title: Treatment of a thoracic dural-pleural fistula with a vascularized omental flap: a case report.
abstract: METHODS
  Case report.
  
  
  OBJECTIVE
  To report an unusual case of pseudomeningocele with dural-pleural fistula formation and spinal cord herniation after anterior thoracic decompression, as well as a unique surgical method for treating this complication.
  
  
  BACKGROUND
  Thoracic pseudomeningocele with fistula formation is a rare but serious complication of spinal surgery. The negative pressure environment created in the pleural space can complicate management and result in dural-plural fistula formation. We report on the use of a vascularized omental flap to treat this complication after failure of more traditional techniques.
  
  
  METHODS
  A 76-year-old man presented with complaints of myeloradiculopathy, including weakness of lower extremities, with gait and bowel and bladder dysfunction after 2 previous decompressions at the T6-T7 level. Revision surgery was complicated by a dural-plural fistula and spinal cord herniation with neurological deterioration requiring reoperation.
  
  
  RESULTS
  Treatment with vascularized omental flap successfully treated the fistula, and the patient had resolution of all symptoms with the exception of some lower extremity neuropathic pain. Postoperative imaging showed excellent decompression of the spinal canal and a small, stable pseudomeningocele without evidence of cerebrospinal fluid hypotension or active dural-pleural fistula.
  
  
  CONCLUSIONS
  Treatment of thoracic psuedomeningoceles and fistulas can be difficult due to the unique negative intrathoracic pressure environment that complicates closure using traditional methods. Alternative treatment options may be necessary when more traditional techniques fail. Our report highlights one such option, a vascularized omental flap, which was used to successfully treat the patient.
authors.affiliation: Department of Orthopedics, Mayo Clinic, Rochester, MN 55905, USA.
authors.forename: Shawn
authors.initials: S
authors.lastname: Sahota
authors.forename: Ahmad
authors.initials: A
authors.lastname: Nassr
authors.forename: Mustafa H
authors.initials: MH
authors.lastname: Khan
authors.forename: Richard W
authors.initials: RW
authors.lastname: Marsh
authors.forename: Steven L
authors.initials: SL
authors.lastname: Moran
authors.forename: Paul M
authors.initials: PM
authors.lastname: Arnold
authors.forename: Mark B
authors.initials: MB
authors.lastname: Dekutoski
mesh_terms: D000368:Aged; D019299:Decompression, Surgical / Q000009:adverse effects; D004388:Dura Mater / Q000601:surgery; D005402:Fistula / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008297:Male; D009852:Omentum / Q000098:blood supply / Q000637:transplantation*; D010995:Pleural Diseases / Q000601:surgery; D013524:Surgical Flaps; D013904:Thoracic Vertebrae / Q000601:surgery*; D016896:Treatment Outcome