Remote Cervical Pseudomeningocele Following Anterior Cervical Corpectomy and Fusion: Report of a Case and Review of the Literature

Abstract

Iatrogenic cervical pseudomeningocele is a rare event and majority are located posteriorly as a delayed complication of inadvertent dural tear after decompressive laminectomy. However, iatrogenic anterior cervical pseudomeningocele subsequent to discectomy or corpectomy is a rare pathology. The time necessary for formation of pseudomeningocele varies and depend on the width of the dural tear and the flow of cerebrospinal fluid leakage. Large tears with high CSF flow usually result in early collection of the cerebrospinal fluid in anterior compartment of the neck designated acute pseudomeningoceles. Micro-tears of dura mater, with low flow of cerebrospinal fluid may lead to late formation of a pseudomeningocele known as chronic ones.Herein a 49-year-old woman in whom cervical pseudomeningocele appeared clinically as a mass on the anterior aspect of the neck, six months after anterior cervical corpectomy for cervical spondylotic myelopathy is presented. Otherwise, she was neurologically stable. Cystoperitoneal shunt was proposed which she refused. Surprisingly, at 2-year follow-up, the cyst had remained of the same size. To the best of our knowledge, this is the first example of post-operative chronic cervical pseudomeningocele in the literature, the event that might propose the self-limited natural course of this rare pathology in chronic cases.keywords: anterior cervical discectomy fusion (acdf), anterior cervical corpectomy fusion (accf), cervical pseudomeningocele, complication, cystoperitoneal shunt volume 10 article 36

Anterior cervical pseudomeningocele causing syncope after spinal surgery: A case report

“…Different surgical techniques have been employed to help reduce the risk of a dural tear, including thinning the OPLL and isolating it from other vertebrae instead of its removal (“floating method”) and using a posterior surgical approach for the decompression [3] . Despite these efforts, an anterior approach with corpectomy is indicated at times, especially if a kyphotic deformity is present, and CSF leaks are a real risk [4] , [27] , [28] . Although primary closure of these tears can occur intraoperatively, there is a risk that suturing itself, may cause new smaller dural defects [27] .…”

“…There is literature supporting conservative management of cervical pseudomeningoceles. Rahimizadeh et al presented non-operative management of cervical pseudomeningocele after anterior cervical corpectomy and fusion [4] . Unlike our case, the patient in Rahimizadeh's case report was asymptomatic [4] .…”

“…Incidental durotomy is a known risk and one of the complications of cervical spine surgery [1] , [2] . The incidence of dural tear in the anterior approach is reported between 0%–8%, being more common in anterior cervical corpectomies than anterior cervical disc fusion surgeries [3] , [4] . In patients with known ossification of the posterior longitudinal ligament (OPLL), the incidence increases to about 6.7%–31.8% [3] .…”

Repair of Postoperative Cervical Pseudomeningocele with the Use of Bone Morphogenetic Protein

“…In instances where the dura is violated without injury to the arachnoid membrane, a true meningocele lined with the arachnoid membrane may develop. However, in dural-arachnoid tears, such as during intradural tumor resection, extravasation of CSF outside of the thecal sac will inadvertently form a pseudomeningocele, a CSF pseudocyst lined by fibrous tissue [4,5].…”

Iatrogenic lumbar giant pseudomeningocele: A report of two cases

“…[2,3,5,7,8] This complication mostly occurs in the lumbar followed by the cervical and thoracic spine. [4-6] In the lumbar region, it is mostly seen following laminectomy for a disc herniation or stenosis.…”