Challenges of Managing Patients with Symptomatic Large Traumatic Cervical Pseudomeningoceles.

Autor: Ganaha S; Department of Neurosurgery, Mayo Clinic, Jacksonville, Florida, USA., Lara-Velazquez M; Department of Neurosurgery, Mayo Clinic, Jacksonville, Florida, USA., Yoon JW; Department of Neurosurgery, Mayo Clinic, Jacksonville, Florida, USA., Akinduro OO; Department of Neurosurgery, Mayo Clinic, Jacksonville, Florida, USA., Clendenen SR; Department of Anesthesiology, Mayo Clinic, Jacksonville, Florida, USA., Murray PM; Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, Florida, USA., Pichelmann MA; Department of Neurosurgery, Mayo Clinic, Jacksonville, Florida, USA., Quinones-Hinojosa A; Department of Neurosurgery, Mayo Clinic, Jacksonville, Florida, USA., Deen HG; Department of Neurosurgery, Mayo Clinic, Jacksonville, Florida, USA. Electronic address: hdeen@mayo.edu.
Jazyk: angličtina
Zdroj: World neurosurgery [World Neurosurg] 2018 Jul; Vol. 115, pp. 128-133. Date of Electronic Publication: 2018 Apr 11.
DOI: 10.1016/j.wneu.2018.04.017
Abstrakt: 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.
(Copyright © 2018 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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