Abstract
Objectives: Pseudomeningocele results from the herniation of meninges through a dural defect with trapping of subarachnoid fluid in the herniated sac. Iatrogenic pseudomeningoceles following spinal surgery have been described, but reports following neurootologic procedures have been scant. The present study evaluates the incidence of pseudomeningocele following neuro-otologic procedures and delineates an algorithm for the management of this postoperative complication.
Methods: A retrospective review of 375 consecutive patients undergoing neuro-otologic procedures at a single institution identified 11 patients with the postoperative complication of pseudomeningocele. The patients' signs and symptoms, method of management, and ultimate outcome were obtained from patient records and office visits.
Results: The incidence of pseudomeningocele formation was 2.9% in the present study. The median time to development of pseudomeningocele was 12 days postoperatively. 8 pseudomeningoceles resolved with nonoperative management including pressure dressing, bed rest, and lumbar spinal drainage. 4 patients failed nonoperative management and required surgical procedures for resolution. All patients ultimately had resolution of their pseudomeningocele, and there were no recurrences during the follow-up period.
Conclusions: Skull-base pseudomeningocele does occur as a complication following neurootologic procedures. It is associated with chronic irritation of the subarachnoid space and chronic headaches. The majority of these cases can be dealt with in a nonoperative manner, but those failing to respond mandate surgical intervention.