Predictors and Management Strategies of Pseudomeningoceles in Neurosurgical Procedures: Breaking the Ice

Abstract

Background: Pseudomeningoceles are extradural collections of CSF that result following a breach in the dural– arachnoid layer. Pseudomeningoceles are recognized complications after cranial and spinal surgery with some centers reporting an incidence exceeding 40%. Aims and Objectives: To evaluate the predictors of post-operative pseudomeningoceles in neurosurgical practice. To formulate a standardised management protocol for treatment of pseudomeningocele. Materials and Methods: This is a prospective study where all cases of cranial and spinal pseudomeningoceles were taken into consideration from October 2016 to October 2018 (2 years ).There were 45 consecutive cases of pseudomeningocele were included in the study. Results: Among the total cranial and spinal cases operated in one year period at our institute incidence of pseudomeningocele was noted to be 1.1% (45/3892). 38 (84.4%) were cranial cases, among them 21 (46.7%) were supratentorial and 17 (37.8%) were infratentorial, 5 (15.6%) cases had primary water tight dural closure, 33 ( 73.3%) duraplasty done using pericranial fascia, Dura was not kept opened in any cases and artificial sealants were not used in any case.7 (15.6%) were spinal cases and 4 cases dura was not opened and didn’t recognize any leak,3 cases dura was opened and primary dural closure done in 2 cases and 1 case closure was done using a muscle graft, no artificial sealants were used. Pseudomeningocele was managed with multiple treatment modalities and best treatment options noted were bed rest with tight bandage application (44.4%), Continuous lumbar drain for 5 days (17.8%), Intermittent lumbar drainage for 5 days (13.3%), these three constituted 75.5% of successful treatment modality used. Post pseudomeningocele development hydrocephalus was noted in 7 (15.6%) among them 3 (6.7%) cases required ventriculo-peritoneal shunt. Only 2(4.4%) patients developed complications like csf leak and meningitis and 3 (6.7%) cases had mortality. Conclusion: We conclude that in our study pseudomeningocele was found to be more common in the supratentorial compartment in contrast to other studies in literature, majority of the cases subsided with conservative management, type of closure of the dura did not impact the outcome, meningitis was not a significant etiology and standardized management protocol has been proposed for effective management of pseudomeningocele.