Completely Ossifiying Pseudomeningocele, a Rare Complication after Spinal Surgery

Abstract

Background: We report the rare case of an ossified pseudomeningocele following laminectomy. The extradural pseudocyst has completely ossified without an overt communication to the subarachnoid space.

Case Report: In 1986, a 41 year-old woman suffered from spinal stenosis at levels L3–5 and was treated by laminectomy. A cerebrospinal fluid (CSF) leakage was observed postoperatively. A follow-up CT scan eleven years after surgery showed an ossified pseudomeningocele in the operated region. However, in our case no surgical resection was performed since the patient suffered only from diffuse back pain without sciatica or any neurological deficit. In 2009 the patient continues to be neurologically intact without a change in clinical complaints. Hence, the file was closed after 23 years without neurosurgical intervention.

Discussion: Seven cases of ossified pseudomeningocele have been previously described in the literature and all were operated on. However, our case shows that ossified extradural pseudocysts do not require operation in every case.

Zusammenfassung

Hintergrund: Wir berichten über den seltenen Fall einer postoperativen, komplett verknöcherten Pseudomeningozele, bei der die Verbindung zwischen Pseudozyste und subarachnoidalem Raum verschlossen ist.

Fallbericht: Eine 41-jährige Patientin wurde 1986 aufgrund einer Spinalkanalstenose in den Höhen LW 3–5 laminektomiert. Bei bekanntem, intraoperativem Duraleck zeigte sich im Verlaufs-CT nach 11 Jahren eine verknöcherte Pseudomeningozele im OP-Gebiet. In unserem Fall wurde auf eine chirurgische Resektion der Pseudozyste verzichtet, da die Patientin nur über diffuse Rückenschmerzen berichtete und weder über radikuläre Schmerzen klagte noch ein neurologisches Defizit aufwies. Bei der Vorstellung 2009 gab die Patientin keine Veränderungen ihres Beschwerdebildes an, sodass der Fall nach 23 Jahren ohne operative Konsequenz abgeschlossen werden konnte.

Diskussion: Sieben aus der Literatur bekannte Fälle einer verknöcherten Pseudomeningozele wurden operativ versorgt. Dieser Fall zeigt im Gegensatz zu den anderen Fallberichten, dass verknöcherte extradurale Pseudozysten nicht in jedem Fall operiert werden müssen.

Key words

ossified pseudomeningocele - neurosurgical complication - extradurale pseudocyst

Schlüsselwörter

Verknöcherte Pseudomeningozele - Neurochirurgische Komplikation - extradurale Pseudozyste

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