Spinal pseudomeningoceles and cerebrospinal fluid fistulas.
Spinal pseudomeningoceles and cerebrospinal fluid (CSF) fistulas are rare extradural collections of CSF that result following a breach in the dural-arachnoid layer. They may occur due to an incidental durotomy, during intradural surgery, or from trauma or congenital abnormality. The majority are iatrogenic and occur in the posterior lumbar region following surgery. Although they are often asymptomatic, they may cause low-back pain, headaches, and even nerve root entrapment. Leakage of CSF from the wound may cause a fistulous tract, which is a conduit for infection and should be repaired immediately. Diagnosis can be confirmed on clinical examination or imaging studies including magnetic resonance imaging, computerized tomography myelography, and radionuclide myelography. Treatment must be specific to each patient because the timing, size, symptoms, and location of the dural breach all affect the choice of therapy. Nonsurgical methods may be used, but more frequently operative repair is required. In this article, the authors review the diagnosis and treatment of spinal pseudomeningoceles and CSF fistulas.
Couture
Daniel
D
Department of Neurosurgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157-1029, USA.
Branch
Charles L
CL
D017217:Blood Patch, Epidural; D017577:Cutaneous Fistula / Q000209:etiology; D003937:Diagnosis, Differential; D003952:Diagnostic Imaging; D004388:Dura Mater / Q000293:injuries; D015718:Fibrin Tissue Adhesive / Q000627:therapeutic use; D005402:Fistula / Q000209:etiology; D006801:Humans; D007431:Intraoperative Complications / Q000175:diagnosis / Q000601:surgery / Q000628:therapy; D007796:Laminectomy; D008159:Lumbar Vertebrae / Q000601:surgery; D008581:Meningitis / Q000209:etiology / Q000517:prevention & control; D008591:Meningomyelocele / Q000175:diagnosis; D013122:Spinal Diseases / Q000209:etiology; D013353:Subdural Effusion / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery / Q000628:therapy; D013536:Suture Techniques
D015718:Fibrin Tissue Adhesive