Post-traumatic occipito-cervical pseudomeningocele without any bony injury

Challenges of Managing Patients with Symptomatic Large Traumatic Cervical Pseudomeningoceles

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.

Posttraumatic Intradiploic Pseudomeningocele of the Occipito-Cervical Region

Pseudomeningocele is a collection of the cerebrospinal fluid in the extradural space due to a defect in the dura-arachnoid layer of the meninge, and manifests as a fibrous capsule in the space of subcutaneous tissues. Classically, growing skull fracture caused by the pseudomeningocele is not uncommon in the pediatric age group. However, a posttraumatic intradiploic pseudomeningoceles is extremely rare, and only a few patients have been described. Herein, the authors present a 6-year-old girl who developed an intradiploic pseudomeningocele of the occipito-cervical region after a severe head trauma.