Cauda equina entrapment in a pseudomeningocele after lumbar schwannoma extirpation

Eur Spine J. 2010 Jul;19 Suppl 2(Suppl 2):S158-61. doi: 10.1007/s00586-009-1219-y. Epub 2009 Nov 19.

Abstract

Incidental or intentional durotomy causing cerebrospinal fluid (CSF) leakage, leading to the formation of a pseudomeningocele is a known complication in spinal surgery. Herniation of nerve roots into such a pseudomeningocele is very rare, but can occur up to years after initial durotomy and has been described to cause permanent neurologic deficit. However, cauda equina fiber herniation and entrapment into a pseudomeningocele has not been reported before. Here, we present a case of symptomatic transdural cauda equina herniation and incarceration into a pseudomeningocele, 3 months after extirpation of a lumbar Schwannoma. A 59-year-old man, who previously underwent intradural Schwannoma extirpation presented 3 months after surgery with back pain, sciatica and loss of bladder filling sensation caused by cauda equina fiber entrapment into a defect in the wall of a pseudomeningocele, diagnosed with magnetic resonance imaging. On re-operation, the pseudomeningocele was resected and the herniated and entrapped cauda fibers were released and replaced intradurally. The dura defect was closed and the patient recovered completely. In conclusion, CSF leakage can cause neurological deficit up to years after durotomy by transdural nerve root herniation and subsequent entrapment. Clinicians should be aware of the possibility of this potentially devastating complication. The present case also underlines the importance of meticulous dura closure in spinal surgery.

Publication types

  • Case Reports

MeSH terms

  • Cauda Equina / pathology
  • Cauda Equina / physiopathology
  • Cauda Equina / surgery
  • Dura Mater / pathology
  • Dura Mater / physiopathology
  • Dura Mater / surgery*
  • Humans
  • Lumbar Vertebrae / diagnostic imaging
  • Lumbar Vertebrae / pathology
  • Lumbar Vertebrae / surgery
  • Male
  • Meningocele / etiology*
  • Meningocele / pathology
  • Meningocele / surgery
  • Middle Aged
  • Neurilemmoma / pathology
  • Neurilemmoma / physiopathology
  • Neurilemmoma / surgery*
  • Polyradiculopathy / etiology*
  • Polyradiculopathy / pathology
  • Polyradiculopathy / surgery
  • Postoperative Complications / etiology*
  • Postoperative Complications / pathology
  • Postoperative Complications / surgery
  • Radiography
  • Spinal Canal / diagnostic imaging
  • Spinal Canal / pathology
  • Spinal Canal / surgery
  • Spinal Cord Neoplasms / pathology
  • Spinal Cord Neoplasms / physiopathology
  • Spinal Cord Neoplasms / surgery*
  • Treatment Outcome