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CC BY-NC-ND 4.0 · Asian J Neurosurg 2021; 16(04): 827-829
DOI: 10.4103/ajns.AJNS_83_21
Case Report

Symptomatic postsurgical lumbar pseudomeningocele treated by ultrasound-guided epidural blood patch application

Rohit Kavishwar
Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt Ltd., Coimbatore, Tamil Nadu
,
Ajoy Shetty
Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt Ltd., Coimbatore, Tamil Nadu
,
Balavenkata Subramanian
Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt Ltd., Coimbatore, Tamil Nadu
,
Shanmuganathan Rajasekaran
Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt Ltd., Coimbatore, Tamil Nadu
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Postsurgical pseudomeningoceles are extradural collections of cerebrospinal fluid (CSF) that results following an intraoperative dural breach. Although usually asymptomatic and self-subsiding, they may present with symptoms of postural headache, blurred vision, diplopia, photophobia, back pain, radiculopathy, and vomiting. Most of the cases recover with conservative measures such as bed rest, hydration, and pressure dressings. Symptomatic patients usually require surgical re-exploration and direct open repair of the durotomy. We report the case of a 48-year-old female who presented with lumbar pseudomeningocele following lumbar microdiscectomy treated by Ultrasound-guided (USG)-guided epidural blood patch application. She had globular swelling at the surgical site, postural headache, and left lower-limb radicular pain with normal neurology. Her magnetic resonance imaging (MRI) showed a left L4 laminar defect with pseudomeningocoele (measuring 5.5 cm × 4.2 cm × 4 cm) with intraspinal communication. USG was used to guide the aspiration of CSF from pseudomeningocele and to apply the epidural blood patch one level above and at the level of laminectomy. Postoperatively, she had marked improvement in her symptoms. At 1-year follow-up, she was completely symptom free and full resolution of pseudomeningocele was seen on 1-year follow-up MRI. This case is being reported to highlight the use of USG-guided epidural blood patch for the treatment of postoperative lumbar pseudomeningocele.

Key-words:

Blood patch - durotomy - epidural - pseudomeningocele

Financial support and sponsorship

Nil.




Publication History

Received: 15 March 2021

Accepted: 25 June 2021

Article published online:
16 August 2022

© 2021. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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