural Tears in lumbar decompressive surgery: Incidence, causes, treatment, results. Asian J Neurosurg. 2010;5(1):54-59.

4. Chaudhry S, Ishaque M. A simple lumbar drainage system. Techniques in Orthopaedics. 2012;27(4):265. doi:10.1097/BTO.0b013e318263f3ca