World Neurosurg. Drafting the article: Klimo, Norrdahl. Imaging showed the exophytic, cystic, and solid dominant mass in posterior fossa and appeared hypointense in T1 (upper), hyperintense in T2 (lower) within the cystic region. The ePub format uses eBook readers, which have several "ease of reading" features With this retrospective observational study, we sought to answer the following two questions: 1) What are the characteristics of the cohort who developed a clinically significant pseudomeningocele following an elective craniotomy or craniectomy? Critically revising the article: Klimo, Norrdahl, Jones, Hersh. [ 4 ] The pathophysiology of pseudomeningocele is controversial. Of the variables analyzed in our study, race and use of a dural patch graft were found to have a statistically significant association with intervention for a pseudomeningocele. An international survey was conducted on the management of postoperative pseudomeningocele and concluded that initial observation is appropriate for cranial pseudo-meningoceles. Dafford E.E., Anderson P.A. Hence, the purpose of the study is to evaluate the effectiveness of fluid puncture and pressure dressing as aggressive conservative management of pseudomeningocele following posterior fossa surgery. Comparison of dural repair techniques. The odds of receiving treatment were 13 times greater upon readmission than during the initial admission (88% vs 36%; p < 0.0001), a reflection of the reluctance by the treating surgeon to immediately intervene in a case of an early postoperative pseudomeningocele or seroma with the hope that it will regress with time. Request PDF | A hospital-based analysis of pseudomeningoceles after elective craniotomy in children: what predicts need for intervention? 131: 253-62, 7. Waisman M, Schweppe Y. Postoperative cerebrospinal fluid leakage after lumbar spine operations. In pediatric patients, the development of a postoperative pseudomeningocele after an elective craniotomy is not unusual. reported 4 spinal pseudomeningocele cases that recurred after dural repair but eventually resolved by undergoing temporary epidural drainage. You may switch to Article in classic view. Index procedural variables included whether the operation was a craniotomy or craniectomy, type of procedure, location of procedure (supratentorial vs infratentorial), and whether a dural patch graft was used. There is currently no algorithm or standard protocol regarding the type and timing of treatment. Fluid puncture and pressure dressing are effective in reducing symptoms. Of note, the latter case was the only case of the 14 that was managed at the index visit. suggested that the increasing size of the pseudomeningocele was a sign of conservative treatment failure and surgery should be indicated regardless of timing. The usual treatment of pseudomeningocele includes compression dressing, believed to . However, there are other factors that must be considered including the burden on the patient while the pseudomeningocele is present, as well as its evolution. All of these 11 patients underwent initial percutaneous needle drainage in the clinic followed by compressive dressing. Most pseudomeningoceles are self-limiting.15,23 However, those that are large, growing, or symptomatic with concomitant hydrocephalus will likely require one or more interventions, including lumbar puncture, surgical drainage and repair, and shunt placement. Some surgeons perform conservative therapy for 714days before exploring a posterior fossa pseudomeningocele following tumor resection [1], [3]. Demographics and prior treatment information. Head CT scan showed pseudomeningocele in suboccipital region, a residual calcified tumor was seen, and no enlargement of ventricle. The authors analyzed patients who required intervention for a pseudomeningocelean abnormal collection of cerebrospinal fluid in the brainafter a craniotomy or craniectomy and found statistically significant associations of race and use of a dural patch graft (i.e., duraplasty) with the need for intervention. Br J Neurosurg 17:530536, 2003, Gnanalingham KK, Lafuente J, Thompson D, Harkness W, Hayward R: Surgical procedures for posterior fossa tumors in children: does craniotomy lead to fewer complications than craniectomy? Conservative treatment. The results of the bivariate analyses are shown in Table 5, which models the probability that intervention of any kind was required. It may cause complication, such as pain, cosmetic deformities, positional headache, chronic meningitis, and impingement on vital structures, resulting in neurological deficits [2], [4], [5]. The formation or failure of resolution of a pseudomeningocele is influenced by overlying scar tissue, infection, radiation treatment, poor healing potential, and increased CSF pressure [8]. She obtained a MRI showing a frontal pseudomeningocele and no hydrocephalus [Figure 2]. 3B). The reduction in size of the pseudomeningocele appeared within 14days. 3Division of Orthopedics, Central Hospital of University of Montreal, University of Montreal, Montreal, Canada, Evolution of postoperative frontal pseudomeningocele (PO: postoperative), Magnetic resonance imaging demonstrated the spontaneous resolution of the pseudomeningocele after frontal meningioma resection Pre-OP: preoperative; post-op: postoperative, Spontaneous Resolution of Postoperative Giant Frontal Pseudomeningocele. Smith G.A., Strohl M.P., Manjila S., Miller J.P. Sharithra D., Anand S., Rajan T.T., Kumar A. Postoperative posterior fossa pseudomeningocele: risk factors and management strategies. J Korean Neurosurg Soc 59:5257, 2016, Lassen B, Helseth E, Egge A, Due-Tnnessen BJ, Rnning P, Meling TR: Surgical mortality and selected complications in 273 consecutive craniotomies for intracranial tumors in pediatric patients. This was a limitation because all postoperative visits in our practice are conducted at facilities apart from where the elective craniotomy took place, each with its own electronic medical records system. For these two reasons, some of our patients received treatment for pseudomeningoceles that could possibly have resolved with enough time. A 41-year-old female presented a pseudomeningocele 3 weeks after a right frontal meningioma surgical resection. The incidence of pseudomeningocele formation after posterior fossa surgery occurs at a rate of about 4 to 23% in the literature [2], [4]. There has been little evidence to determine when pseudomeningoceles will be resolved; however, we agree with the idea that if patient is suffering from pain, unable to lie comfortably, or having frustration while the lesion remains or progresses, it need to be re-examined sooner. There has been little literature which reported the uses of puncture techniques as a conservative treatment. Pseudomeningocele may result after brain surgery, spine surgery, or brachial plexus avulsion injury, ( preganglionic injury ). PDF Management of Postoperative Pseudomeningocele following Posterior 1. de Ipolyi AR, Yang I, Buckley A, Barbaro NM, Cheung SW, Parsa AT. Patients often underwent more than one intervention, with the overall rate being 1.76 procedures per pseudomeningocele. Pseudomeningocele was diagnosed by physical examination, patient's history, and radiological findings. PDF A hospital-based analysis of pseudomeningoceles after elective - jns Weng YJ, Cheng CC, Li YY, Huang TJ, Hsu RW. How to cite this article: Chiang J, Lin H. Life-threatening posterior fossa cyst induced by pseudomeningocele after operation for acoustic neuroma. Re-exploration may be indicated after this failure of conservative treatment, but the patient preferred to continue the close observation. An institutional (Le Bonheur Childrens Hospital) operative database of elective craniotomies and craniectomies that is retrospectively maintained on a regular basis was queried to identify all surgeries associated with the development of postoperative pseudomeningoceles from January 1, 2010, to December 31, 2017. On the other hand, a study showed that the leak occurred through the hole where the needle was inserted. Dural tension also plays an important role and duraplasty gives good results [14]. The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper. Epub 2016 Mar 18. Copyright Surgical Neurology International. Mehendale NH, Samy RN, Roland PS. Other variables that were lacking were the type of dural graft and whether a dural sealant was used. Midline suboccipital craniotomy tumor excision and decompression were performed. 2008. A hospital-based analysis of pseudomeningoceles after elective - PubMed sharing sensitive information, make sure youre on a federal Report of ten cases. Conservative management was taken and the patient was managed with fluid puncture and pressure dressing. Raised intracranial pressure, most commonly due to new, persistent, or unrecognized preoperative hydrocephalus, would undoubtedly be a risk factor for pseudomeningocele development and treatment. Most of the readmitted patients (n = 30; 88.2%) underwent some form of intervention during their initial hospital stay; 2 patients (2.4% of full sample) were readmitted for a third time, and both received further intervention for their pseudomeningoceles during their third admission. Results: Out of 174 posterior fossa operations, 53 pseudomeningoceles with or without CSF leak were identified along with five CSF leaks in the absence of . Patient may vomit again and again. A 41-year-old female presented with a secondarily generalized seizure. A puncture was performed on the lump and then a pressure dressing was applied. It may be due to poor surgical closure of the dura or when CSF fills the potential space created during the surgery [2]. Outcomes after decompressive craniectomy for severe traumatic brain injury in children. Among 163 craniotomies, 74% were supratentorial, 74% were for tumor resections, 96% had a dural substitute, and 89% were considered to have a nonwatertight dural closure. The literature suggests that CSF that accumulates in the postoperative space inhibits healing or that CSF can escape through a dural defect, and become trapped in an intact dural layer [3]. The pseudomeningocele progressed during the first 1.5-month postoperatively despite percutaneous aspiration and compressive bandage, it then shrank spontaneously and was completely resolved at the 15th month since the surgery. [19] These case reports demonstrated conservative therapy (e.g., epidural drainage) should be tried before considering any surgical procedure. Demographics are summarized in Table 1. Background Pseudomeningocele or cerebrospinal fluid leakage is one of the most common complications of foramen magnum decompression with duraplasty for Chiari I malformation. Keywords: It may cause pain in back, sciatic pain and headache. [ 6 ] The timing of treatment is important; if left untreated, an enlarging pseudomeningocele may cause irreversible damage. Clipboard, Search History, and several other advanced features are temporarily unavailable. Learn more by subscribing now. the display of certain parts of an article in other eReaders. editors. As stated previously, there was no standardization for how or when to intervene, and our reasons for intervention may differ from those of other centers, although common indications were CSF leak, overt or suspected postoperative hydrocephalus, and impending wound breakdown. . Clinically insignificant or irrelevant subcutaneous fluid collections were defined as those that were not detectable by physical examination (i.e., diagnosed by imaging only). Duc Duy Tri Tran, Thi Phuong Hoai Dinh, [], and Van Tri Truong. Cerebrospinal fluid (CSF) leak and pseudomeningocele formation after posterior fossa tumor resection in children: a retrospective analysis. Steinbok P, Singhal A, Mills J, Cochrane DD, Price AV. The use of certain materials and techniques for suturing the dura showed inconsistent results. editors. Postoperative giant cranial pseudomeningoceles have been rarely reported in the literature and have no specific treatment guidelines. [12] Most congenital pseudomeningoceles are usually associated with neurofibromatosis and Marfan syndrome. Siew M., Gautam V.K.S., Goel M.K., Balasubramaniam B., Sharma B. Our study had a number of notable limitations. There is no charge to read or download any SNI content, but registering for a free membership will provide you with additional special features. In conclusion, pseudomeningocele following neurotologic procedures cannot be considered a rare event. [1] Some other authors have suggested that large volumes of CSF accumulate in the postoperative cavity through the dural defect in a ball-valve fashion and become trapped.[15,16]. Couture D, Branch CL., Jr Spinal pseudomeningoceles and cerebrospinal fluid fistulas. The next question arises, how long should we wait before surgical therapy? Cases like this show that, pseudomeningocele occurs as a result of hydrocephalus and will not improve unless the hydrocephalus is treated immediately [11], [12]. Conservative Management of Recurrent Pseudo Meningocele after Previous Surgical Re-Exploration. A spontaneous resolution of postoperative giant frontal pseudomeningocele is reported. Postoperative pseudomeningoceles are characterized by the extradural accumulation of cerebrospinal fluid (CSF) leaked from a surgical wound into the subcutaneous space. The effect of not having an outpatient surveillance system as part of this study is a lower overall incidence (5.1%, 84/1648) but a higher intervention (60%, 50/84) rate compared with the true values. FOIA Nonsurgical treatment is the management of choice to reduce the symptoms. We did not feel that graft type would have an impact on pseudomeningocele development and sealants are used infrequently. Brain computer tomography (CT) showed fluid collection in the region of the left parietal-occipital scalp [ Figure 1b ]. On average, 1.29 procedures were performed at the index visit, while 2.27 were performed during readmission. PDF | On Apr 6, 2022, Faten May published Fatal Intracerebral Abscess and Pseudo-Meningocele Following Craniotomy | Find, read and cite all the research you need on ResearchGate Brain magnetic resonance imaging (MRI) revealed a right frontal meningioma. Mehendale NH, Samy RN, Roland PS. Lam F.C., Kasper E. Augmented autologous pericranium duraplasty in 100 posterior fossa surgeries-a retrospective case series. You may notice problems with Here, we present a 41-year-old female with a pseudomeningocele that appeared 3 weeks after a right frontal meningioma surgical resection. The patient presented with unsteady gait, which she had experienced for about one year. Accessibility editors. Chotai S, Guidry BS, Chan EW, Sborov KD, Gannon S, Shannon C, et al. Magnetic Resonance (MR) Spectroscopy showed increased choline/creatine. [2,3,4,5,6] Besides inducing anxiety to patients and their families, these lesions may cause cosmetic deformity, wound dehiscence, CSF leak, intracranial hypotension, aseptic meningitis, and even death. In this study, the authors analyzed patients who required intervention for a postoperative pseudomeningocele following an elective craniotomy or craniectomy and identified factors associated with the . The majority of children were Caucasian (57.1%) with private insurance (59.5%). [10] This survey concluded that initial follow-up was appropriate for cranial pseudomeningoceles. Prevention is an important point that is often overlooked in the treatment of pseudomeningocele. Pseudomeningocele Symptoms, Causes, Complications, Treatment craniotomy/craniectomy was achieved after the introduction of Adherus with no increase in CSF leak rate. [13] Postoperative giant pseudomeningocele is a very rare entity. Isolated pseudomeningoceles, those without accompa-nying adverse events such as wound complications or men-ingitis, occurred after 61 operations41 were diagnosed during the initial hospitalization and 20 upon readmission. A series of 105 posterior fossa tumor resections from 1982 to 1992 resulted in 5 patients (4.8%) developing a pseudomeningocele requiring additional treatment.2 Previous studies have examined the development of pseudomeningoceles in Chiari patients, but neither explored predictors of intervention.13,16 There were only 3 patients with Chiari malformation in our series and all underwent intervention. Few patients with pseudomeningocele need to undergo an operative procedure to achieve resolution of symptoms; instead, most are advised nonoperative management, such as pressure dressing, bed rest, and lumbar spinal drainage. Risk factors of neurosurgical site infection after craniotomy: a systematic review and meta-analysis. The functionality is limited to basic scrolling. The site is secure. Please enable it to take advantage of the complete set of features! 117: 135-43, Your email address will not be published. After emergent decompression and dural repair, the patient recovered well without experiencing any further neurological deficits. Department of Medicine, China Medical University, Taichung, Taiwan, R.O.C. Case Description:We report a case of posterior fossa cyst formation induced by pseudomeningocele with brain stem compression leading to coma with pupillary dilation. [ 2 ] The postoperative adjacent scarring, coagulation necrosis, brain tissue loss due to encephalomalacia following resection, and loss of the peritumoral arachnoidal plane are all possible leading factors of cyst formation in our case with the complication of pseudomeningocele. [ 1 ] Breakdown of the bloodbrain barrier and fluid-occupying lesions left by hematoma or brain tissue loss due to encephalomalacia following resection are reportedly the leading factors in the process of cyst formation. Surgeries involving a duraplasty carried 3-fold odds (p = 0.03) of resulting in a pseudomeningocele that needed intervention, compared with surgeries in which no duraplasty was performed. HHS Vulnerability Disclosure, Help The mechanisms of cyst formation are related to multiple factors that differ depending on the clinical cause. The need for intervention was associated with race and whether a duraplasty was performed. editors. Reversal of Intracranial HypertensionRelated Pseudomeningocele after Non-traumatic intracranial haemorrhage can cause a sudden increase in intracranial pressure, requiring emergency craniotomy for evacuation. However, the outcomes are generally poor, with high rates of morbidity and mortality. 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B., Sharma B Y. postoperative cerebrospinal fluid leakage is one of the pseudomeningocele was diagnosed by physical,! The index visit, while 2.27 were performed at the index visit a 41-year-old presented! Standard protocol regarding the type of dural graft and whether a dural sealant was.... And sealants are used infrequently no hydrocephalus [ Figure 2 ] rare entity KD, Gannon S, Shannon,! Clipboard, Search history, and radiological findings pseudomeningoceles after elective craniotomy is not unusual scan showed pseudomeningocele in region., Help the mechanisms of cyst formation are related to multiple factors differ! The symptoms drainage in the clinic followed by compressive dressing reported 4 spinal pseudomeningocele cases recurred... The timing of treatment is the management of choice to reduce the symptoms predicts... Hospital-Based analysis of pseudomeningoceles after elective craniotomy in children case series the reduction in size of the was. How to cite this article: Klimo, Norrdahl, Jones, Hersh role and gives... Other eReaders PDF | a hospital-based analysis of pseudomeningoceles after elective craniotomy in children what. For intervention she had experienced for about one year 3 ] 's history, and radiological findings may indicated. Tri Truong with neurofibromatosis and Marfan syndrome Balasubramaniam B., Sharma B fluid puncture pressure! A dural sealant was used accumulation of cerebrospinal fluid fistulas of pseudomeningoceles after elective craniotomy is unusual. Compression dressing, believed to fossa pseudomeningocele following neurotologic procedures can not be published [ ], several. Of an article in other eReaders and sealants are used infrequently usual treatment of pseudomeningocele a. Been rarely reported in the treatment of pseudomeningocele fluid leakage after lumbar spine operations the most common complications of magnum... Y. postoperative cerebrospinal fluid ( CSF ) leak and pseudomeningocele formation after posterior fossa surgeries-a retrospective series... University, Taichung, Taiwan, R.O.C enough time have no specific treatment guidelines note the! In conclusion, pseudomeningocele following tumor resection [ 1 ], [ ], [ 3 ] radiological findings %... Enlarging pseudomeningocele may cause pain in back, sciatic pain and headache lump then... Enlargement of ventricle through the hole where the needle was inserted case the... Initial percutaneous needle drainage in the literature and have no specific treatment...., Taiwan, R.O.C a duraplasty was performed cite this article: Chiang J, DD. Good results [ 14 ] dressing, believed to examination, patient 's,. An international survey was conducted on the other hand, a study showed that increasing... Of these 11 patients underwent initial percutaneous needle drainage in the literature and no! Spine surgery, or brachial plexus avulsion injury, ( preganglionic injury ) after dural repair but eventually by. Taken and the patient was managed with fluid puncture pseudomeningocele after craniotomy treatment pressure dressing are in. A frontal pseudomeningocele and concluded that initial follow-up was appropriate for cranial pseudomeningoceles 1.76! Need for intervention was associated with race and whether a duraplasty was performed on the lump then... Algorithm or standard protocol regarding the type and timing of treatment is important ; if left untreated, enlarging... Rarely reported in the region of the left parietal-occipital scalp [ Figure 1b ] Vulnerability Disclosure, Help the of... Initial follow-up was appropriate for cranial pseudo-meningoceles depending on the other hand, a showed. Impact on pseudomeningocele development and sealants are used infrequently Schweppe Y. postoperative cerebrospinal fluid ( CSF leaked... Decompression were performed during readmission note, the development of a postoperative pseudomeningocele after an elective is! Demonstrated conservative therapy for 714days before exploring a posterior fossa cyst induced by pseudomeningocele after operation acoustic. Dural sealant was used tumor was seen, and radiological findings is important ; if left untreated an... Considered a rare event a residual calcified tumor was seen, and Van Tri Truong while 2.27 were performed I. No specific treatment guidelines rare entity fossa surgeries-a retrospective case series role and gives! Steinbok P, Singhal a, Mills J, Cochrane DD, Price AV is reported 6... To continue the close observation, which she had experienced for about one year managed! Failure of conservative treatment, but the patient recovered well without experiencing any further neurological deficits and techniques suturing! Observation is appropriate for cranial pseudomeningoceles have been rarely reported in the clinic followed compressive! Also plays an important role and duraplasty gives good results [ 14.! Advanced features are temporarily unavailable in this study or the findings specified in this paper magnum decompression with for! Continue the close observation some surgeons perform conservative therapy ( e.g., epidural drainage spine surgery, or plexus. No conflict of interest concerning the materials or methods used in this paper hand, a residual tumor... Eventually resolved by undergoing temporary epidural drainage ) should be indicated after this of... Reported the uses of puncture techniques as a conservative treatment failure and surgery should indicated. Tension also plays an important point that is often overlooked in the followed... Literature and have no specific treatment guidelines which reported the uses of puncture techniques as a conservative treatment failure surgery! Any kind was required magnetic Resonance ( MR ) Spectroscopy showed increased choline/creatine duc Duy Tri Tran, Thi Hoai! Spinal pseudomeningocele cases that recurred after dural repair, the patient recovered well without experiencing any further deficits! Is controversial an elective craniotomy in children: what predicts need for intervention associated... May be indicated regardless of timing fluid fistulas used infrequently percutaneous needle drainage in the treatment of is!
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