Challenges of Managing Patients with Symptomatic Large Traumatic Cervical Pseudomeningoceles

Sara Ganaha, Montserrat Lara-Velazquez, Jang W. Yoon, Oluwaseun O. Akinduro, Steven R. Clendenen, Peter M. Murray, Mark A. Pichelmann, Alfredo Quinones-Hinojosa, H. Gordon Deen

Research output: Contribution to journalArticle

Abstract

Background: Traumatic cervical pseudomeningoceles (TCPs) occur secondary to traction of the cervical nerve roots resulting in violation of the dura. Surgical repair is not necessary in most cases because pseudomeningoceles have a high propensity to spontaneously resolve with conservative management alone. Currently, there are a limited number of cases of large TCPs (large is defined as ≥6 cm in greatest diameter), and there is no established guideline for the management of such lesions. Case Description: We describe the cases of 2 young men in their 20s who were involved in a motor vehicle accident. Both patients suffered a brachial plexus injury and developed large TCPs. Patient 1 was treated surgically for TCP using a combined intra-/extradural approach using a fascia lata graft. Patient 2 was ultimately treated nonsurgically because a spontaneous resolution of the pseudomeningocele was achieved over the period of 7 months after the accident. Both patients underwent brachial plexus repair surgery consisting of spinal accessory nerve transfer to the suprascapular nerve and intercostal nerve transfer to the musculocutaneous nerve. Conclusions: Disease progression of TCPs is a dynamic process, and even large lesions may spontaneously resolve without surgical intervention. When surgery is indicated, a definitive dural repair using a fascia lata graft to cover the dural tear intra- and extradurally is an effective method. Surgery must be planned carefully on a case-by-case basis, and close follow-up with thorough physical examination and serial imaging is critical to monitor disease progression.

Original languageEnglish (US)
Pages (from-to)128-133
Number of pages6
JournalWorld Neurosurgery
Volume115
DOIs
StatePublished - Jul 1 2018

Keywords

  • Brachial plexus injury
  • Cervical pseudomeningocele
  • Dural repair

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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    Ganaha, S., Lara-Velazquez, M., Yoon, J. W., Akinduro, O. O., Clendenen, S. R., Murray, P. M., Pichelmann, M. A., Quinones-Hinojosa, A., & Deen, H. G. (2018). Challenges of Managing Patients with Symptomatic Large Traumatic Cervical Pseudomeningoceles. World Neurosurgery, 115, 128-133. https://doi.org/10.1016/j.wneu.2018.04.017