title: A Giant Lumbar Pseudomeningocele in a Patient with Neurofibromatosis Type 1: A Case Report.
abstract: This is a rare case of giant lumbar pseudomeningocele with intra-abdominal extension in patient with neurofibromatosis type 1 (NF1). The patient's clinical course is retrospectively reviewed. A 34-year-old female affected by NF1 was referred to our institution for persistent low back pain and MRI diagnosis of pseudomeningocele located at L3 level with paravertebral extension. From the first surgical procedure by a posterior approach until the relapse of the pseudomeningocele documented by MRI, the patient underwent two subsequent posterior surgical procedures to repair the dural sac defect with fat graft and fibrin glue. One month after the third operation, the abdominal MRI showed a giant intra-abdominal pseudomeningocele causing compression of visceral structures. The patient was asymptomatic. The pseudomeningocele was treated with an anterior abdominal approach and the use of the acellular dermal matrix (ADM) sutured directly on the dural defect on the anterolateral wall of the spinal canal. After six months of follow-up the MRI showed no relapse of the pseudomeningocele. Our case highlights the possible use of ADM as an effective and safe alternative to the traditional fat graft to repair challenging and large dural defects.
authors.affiliation: Department of Neurosurgery, Università Politecnica delle Marche, Ospedali Riuniti Umberto I, Ancona, Italy.
authors.forename: Mauro
authors.identifier: 0000-0001-7305-6951
authors.initials: M
authors.lastname: Dobran
authors.affiliation: Department of Neurosurgery, Università Politecnica delle Marche, Ospedali Riuniti Umberto I, Ancona, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Iacoangeli
authors.affiliation: Department of Emergency Surgery, Ospedali Riuniti Umberto I, Ancona, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Ruscelli
authors.affiliation: Department of Neurosurgery, Università Politecnica delle Marche, Ospedali Riuniti Umberto I, Ancona, Italy.
authors.forename: Martina
authors.initials: M
authors.lastname: Della Costanza
authors.affiliation: Department of Neurosurgery, Università Politecnica delle Marche, Ospedali Riuniti Umberto I, Ancona, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Nasi
authors.affiliation: Department of Neurosurgery, Università Politecnica delle Marche, Ospedali Riuniti Umberto I, Ancona, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Scerrati