Spinal pseudomeningoceles and cerebrospinal fluid fistulas

Abstract

<jats:p>Spinal pseudomeningoceles and cerebrospinal fluid (CSF) fistulas are rare extradural collections of CSF that result following a breach in the dural–arachnoid layer. They may occur due to an incidental durotomy, during intradural surgery, or from trauma or congenital abnormality. The majority are iatrogenic and occur in the posterior lumbar region following surgery. Although they are often asymptomatic, they may cause low-back pain, headaches, and even nerve root entrapment. Leakage of CSF from the wound may cause a fistulous tract, which is a conduit for infection and should be repaired immediately.</jats:p> <jats:p>Diagnosis can be confirmed on clinical examination or imaging studies including magnetic resonance imaging, computerized tomography myelography, and radionuclide myelography. Treatment must be specific to each patient because the timing, size, symptoms, and location of the dural breach all affect the choice of therapy. Nonsurgical methods may be used, but more frequently operative repair is required.</jats:p> <jats:p>In this article, the authors review the diagnosis and treatment of spinal pseudomeningoceles and CSF fistulas.</jats:p>

Foreign body causing a neuro-enteric fistula and pneumocephalus: a case report

“…The more common causes include durotomies during surgery, penetrating trauma or other open fractures of the cranium or spine, or due to a congenital abnormality. CSF leak can result in formation of a fistula, predisposing to infection if the fistula connects to the outside or to a contaminated space [1].…”

Postpartum workup of postdural puncture headache leads to diagnosis and surgical treatment of thoracic pseudomeningocele: a case report

“…3 True meningoceles are extradural collections of CSF in an arachnoid-lined capsule, while pseudomeningoceles are extradural collections of CSF that occur when the dura is breached and may be contained in an arachnoid-lined membrane or in a fibrous capsule. 4 Pseudomeningoceles are primarily iatrogenic, caused by incidental durotomies during spinal or intradural surgery, but they may also occur traumatically or congenitally. In many cases, they are asymptomatic, but they may cause various signs and symptoms, including headache, infection, back pain, radiculopathy, and myelopathy.…”

Calcified pseudomeningocele of the lumbar spine: a review

“…For complicated cases, the incidence is higher and has been reported to be as high as 43 % in surgery for tethered cord [4]. Some authors speculate that both pseudomeningocele and the calcification of such an entity may go undiagnosed for the lack of symptoms [10,14,17,18].…”

“…It has been suggested that as a contributing factor the communication between the pseudomeningocele and the subdural space may act as a one-way flap valve, either by scar tissue or nerve elements, directing CSF towards the pseudomeningocele [10]. Other contributing factors in maintaining the amount of liquid to form pseudomeningoceles may be osmosis, the hydrostatic pressure of standing, the pulsatile nature of spinal fluid dynamics, dead space after surgery, nutritional deficits, steroids, infection and radiation [4,10,18]. The collection of CSF is eventually walled off presumably by a connective tissue reaction and protein precipitation developing into a non-absorbing membrane [16,17].…”

“…Regarding the formation of spinal pseudomeningocele there have been several opinions and reflecting this is the inconsistent nomenclature such as meningeal pseudocyst, extradural cysts, arachnoid cysts, lumbar cysts, spurious meningocele, acquired meningocele, iatrogenic meningocele, arachnoid diverticulum, false cyst and pseudomeningocele [4,10,17]. Traditionally pseudomeningoceles are divided into two groups namely congenital (non-traumatic) and traumatic pseudomeningocele [13].…”