Fascia lata packing and tension suturing for symptomatic pseudomeningocele after recurrent cervical intradural tumour resection

Abstract

In recurrent posterior cervical intradural tumour resections, serious complications can be developed. The dural can become affected by inflammatory factors or removed during tumor resection; if cerebrospinal fluid (CSF) leakage cannot be stopped by duraplasty, artificial meninges or fascia repair, large pseudomeningocele can develop posteriorly within the soft tissue of the neck. When the pressure of the CSF cannot be maintained steadily, persistent clinical symptoms can occur, such as postural headache or central fever. Moreover, the skin can also be penetrated in a few patients even after extension of the drainage duration, lumbar cistern drainage or skin suturing, leading to the induction of life-threatening intra-cranial infections. Is there a simple and effective surgical method to address this scenario? The aim of this study was, therefore, to investigate the effectiveness of fascia lata packing and tension suturing in the treatment of symptomatic pseudomeningocele after recurrent posterior cervical intradural tumour resection. In our study, nine consecutive spinal surgery patients were recruited from January 2008 to January 2018. All pseudomeningoceles were combined with postural headache, central neurological fever or wound non-union. There were 3 cases of melanocytoma, 3 cases of nasopharyngeal carcinoma metastasis, 2 cases of breast cancer metastasis, and 1 case of spinal canal lymphadenoma. Standard patient demographics, diagnosis, post-operative symptoms, wound healing time, and the largest pre- and last follow-up pseudomeningocele area on axial MRI sections were recorded. All cases were followed-up successfully, from 12 to 24 months, with an average of 15.3 months. Our observations indicate that all wounds healed successfully. The wound union time was 20.7 days on average. After wound union, these patients became symptom free. The largest cerebrospinal fluid area on axial MRI sections improved significantly from 42.9 ± 5.01 cm2 at p re-operation to 6.6 ± 1.89 cm2 at 1 year post-operation (P < 0.05); Our data indicate that .the proposed procedure is simple, safe and effective. And more importantly, it allows rapid closure of any cerebrospinal fluid leakage pools.

Incidental Durotomy Repair in Lumbar Spine Surgery: Institutional Experience and Review of Literature

“…In some reports, a flap from the tensor fascia lata muscle could be used to augment the paraspinal musculature during revision surgery for dural tears that resulted in pseudomeningocele. [40][41][42] Paraspinal muscle flaps may be used during the primary durotomy repair, however, with the degree of dissection and tissue manipulation, we maintain these flaps for revision surgery within our algorithm.…”

Management of postoperative cervical pseudomeningocele with percutaneous aspiration and epidural blood patch

“…7 Management options then include lumbar drain placement, bed rest, reinforced suturing of the surgical site if there is a leak, and surgical revision, if required. Additional methods have also been previously reported, which include open surgery with fascia lata packing combined with tension suturing, 8 and even cervical-peritoneal shunt placement for recurrent postoperative cervical pseudomeningocele. 9 While the use of aspiration and blood patch has been previously described in cases of post-operative lumbar pseudomeningoceles, [2][3][4][5][6] its effectiveness in cases of the posterior cervical spine have not been documented.…”

“…7 Management options then include lumbar drain placement, bed rest, reinforced suturing of the surgical site if there is a leak, and surgical revision, if required. Additional methods have also been previously reported, which include open surgery with fascia lata packing combined with tension suturing, 8 and even cervical-peritoneal shunt placement for recurrent postoperative cervical pseudomeningocele. 9…”