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

Fingerprint

Nerve Transfer
Fascia Lata
Brachial Plexus
Accidents
Disease Progression
Arm Injuries
Musculocutaneous Nerve
Intercostal Nerves
Accessory Nerve
Transplants
Traction
Motor Vehicles
Tears
Physical Examination
Guidelines
Conservative Treatment

Keywords

  • Brachial plexus injury
  • Cervical pseudomeningocele
  • Dural repair

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Ganaha, S., Lara-Velazquez, M., Yoon, J. W., Akinduro, O. O., Clendenen, S. R., Murray, P. M., ... 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

Challenges of Managing Patients with Symptomatic Large Traumatic Cervical Pseudomeningoceles. / Ganaha, Sara; Lara-Velazquez, Montserrat; Yoon, Jang W.; Akinduro, Oluwaseun O.; Clendenen, Steven R.; Murray, Peter M.; Pichelmann, Mark A.; Quinones-Hinojosa, Alfredo; Deen, H. Gordon.

In: World Neurosurgery, Vol. 115, 01.07.2018, p. 128-133.

Research output: Contribution to journalArticle

Ganaha, S, Lara-Velazquez, M, Yoon, JW, Akinduro, OO, Clendenen, SR, Murray, PM, Pichelmann, MA, Quinones-Hinojosa, A & Deen, HG 2018, 'Challenges of Managing Patients with Symptomatic Large Traumatic Cervical Pseudomeningoceles', World Neurosurgery, vol. 115, pp. 128-133. https://doi.org/10.1016/j.wneu.2018.04.017
Ganaha S, Lara-Velazquez M, Yoon JW, Akinduro OO, Clendenen SR, Murray PM et al. Challenges of Managing Patients with Symptomatic Large Traumatic Cervical Pseudomeningoceles. World Neurosurgery. 2018 Jul 1;115:128-133. https://doi.org/10.1016/j.wneu.2018.04.017
Ganaha, Sara ; Lara-Velazquez, Montserrat ; Yoon, Jang W. ; Akinduro, Oluwaseun O. ; Clendenen, Steven R. ; Murray, Peter M. ; Pichelmann, Mark A. ; Quinones-Hinojosa, Alfredo ; Deen, H. Gordon. / Challenges of Managing Patients with Symptomatic Large Traumatic Cervical Pseudomeningoceles. In: World Neurosurgery. 2018 ; Vol. 115. pp. 128-133.
@article{5596ba6c93f74d0db7586d50b0a32b63,
title = "Challenges of Managing Patients with Symptomatic Large Traumatic Cervical Pseudomeningoceles",
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.",
keywords = "Brachial plexus injury, Cervical pseudomeningocele, Dural repair",
author = "Sara Ganaha and Montserrat Lara-Velazquez and Yoon, {Jang W.} and Akinduro, {Oluwaseun O.} and Clendenen, {Steven R.} and Murray, {Peter M.} and Pichelmann, {Mark A.} and Alfredo Quinones-Hinojosa and Deen, {H. Gordon}",
year = "2018",
month = "7",
day = "1",
doi = "10.1016/j.wneu.2018.04.017",
language = "English (US)",
volume = "115",
pages = "128--133",
journal = "World Neurosurgery",
issn = "1878-8750",
publisher = "Elsevier Inc.",

}

TY - JOUR

T1 - Challenges of Managing Patients with Symptomatic Large Traumatic Cervical Pseudomeningoceles

AU - Ganaha, Sara

AU - Lara-Velazquez, Montserrat

AU - Yoon, Jang W.

AU - Akinduro, Oluwaseun O.

AU - Clendenen, Steven R.

AU - Murray, Peter M.

AU - Pichelmann, Mark A.

AU - Quinones-Hinojosa, Alfredo

AU - Deen, H. Gordon

PY - 2018/7/1

Y1 - 2018/7/1

N2 - 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.

AB - 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.

KW - Brachial plexus injury

KW - Cervical pseudomeningocele

KW - Dural repair

UR - http://www.scopus.com/inward/record.url?scp=85046663416&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85046663416&partnerID=8YFLogxK

U2 - 10.1016/j.wneu.2018.04.017

DO - 10.1016/j.wneu.2018.04.017

M3 - Article

C2 - 29654960

AN - SCOPUS:85046663416

VL - 115

SP - 128

EP - 133

JO - World Neurosurgery

JF - World Neurosurgery

SN - 1878-8750

ER -