In difficult-to-repair dural defects, surgical repair can be supplemented with temporary postoperative CSF diversion (lumbar drain). may require a lumbar drain. The time interval between surgery and the onset of symptoms may range from months to years. The patient remains symptom free almost 2 years after closure. Pseudomeningocele is a rare but well-known complication of lumbar spine surgery, which arises in 0.068%0.1% of individuals in large series of patients undergoing laminectomy and in up to 2% of patients with postlaminectomy symptoms. 32. ICD-10-CM Diagnosis Code G96.198. Symptoms related to the pseudomeningocele resolved following dural repair and fat graft transplantation. Whether symptomatic pseudomeningocele is best treated conservatively or surgically remains controversial. could pay for a neuroscience-trained nurse to answer Helpline calls for one hour. The symptoms I have are severe low back pain mostly left of center which increases with walking and bending, worsening double vision and left ear pusitile tinintus, dull headache. OBJECTIVE In pediatric patients, the development of a postoperative pseudomeningocele after an elective craniotomy is not unusual. Some scientists believe that pseudomeningocele is caused by problems in the subarachnoid space, such as intradural defects, while others believe it may be related to defective CSF absorption, secondary to conditions such as subarachnoid scarring and hydrocephalus. Pseudomeningocele is clearly demonstrated on suc-tomy (figs. Pseudomeningocele or cerebrospinal fluid leakage is one of the most common complications of foramen magnum decompression with duraplasty for Chiari I malformation. The journal has a broad International perspective, and emphasises the advances occurring in Asia, the Pacific Rim We report a case of a known pseudomeningocele resulting in acute intraoperative compression of the intrathoracic trachea and an unexpected variable expiratory obstruction. Other symptoms may include a new severe radiating pain down your leg or arm. Majority of pseudomeningoceles occurs after lumbar spine surgery and resolves spontaneously. It may also cause pain in neck region. 1-36 Patients commonly present with new weakness in the deltoid and/or biceps brachii, sensory deficits, and/or pain in PROCEDURE: The patient was placed on the CT scan table in a prone position. Given the constellation of symptoms with the background of a young and high BMI phenotype, there was concern for an underlying undiagnosed and perhaps exacerbated idiopathic intracranial hypertension (IIH) causing impaired healing and propagation of a pseudomeningocele. Small pseudomeningoceles associated with minimal symptoms has been reported to require no treatment [7, 28]. However, pseudomeningocele is sometimes associated with symptoms. Repeat MRI scans done 8 weeks and 6 months after surgery showed progressive decrease in the size of the pseudomeningocele, till there was only a tiny focus of fluid left. Diagnosis was based on symptoms of lumbar wound swelling, postural headaches, back and leg pain, and was confirmed by imaging studies. The authors revisit pseudomeningocele as a possible cause of failed back syndrome with its literature review after coming across two post-laminectomy patients with symptoms of low back pain, radicular pain and swelling over the operative site in past year. c cause signs and symptoms either by mass effect with compression of neural elements or by herniation of neural structures through the dura mater [1 , 4]. Other than these, patient feels a palpable subcutaneous bulge. Sometimes patient experience non postural headache. Abstract Keywords ossified pseudomeningocele shunt malfunction The signs and symptoms associated with pseudomeningocele vary widely, including back pain, sciatic pain, headache, neck pain, nausea, vomiting, tinnitus and a palpable mass, although most pseudomeningoceles remain asymptomatic. The mean time to symptom presentation was 30.7 days (range 2-157 days). Pseudomeningocele: "A leak of spinal fluid through the duraplasty creates a pocket of CSF in the posterior cervical muscles. The symptoms associated with pseudomeningocele vary widely, including back pain, sciatic pain, headache, neck pain, nausea, vomiting, tinnitus and a palpable mass. Early diagnosis is critical and is made clinically by characteristic symptoms of saddle-like paresthesias combined with acute back and leg pain. To the authors' knowledge, such a pseudomeningocele in a patient with Marfan syndrome has been reported only twice, and this case features the largest pseudomeningocele to date. Incidental durotomy is a relatively common occurrence in spinal surgery, estimated to occur in 1% to 17% of spinal surgery cases. The small size produced minimal pseudomeningocele symptoms and introducing a tract directly to the defect could have had deleterious effects. How bad it is. Posts. The symptoms of ITB withdrawal improved over the next 18 hours. postoperative bed rest for 4-7 days. Methods Retrospective analyses of six such cases was made including: clinical signs and symptoms, radiological findings, and Common symptoms reported by people with pseudomeningocele. (or a closely related substance) to relieve or avoid withdrawal symptoms. 1 and 2). 14. Other disorders of meninges, not elsewhere classified. Background and Importance Lumbar pseudomeningocele is an extradural cystic collection of Fig. They were treated between July 1990 and July 1998. The incidence of this complication has been reported to be between 0% and 30% depending on procedure type and approach. This disclosed a pseudomeningocele, which was closed. A pseudomeningocele is an abnormal collection of spinal fluid which can form from the dura being opened as part of Chiari surgery. A pseudomeningocele is a collection of the water-like fluid that normal surrounds the brain in the space created during surgery outside the normal covering of the brain (called the dura). Been several years and hasnt healed yet. Ernst Haberi - the symptoms were perhaps unusual as they were nausea following walking other than minimal distances. 116. pseudomeningocele Information, Symptoms, Treatments and Resources. The treatment of pseudomeningocele is controversial, particularly in asymptomatic patients. The researchers found that a postoperative symptomatic pseudomeningocele has lingering effects at 1 year, which significantly diminishes the overall benefit of suboccipital decompression for CM-related symptoms. While the authors use this finding to argue for a less invasive approach, I have a different view. PMCs might be a cause of clinical deterioration over short postoperative periods. In a second case, a 25-year old patient injured himself in a Urgent MRI is performed to confirm the cause. OBJECTIVE In pediatric patients, the development of a postoperative pseudomeningocele after an elective craniotomy is not unusual. Patient may feel dizziness and heavy head. the cervical spine, consistent with pseudomeningocele [7]. patients, and confirmed as a giant pseudomeningocele by MRI carried out before the combined treatment pro-tocol. Suboccipital craniotomy is a workhorse neurosurgical operation for approaching the posterior fossa .Because of its gravity-dependent location, posterior fossa approaches carry a higher risk of pseudomeningocele and cerebrospinal fluid leak (CSF) .In the reported literature, with various underlying pathologies and radiographic or clinical criteria, the rate of Chiari III and IV malformations have a high incidence of infant mortality. The usual treatment of The pseudomeningocele and dural tear were treated with an outpatient EBP done via an epidural catheter using a caudal entry point resulting from alteration of lumbar anatomy after lumbar The pseudomeningocele was percutaneously aspirated and approximately 15 hours later the patient developed signs and symptoms of acute baclofen withdrawal. The clinical presentation of the pseudomeningocele can be variable, or even asymptomatic [15]. Pseudomeningocele Treatment? Surgery was the only option. Wound infection; Development of painful pseudoarthrosis (failure of adequate fusion to occur) (A) A 26-year-old obese female, body height of 170 cm, body weight Damage to the dura, resulting in a cerebrospinal fluid leak or pocket of cerebral spinal fluid beneath the incision (pseudomeningocele) Mechanical complications of the graft and plate (including graft migration, breakage of the plate, screw pullout, etc.) A small pseudomeningocele without connection to the subarachnoidal space can show no symptoms. Diagnosis was based on symptoms of lumbar wound swelling, postural headaches, back and leg pain, and was confirmed by imaging studies. We report a case of a known pseudomeningocele resulting in acute intraoperative compression of the intrathoracic trachea and an unexpected variable expiratory obstruction. Although ossified pseudomeningocele is a rare entity following VP shunt placement, it should be suspected if patients present with aggravated symptoms, especially if there is shunt malfunction as the treatment option varies with the presence or absence of resultant symptoms and ossification. 1.-Postoperative cervical pseudomeningocele. About this community. MRI revealed a pseudomeningocele compressing the thoracic spinal cord. The Editors of Clinical Imaging in conjunction with the Elsevier Office of Continuing Medical Education are pleased to offer an AMA PRA Category 1 CME credit program for registered Clinical Imaging physician reviewers who complete manuscript reviews. The option of This relieved the postural headache symptoms immediately. In most cases, the pseudomeningocele is asymptomatic and does not show any symptoms. If the fluid collection enlarges, it pushes the duraplasty membrane into the foramen magnum region causing crowing and recurrence of the Chiari symptoms. Spinal pseudomeningocoeles can occur in less than 2% of patients following laminectomy or discectomy 4. This case is being reported to highlight the use of USG-guided epidural blood patch for the treatment of postoperative lumbar pseudomeningocele. Methods An IRB approved, retrospective chart review analyzed the outcomes, imaging, and complications of 19 patients who received blood patch(es) for symptoms of postoperative pseudomeningocele, between 2009 and 2015. The researchers found that a postoperative symptomatic pseudomeningocele has lingering effects at 1 year, which significantly diminishes the overall benefit of suboccipital decompression for CM-related symptoms.. Pseudomeningocele An abnormal collection of cerebrospinal fluid, sometimes found around the surgery site after decompression surgery. Pseudomeningocele. The aim of this study is to assess the clinical features and treatment of PMC and provide the technical notes with revision surgery. The patient underwent surgical drainage of the cyst. Depressed mood. The findings were confirmed on histopathology. in resolving pseudomeningocele symptoms. Patient may vomit again and again. In this case of chronic aseptic meningitis after posterior fossa surgery, closure of the pseudomeningocele found at exploratory surgery led to Sometimes this nerve herniation, in addition to causing severe pain, may actually plug the hole, meaning the only symptom of the spinal fluid leak is this new pain. Intracranial hypotension is also reported. Fig. Key words: arachnoiditis ossificans, pseudomeningocele, leptomeninges calcifications, clinical symptoms, treatment Introduction Arachnoiditis ossificans (AO) is a pathologic ossification of the arachnoid due to chronic inflammation of arachnoid cell clusters, always associated with neurologi-cal symptoms and chronic backache 1. Spinal pseudomeningocele can present in varied ways and earliest detection is the key to avoid such complications. The interval between trauma or laminectomy and discovery of the pseudomeningocele varies from a few months to symptoms in many of the patients, or even because surgeons refuse to publish negative results [4]. 12 Initial signs and symptoms in the lumbar region Posts on pseudomeningocele (167) Pseudomeningocele and bilateral facet hypertrophy - Orthopedics Community - Jul 19, 2014. A nontargeted epidural blood patch was performed with subsequent resolution of the patient's symptoms. The Spinal CSF Leak Foundation is a 501 (c) (3) nonprofit health foundation focused on raising awareness, providing education, and funding research for spinal CSF leaks. Awareness of rare possibility of neurological decline from posterior cervical pseudomeningocele can help in early diagnosis and quick remedial action to reverse the symptoms. At 1-year follow-up, she was completely symptom free and full resolution of pseudomeningocele was seen on 1-year follow-up MRI. A pseudomeningocele is an extravasation of cerebrospinal fluid that occurs due to an abnormal communication between the dural-arachnoid layer and extradural tissues. In almost all described cases, as in the case of our patient, symptoms of intracranial hypotension syndrome appear only 23 weeks after the operation. This International journal, Journal of Clinical Neuroscience publishes articles on clinical neurosurgery and neurology and the related neurosciences such as neuro-pathology, neuro-radiology, neuro-ophthalmology and neuro-physiology. MRI L-Spine shows ballooned intrathecal space with pseudomeningocele and arachnoiditis L4-5. Although rare, pseudomeningocele is a possibility in patients with recurrent back pain, radicular pain, or a persistent headache following spinal surgery. Doctors here locally are not concernned since no negative findings from lower limb EMG studies. User Journals. However, if hydrocephalus occurs, spinal drainage may cause brain herniation. The pathophysiology of pseudomeningocele is controversial. Standard patient demographics, diagnosis, post-operative symptoms, wound healing time, and the largest pre- and last follow-up pseudomeningocele area on axial MRI sections were recorded. Low pressure symptoms are worse and better depending on rest verses activity. Case presentation: We present an exceptional case of a 47-year-old man with a rare spontaneus pseudomeningocele of the sphenoid sinus without any obvious clinical symptoms, which resembles a mucocele on CT and MRI scans and which was first correctly diagnosed after an exploratory sphenoidotomy. 13 They also found a high incidence of pseudomeningocele (43%) and CSF fistula (13%) in patients after surgical correction of the tethered spinal cord. In this study, the authors analyzed patients who required intervention for a postoperative pseudomeningocele following an elective craniotomy or Now I have one at L3-4 from prior drain ports. A lumbar puncture decreased the size of supraclavicular mass only transiently. They say just "go see CONCLUSION Although rare, pseudomeningocele is a possibility in patients with recurrent back pain, radicular pain, or a persistent headache following spinal surgery. Nothing reported yet. There are three groups of pseudomeningocele: congenital, traumatic, and iatrogenic. In most cases this fluid remains static or diminished over time and may even disappear. Most will resolve with time, but some may require intervention. Arnold-Chiari, or simply Chiari malformation, is the name given to a group of deformities of the posterior fossa and hindbrain (cerebellum, pons, and medulla oblongata). In the lumbar region, the contents were As symptoms worsened, she presented to another institution where MRI of the lumbar spine indicated sacral fracture with pseudomeningocele. The EOCME is accredited by the In this study, the authors analyzed patients who required intervention for a postoperative pseudomeningocele following an elective craniotomy or MRI revealed a pseudomeningocele. I was recently diagnosed with a pseudomeningocele and am struggling with deciding whether or not to have it treated. The Spine Journal is the #1 ranked spine journal in the Orthopaedics category Patient satisfaction phone survey was attempted for all of these patients. Symptoms can be more manageable but still frustrating to continue like this. As a result, the patient underwent an exploration of the ITB infusion system with an intraoperative epidural blood patch. Methods Retrospective analyses of six such cases was made including: clinical signs and symptoms, radiological findings, and Pseudomeningocele may result after brain surgery, spine surgery, or brachial plexus avulsion injury, (preganglionic injury). Superficial siderosis and its related symptoms, including hearing loss, should be considered in patients with hemorrhagic tumor related to the CSF space. The authors suggest a trial of focal compression for symptomatic relief of postural headache from pseudomeningocele. Practitioners treating chronic low back pain need to be aware of this potential hazard. On follow-up, she had complete resolution of her symptoms, and MRI did not show a residual lesion. Postoperative complications in up to 41% of patients: CSF leak, pseudomeningocele, infection. Introduction. As far as we know, the combination of subdural haematomata and lumbar pseudomeningocele after a discectomy with the application of ADCON-L gel has not previously been described. Usually, cerebrospinal fluid leakage is treated with lumbar drainage and/or secondary suture. The patients ventriculoperitoneal shunt system was exchanged for a new device, which led to the resolution of his bulge and neurological symptoms. fied pseudomeningocele is a rare entity following VP shunt placement, it should be suspected if patients present with aggravated symptoms, especially if there is shunt malfunction as the treatment option varies with the presence or absence of resultant symptoms and ossification. What people are taking for it. Some cases manifest with a fluctuating mass that increases with the valsalva maneuver, similar to the clinical condition reported in this article [5]. Postoperative C5 palsy is a known complication of cervical decompressive spinal surgery. I'm a 20 year old female. MRI revealed a pseudomeningocele. A pseudomeningocele, or a collection of cerebrospinal fluid, typically presents as a postoperative complication, and can be asymptomatic and resolve spontaneously, though some present with headaches, low back pain, or radicular symptoms. In all patients subarachnoid CSF drainage and initial operative attempts to obliterate the pseudomeningocele had failed. In all patients subarachnoid CSF drainage and initial operative attempts to obliterate the pseudomeningocele had failed. The commonest symptoms were pain in the neck or back (63%), headache (55%), nausea or vomiting (36%) and pain or numbness in the limbs (18%). tract which represents a pseudomeningocele". Given the constellation of symptoms with the background of a young and high BMI phenotype, there was concern for an underlying undiagnosed and perhaps exacerbated idiopathic intracranial hypertension (IIH) causing impaired healing and propagation of a pseudomeningocele. Pseudomeningocele (PMC) is a rare complication following thoracic spinal decompression surgery. Other symptoms include tinnitus and a palpable mass in the cavities. 1 8 A dural defect can lead to a pseudomeningocele, or collection of cerebrospinal fluid (CSF), causing symptoms of postural headache, blurry vision, dizziness, diplopia, photophobia, tinnitus, pain, nausea, and vomiting. Spinal pseudomeningocoeles can occur in less than 2% of patients following laminectomy or discectomy 4. A pseudomeningocele refers to an abnormal collection of cerebrospinal fluid that occurs due to leakage from the CSF-filled spaces surrounding the brain and / or spinal cord as a result of trauma or surgery. Pseudomeningocele is a source of considerable morbidity after posterior fossa surgery, but incidence and optimal management strategies are u Presenting symptoms, diagnosis, and comorbidities are shown in Table 2. (see attached images). Fatigue. It develops when an extradural collection of cerebrospinal fluid (CSF) develops after a dural breach. prevents pseudomeningocele and durocutaneous fistula sequalae. pseudomeningocele include water-tight closure, tissue glue and duroplasty. Practitioners treating chronic low back pain need to be aware of this potential hazard. Initial symptoms included throbbing headaches relieved by lying flat. In contrast to a meningocele, in which the fluid is surrounded and confined by dura mater, in a pseudomeningocele, the fluid has no surrounding membrane, but is contained in a cavity reported that 43% of patients with intramedullary spinal cord neoplasms previously treated with radiation developed a CSF fistula or pseudomeningocele after surgery. It may cause pain in back, sciatic pain and headache. Postoperatively, she had marked improvement in her symptoms. I had one at T9-10 after first surgery to fix a leak. Issues range from cerebellar tonsillar herniation through the foramen magnum to the absence of the cerebellum with or without other associated intracranial or extracranial defects such as It shows symptoms only in chronic or severe Most will resolve with time, but some may require intervention. MRI revealed a pseudomeningocele compressing the thoracic spinal cord. Traumatic brachial nerve root avulsion with pseudomeningocele formation is a devastating injury that, in the case presented, produced permanent paralysis of the right upper extremity. A pseudomeningocele is a collection of CSF not lined by arachnoid or dura mater. Intraoperatively, a dural violation is either not recognized or inadequately repaired, resulting in a persistent opening. Back pain or radiculopathy can ensue. fashion. Typically, there aren't any signs or symptoms because the spinal nerves aren't involved. Most of the cases of radicular symptoms in the literature described have been secondary to tethering of nerve root at durotomy site or nerve root herniation into the pseudomeningocele sac. Symptoms related to the pseudomeningocele resolved following dural repair and fat graft transplantation. symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94) Diseases of the nervous system; G97. Pseudomeningocele is an extradural cystic collection of cerebrospinal fluid (CSF) and is rare and typically asymptomatic. Pseudomeningocele after spine surgery can cause various symptoms, but it can also be silent. RESULT: CT guided spinal aspiration with administration of fibrin glue. iatrogenic. Background and Objectives Patients with postlaminectomy pseudomeningoceles may present to pain management centers without having been diagnosed previously. Clinically, patients may present with a variety of signs or symptoms ranging from Pseudomeningocele Symptoms People suffering from pseudomeningocele reported headache at the specified region where leakage is located. Since the pseudomeningocele is inside the cranium, it can cause a mass effect that can raise intracranial pressure. Synonyms: Click here to cancel reply. Developed by renowned radiologists in each specialty, STATdx provides comprehensive decision support you can rely on - Pseudomeningocele But you can sometimes see signs on the newborn's skin above the spinal problem, including a tuft of hair, a small dimple or a birthmark. Zide et al. A brief history - I began leaking after a fall three years ago on the ice which caused a fracture of the sacrum which tore a tarlov cyst in the sacral area causing a CSF leak. 2% lidocaine was used as a local anesthetic. Smoker, 4 years + on Norco 10 mg QID (but Oxycontin worked better), + Flexeril, Celexa, Klonopin and ibuprofen. One patient with pain and numbness in the legs who underwent MRI was shown to have a trapped nerve root within the pseudomeningocele (Figure 3 ). [6] , [9] , [10] , [11] Focal radiculopathy as described in the present case secondary to mass effect due to small pseudomeningocle is rather atypical.