Spontaneous resolution of lumbar pseudomeningocoele

Abstract

Study design: A case report of spontaneous resolution of a lumbar postdiscectomy pseudomeningocoele. Objectives: To suggest the role of nonoperative treatment even in symptomatic pseudomeningocoeles. Setting: Withybush General Hospital, Haverfordwest, Pembrokeshire, South Wales, UK. Case report: A 65-year-old lady underwent L4/L5 discectomy for lumbar disc prolapse in 1998. As the patient did not have relief of symptoms, an MRI was taken at 1 month following the operation, which showed a residual disc at L4/L5 and a pseudomeningocoele communicating with the subarachnoid space. The patient could not undergo further treatment because of the untimely demise of the surgeon. Over the next 3 months, the symptoms began to improve and the patient was totally asymptomatic and remained so for 3 years. In 2001, she was seen for a recurring leg pain and back pain and an MRI was done, which showed complete disappearance of the pseudomeningocoele but with recurrent disc lesion. Conclusion: Although the current medical literature favours re-exploration and repair of the dural defect in symptomatic pseudomeningocoele, the authors are of the opinion that conservative treatment may have a role in the treatment of the above condition as illustrated by the above example.

Lumbar pseudomeningocele presenting as decerebrate rigidity—A rare case entity

“…The symptoms associated with pseudomeningocele vary widely, including back pain, sciatic pain, headache, neck pain, nausea, vomiting, tinnitus and a palpable mass. However most of the pseudomeningoceles remain asymptomatic [10] , [11] . Symptoms may appear at any time and the severity of symptoms does not necessarily correlate with the size.…”

Post-exertional thoracic pseudomeningocoele in a 41-year-old woman: a rare cause of interscapular pain

“…1,2 Some large ones have been managed indirectly by CSF diversion shunts, 6 while there are reports of spontaneous resolution of pseudomeningocoeles. 8,9 This case report is unique in that there is hardly any mention in the literature of this condition occurring in the setting of physical exertion. While sudden spinal pain following physical exertion is common in clinical practice, it is mainly encountered in the lumbar spine and where sprains and strains have been excluded, it is usually due to annular tears of intervertebral discs or else, in a few cases, disc prolapses or fractures of osteoporotic vertebra in our experience.…”

A review article on the diagnosis and treatment of cerebrospinal fluid fistulas and dural tears occurring during spinal surgery

“…[35] They presented a 65-year-old female who following an L4-L5 diskectomy developed an MR-documented pseudomeningocele. She continued to improve without operative intervention, and was asymptomatic 3 years later without having undergone any further treatment.…”