Post-surgical thoracic pseudomeningocele causing spinal cord compression

Mohamed Macki, Sheng-fu Lo, Mohamad Bydon, Paul Kaloostian, Ali Bydon

Research output: Contribution to journalArticle

Abstract

Pseudomeningoceles are extradural cerebrospinal fluid collections categorized into three groups: traumatic, congenital, and iatrogenic. Iatrogenic pseudomeningoceles occur after durotomy, usually after cervical or lumbar spine surgery. Although many remain asymptomatic, pseudomeningoceles can compress or herniate the spinal cord and nerve roots. We present a 57-year-old woman who had a thoracic laminectomy and discectomy. Two weeks after surgery, she presented with lower extremity weakness and gait difficulty. Physical examination revealed hyperreflexia and a T11 sensory level. MRI revealed a pseudomeningocele compressing the thoracic spinal cord. The patient underwent surgical drainage of the cyst. On follow-up, she had complete resolution of her symptoms, and MRI did not show a residual lesion. To our knowledge, this is the second documented post-operative pseudomeningocele causing symptomatic spinal cord compression of the thoracic spine. In this article, a review of the literature is presented, including four reported patients with post-traumatic pseudomeningocele causing myelopathic symptoms and 20 patients with iatrogenic pseudomeningocele that resulted in neurological decline due to herniation or compression of neural tissue. Treatment options for these lesions include conservative management, epidural blood patch, lumbar subarachnoid drainage, and lumbo-peritoneal shunt placement. Surgical repair, usually by primary dural closure, remains the definitive treatment modality for iatrogenic symptomatic pseudomeningoceles.

Original languageEnglish (US)
Pages (from-to)367-372
Number of pages6
JournalJournal of Clinical Neuroscience
Volume21
Issue number3
DOIs
StatePublished - Mar 2014

Fingerprint

Spinal Cord Compression
Thorax
Drainage
Spinal Cord
Spine
Epidural Blood Patch
Diskectomy
Abnormal Reflexes
Laminectomy
Spinal Nerve Roots
Gait
Physical Examination
Cerebrospinal Fluid
Cysts
Lower Extremity
Therapeutics

Keywords

  • Durotomy
  • Myelopathy
  • Outcomes
  • Pseudomeningocele
  • Spinal cord compression
  • Spine

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology
  • Physiology (medical)

Cite this

Post-surgical thoracic pseudomeningocele causing spinal cord compression. / Macki, Mohamed; Lo, Sheng-fu; Bydon, Mohamad; Kaloostian, Paul; Bydon, Ali.

In: Journal of Clinical Neuroscience, Vol. 21, No. 3, 03.2014, p. 367-372.

Research output: Contribution to journalArticle

Macki, Mohamed ; Lo, Sheng-fu ; Bydon, Mohamad ; Kaloostian, Paul ; Bydon, Ali. / Post-surgical thoracic pseudomeningocele causing spinal cord compression. In: Journal of Clinical Neuroscience. 2014 ; Vol. 21, No. 3. pp. 367-372.
@article{a78057d3c62e435292174b2eca68b24f,
title = "Post-surgical thoracic pseudomeningocele causing spinal cord compression",
abstract = "Pseudomeningoceles are extradural cerebrospinal fluid collections categorized into three groups: traumatic, congenital, and iatrogenic. Iatrogenic pseudomeningoceles occur after durotomy, usually after cervical or lumbar spine surgery. Although many remain asymptomatic, pseudomeningoceles can compress or herniate the spinal cord and nerve roots. We present a 57-year-old woman who had a thoracic laminectomy and discectomy. Two weeks after surgery, she presented with lower extremity weakness and gait difficulty. Physical examination revealed hyperreflexia and a T11 sensory level. MRI revealed a pseudomeningocele compressing the thoracic spinal cord. The patient underwent surgical drainage of the cyst. On follow-up, she had complete resolution of her symptoms, and MRI did not show a residual lesion. To our knowledge, this is the second documented post-operative pseudomeningocele causing symptomatic spinal cord compression of the thoracic spine. In this article, a review of the literature is presented, including four reported patients with post-traumatic pseudomeningocele causing myelopathic symptoms and 20 patients with iatrogenic pseudomeningocele that resulted in neurological decline due to herniation or compression of neural tissue. Treatment options for these lesions include conservative management, epidural blood patch, lumbar subarachnoid drainage, and lumbo-peritoneal shunt placement. Surgical repair, usually by primary dural closure, remains the definitive treatment modality for iatrogenic symptomatic pseudomeningoceles.",
keywords = "Durotomy, Myelopathy, Outcomes, Pseudomeningocele, Spinal cord compression, Spine",
author = "Mohamed Macki and Sheng-fu Lo and Mohamad Bydon and Paul Kaloostian and Ali Bydon",
year = "2014",
month = "3",
doi = "10.1016/j.jocn.2013.05.004",
language = "English (US)",
volume = "21",
pages = "367--372",
journal = "Journal of Clinical Neuroscience",
issn = "0967-5868",
publisher = "Churchill Livingstone",
number = "3",

}

TY - JOUR

T1 - Post-surgical thoracic pseudomeningocele causing spinal cord compression

AU - Macki, Mohamed

AU - Lo, Sheng-fu

AU - Bydon, Mohamad

AU - Kaloostian, Paul

AU - Bydon, Ali

PY - 2014/3

Y1 - 2014/3

N2 - Pseudomeningoceles are extradural cerebrospinal fluid collections categorized into three groups: traumatic, congenital, and iatrogenic. Iatrogenic pseudomeningoceles occur after durotomy, usually after cervical or lumbar spine surgery. Although many remain asymptomatic, pseudomeningoceles can compress or herniate the spinal cord and nerve roots. We present a 57-year-old woman who had a thoracic laminectomy and discectomy. Two weeks after surgery, she presented with lower extremity weakness and gait difficulty. Physical examination revealed hyperreflexia and a T11 sensory level. MRI revealed a pseudomeningocele compressing the thoracic spinal cord. The patient underwent surgical drainage of the cyst. On follow-up, she had complete resolution of her symptoms, and MRI did not show a residual lesion. To our knowledge, this is the second documented post-operative pseudomeningocele causing symptomatic spinal cord compression of the thoracic spine. In this article, a review of the literature is presented, including four reported patients with post-traumatic pseudomeningocele causing myelopathic symptoms and 20 patients with iatrogenic pseudomeningocele that resulted in neurological decline due to herniation or compression of neural tissue. Treatment options for these lesions include conservative management, epidural blood patch, lumbar subarachnoid drainage, and lumbo-peritoneal shunt placement. Surgical repair, usually by primary dural closure, remains the definitive treatment modality for iatrogenic symptomatic pseudomeningoceles.

AB - Pseudomeningoceles are extradural cerebrospinal fluid collections categorized into three groups: traumatic, congenital, and iatrogenic. Iatrogenic pseudomeningoceles occur after durotomy, usually after cervical or lumbar spine surgery. Although many remain asymptomatic, pseudomeningoceles can compress or herniate the spinal cord and nerve roots. We present a 57-year-old woman who had a thoracic laminectomy and discectomy. Two weeks after surgery, she presented with lower extremity weakness and gait difficulty. Physical examination revealed hyperreflexia and a T11 sensory level. MRI revealed a pseudomeningocele compressing the thoracic spinal cord. The patient underwent surgical drainage of the cyst. On follow-up, she had complete resolution of her symptoms, and MRI did not show a residual lesion. To our knowledge, this is the second documented post-operative pseudomeningocele causing symptomatic spinal cord compression of the thoracic spine. In this article, a review of the literature is presented, including four reported patients with post-traumatic pseudomeningocele causing myelopathic symptoms and 20 patients with iatrogenic pseudomeningocele that resulted in neurological decline due to herniation or compression of neural tissue. Treatment options for these lesions include conservative management, epidural blood patch, lumbar subarachnoid drainage, and lumbo-peritoneal shunt placement. Surgical repair, usually by primary dural closure, remains the definitive treatment modality for iatrogenic symptomatic pseudomeningoceles.

KW - Durotomy

KW - Myelopathy

KW - Outcomes

KW - Pseudomeningocele

KW - Spinal cord compression

KW - Spine

UR - http://www.scopus.com/inward/record.url?scp=84895175190&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84895175190&partnerID=8YFLogxK

U2 - 10.1016/j.jocn.2013.05.004

DO - 10.1016/j.jocn.2013.05.004

M3 - Article

C2 - 24210805

AN - SCOPUS:84895175190

VL - 21

SP - 367

EP - 372

JO - Journal of Clinical Neuroscience

JF - Journal of Clinical Neuroscience

SN - 0967-5868

IS - 3

ER -