Postoperative posterior fossa pseudomeningocele: risk factors and management strategies

Abstract

Background: Pseudomeningocele is a considerable morbidity after posterior fossa surgery. Its incidence and optimal management strategies are quite unclear. Hence the objective of this study is to define the risk factors and evaluate the management strategies and to study the incidence and morbidity of postoperative posterior fossa pseudomeningocele.Methods: A retrospective study of 33 patients undergone posterior fossa surgery for variety of diseases in the department of neurosurgery, Saveetha Medical College and Hospital from January 2015 to December 2018 with emphasis on incidence of pseudomeningocele,its morbidity and treatment strategies.Results: Out of 33 posterior fossa surgeries performed, 9 developed pseudomeningocele. Hence the incidence of pseudomeningocele in hospital is 27.27%. Out of 9 patients who developed pseudomeningocele, 6 patients were symptomatic, and aspiration was done to 5 patients and one patient underwent resurgery. That one patient underwent subgaleal-peritoneal shunt, excision of recurrent tumor was performed after which the symptoms subsided.Conclusions: Psudomeningocele is a well-known complication of posterior fossa surgery. The risk factors for pseudomeningocele formation after posterior fossa surgery has been evaluated. Age, sex and type of surgery are found to be a risk factors in our study. Conservative management is effective in most cases to reduce the symptoms. Surgical intervention is advocated, only when conservative treatment fails. Preventive measures like careful perioperative planning, strict adherence to aseptic techniques, usage of autologous pericranium with dural sealant augmentation, polyethylene glycol hydrogel dural sealant can be adopted.