suboccipital_pseudomeningocele_treatment

Suboccipital pseudomeningocele treatment

Suboccipital pseudomeningocele treatment options (up to 67% require permanent cerebrospinal fluid drainage 1)):

1. noninvasive measures: expectant management, fluid restriction diet, head wrapping, keeping HOB elevated, acetazolamide. Steroids may be used if aseptic meningitis is suspected

2. percutaneous aspiration: “tap and wrap.” Risks introducing bacteria, causing infection

3. direct surgical exploration with multilayer re-closure

4. lumbar drainage: effective only if pseudomeningocele communicates with the subarachnoid space.

✖ May produce acute posterior fossa syndrome (H/A, nausea, vomiting, ataxia…) 2) especially if the pseudomeningocele doesn’t communicate. Symptoms usually resolve with prompt discontinuation of lumbar drainage 3) 4). Other potential complications: vagal nerve palsy, tonsillar herniation, subdural hematoma, kinking of PCA → stroke. Drainage options:

a) External lumbar cerebrospinal fluid drainage (temporary)

b) Lumboperitoneal shunt (permanent)

5. Ventricular drainage

a) EVD (temporary)

b) shunt (permanent)


1)
Culley DJ, Berger MS, Shaw D, et al. An Analysis of Factors Determining the Need for Ventriculoperitoneal Shunts After Posterior Fossa Tumor Surgery in Children. Neurosurgery. 1994; 34:402–408
2) , 3)
Manley GT, Dillon W. Acute posterior fossa syndro- me following lumbar drainage for treatment of sub-occipital pseudomeningocele. Report of three cases. J Neurosurg. 2000; 92:469–474
4)
Roland PS, Marple BF, Meyerhoff WL, et al. Complications of lumbar spinal fluid drainage. Otolaryngol Head Neck Surg. 1992; 107:564–569
  • suboccipital_pseudomeningocele_treatment.txt
  • Last modified: 2022/02/22 11:33
  • by administrador