Post-surgical giant pseudo meningocele in a patient with cervical neurofibroma: Case report and literature review

Raghavendra H, Varsha KS, Arun Reddy, Samsun Sujith, Kalyan Rao T, Sunanda G, Swarna latha

Pdf Page Numbers :- 98-101

Raghavendra H^1,*, Varsha KS², Arun Reddy¹, Samsun Sujith¹, Kalyan Rao T², Sunanda G² and Swarna latha³

¹Department of Neurosurgery, ESIC Medical College and Super Speciality Hospital, Hyderabad-500038, Telangana, India

²Department of Anaesthesiology, ESIC Medical College and Super Speciality Hospital, Hyderabad-500038, Telangana, India

³Department of Radiology, ESIC Medical College and Super Speciality Hospital, Hyderabad-500038, Telangana, India

*Corresponding author: Dr. Raghavendra H, Department of Neurosurgery, ESIC Medical College and Super Speciality Hospital, Hyderabad-500038, Telangana, India. Email: harpanahalli.raghavendra@gmail.com

Received 8 April 2017; Revised 16 May 2017; Accepted 26 June 2017; Published 30 June 2017

Citation: Raghavendra H, Varsha KS, Reddy A, Sujith S, Rao KT, Sunanda G, latha S. Post-surgical giant pseudo meningocele in a patient with cervical neurofibroma: Case report and literature review. J Med Sci Res. 2017; 5(3):98-101. DOI: http://dx.doi.org/10.17727/JMSR.2017/5-18 

Copyright: © 2017 Raghavendra H et al. Published by KIMS Foundation and Research Center. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

PDF

Abstract

A patient aged 48-year-old, presented to the outpatient department with neck pain and weakness of all the limbs for three months. On examination, he had power 3/5 in all the limbs with bilateral hand grip weakness of 50%. Neuroimaging study showed a dumbell shaped lesion with compression of the spinal cord in the cervical region that was identified as a C4/C5 neurofibroma. Cervical laminectomy and excision of the tumour and unilateral lateral mass screw and rod fixation was done. Post operatively patient was discharged with improved motor power. One month after surgery, he presented with bulging at the operative site, which was diagnosed as a pseudo meningocele that did not respond to conservative therapy. As swelling was increasing size and becoming tense and also complaining of severe neck pain and postural hypotension, it was managed surgically, three months after first surgery, by excision of pseudo meningocele with primary repair of dural defect with muscle graft and lumbar drain inserted intraoperatively which was removed after five days. Patient’s neck pain and hypotensive episode were improved after repair. Possible causes for the development of post-operative pseudo meningocele can be soft tissue and paravertebral muscle damage or high intradural pressures that causes leakage of cerebrospinal fluid from a very small dural defect. Shunt insertion should be reserved for patients with impaired cerebrospinal fluid absorption or those with a refractory fistula, despite medical therapies and direct surgical repairs.

Keywords: post-surgical; pseudo meningocele; cervical neurofibroma