Management of Postoperative Pseudomeningocele following Posterior Cranial Fossa Surgery
Keywords:
Pseudomeningocele, Posterior cranial fossa surgery, Cerebrospinal fluid lumbar drainageAbstract
Objective: Pseudomeningoceles are common complications after posterior fossa surgery. Management guide-lines are lacking, and radically different suggested treatments varying from observation to immediate surgical intervention are encountered in literature. The purpose of our study was to detail our experience in the manage-ment of pseudomeningocele following posterior fossa surgery.
Methods: A retrospective, single-center study was conducted on 137 patients who underwent elective posterior fossa surgery for a variety of diseases. Patients with post operative pseudomeningocele formation were initially treated with conservative measures including bed rest, head elevation, pressure dressing and CSF lumbar drain-age. Surgical re-exploration and repair of the dural rent was done in case the pseudomeningocele didn’t settle with these conservative measures. In patients having gross hydrocephalus on post-operative CT scan a VP (ventriculo-peritoneal) shunt was done in case the conservative measures failed.
Results: There were 8 (5.8%) cases of pseudomeningocele formation after posterior fossa surgery. The pseudomeningocele didn’t settle with conservative measures in any case. Surgical re-exploration and repair of the dural rent lead to the settlement of pseudomeingocele in four cases. VP shunting for gross hydrocephalus on post operative CT lead to the settlement of the pseudomeningocele in the other four cases. Conclusion: Although it has been stated in literature that most cases of pseudomeningocele settle with conser-vative treatment with only a few requiring surgical intervention, our findings were different with conservative measures failing to resolve the pseudomeningocele in all the cases. We believe that it would be beneficial to take an aggressive attitude toward this condition and to consider the possibility of early surgical intervention more seriously.
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