SURGICAL TREATMENT OF IATROGENIC PSEUDOMENINGOCELES

• Published in: The journal of Turkish spinal surgery 2023-04, Vol.34 (2), p.71-75
• Main Authors: Oktay, Kadir, Güzel, Ebru, Akbaba, Mevlana, Baykara, Okay, Er, Uygur, Güzel, Aslan
• Format: Article
• Language: English
• Subjects: Abscesses; Back pain; Back surgery; Cauda Equina Syndrome; Congenital diseases; Diagnostic tests; Epidural; Hypotension; Iatrogenesis; Infections; Infectious diseases; Magnetic resonance imaging; Medical records; Neurosurgery; Patients
• ISSN: 1301-0336; 2147-5903
• DOI: 10.4274/jtss.galenos.2023.88598

Objective: Pseudomeningocele that develops after spinal surgery is a rare complication that should be well-guided by surgeons. In the absence of proper treatment, it may increase the morbidity of the patients. Materials and Methods: The medical records of 13 patients with iatrogenic pseudomeningocele who underwent primary dura repair with myofascial flap support and lumbar subarachnoid drainage, were retrospectively reviewed. Results: There were four female (31%) and 9 male (69%) patients in the study cohort. The mean age of the patients was 45 years (2-68 years). Six patients had decompression with implanted fusion, 5 patients had microdiscectomy, 1 patient had untethering for tethered cord syndrome and 1 patient had intradural extramedullary tumor excision as the first operation. One patient had a pseudomeningocele at the cervical region and the other patients’ lesions were at the lumbar region. Revision microdiscectomies were performed in 5 patients with recurrent/residual disc herniations, and abscess drainage was performed in 1 patient with an abscess at the operation site. Infected cases were consulted in the infectious diseases department, and antibiotherapy was given for appropriate periods. None of the patients had any additional complications and persistence or recurrence of the pseudomeningocele following dura repair and lumbar subarachnoid drainage. The complaints of all the patients were resolved. Conclusion: Although there are cases with iatrogenic pseudomeningoceles who present spontaneous recovery in the literature, most of these cases require surgical exploration and primary repair. Surgical repair with myofascial flap support and lumbar subarachnoid drainage seems to be an effective option in patients with iatrogenic pseudomeningoceles.