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

Schartz, Derrek; Ismail, Rahim; Rahman, Akm A; Bender, Matthew T.; Westesson, Per‐Lennart; Mesfin, Addisu; Kessler, Alexander T.

doi:10.1177/15910199221113714

Cited by 1 publication

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“…Recently, and given the good results and its widespread use in lumbar surgery, the use of the epidural blood patch has been published, injecting 2.5 to 15 mL of autologous blood into the epidural space at the level of the lesion ( 20 ) with the possibility of using CT scan as a guide, or even ultrasound ( 21 ). In a recent case series, this method has been postulated to be used as a second line after persistence of postural headache or surgical wound drainage following failure of primary dural leak repair ( 22 ). In our case, since most cranial nerve palsies tend to resolve spontaneously ( 10 ), and in the absence of other neurological symptoms or signs, we did not consider trying this option.…”

Section: Discussionmentioning

confidence: 99%

Abducens nerve palsy associated with pseudomeningocele after cervical spine surgery: a case report

et al. 2023

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Background Cerebrospinal fluid leakage can cause abducens nerve palsy (ANP) secondary to downward brain traction, caused by intracranial hypotension. We present the first case after cervical fixation and fusion with spinal cord decompression. Case Description We present a 65-year-old male, who undergone C5-C6 decompression by laminectomy and C3-T2 fixation and fusion, without intraoperative complications. Two months later, the patient referred a 2-week history of diplopia, with no other accompanying symptom. Clinical examination revealed a lack of lateral gaze of the left eye. Cervical MRI disclosed findings compatible with pseudomeningocele. Given the time of evolution, the subacute clinical findings and the absence of image or clinical data of infection or intracranial hypotension, we decided to perform conservative treatment. We submitted the patient to periodic clinical examinations and we confirmed progressive clinical improvement of diplopia, in association with neurologic and ophthalmologic specialists. At this time, six months after surgery, the patient is asymptomatic. The swelling has significantly decreased in size. Control MRI revealed no growth of the pseudomeningocele. Conclusions ANP secondary to intracranial hypotension after cervical spine surgery requires immediate imaging tests and clinical evaluation from neurology and ophthalmology specialists. Management can be conservative, as long as diplopia is the only clinical and radiological finding and wound does not show signs of infection.

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