Significance of Pseudomeningocele After Decompressive Surgery for Chiari I Malformation.
Chiari I malformation
complications
decompressive surgery
pseudomeningocele
surgical and radiological outcomes
Journal
Frontiers in surgery
ISSN: 2296-875X
Titre abrégé: Front Surg
Pays: Switzerland
ID NLM: 101645127
Informations de publication
Date de publication:
2022
2022
Historique:
received:
13
03
2022
accepted:
12
04
2022
entrez:
29
8
2022
pubmed:
30
8
2022
medline:
30
8
2022
Statut:
epublish
Résumé
Pseudomeningoceles (PMCs) as abnormal collections of cerebrospinal fluid are quite common findings on follow-up MRI after Chiari decompression surgery (CDS). However, the importance of their identification has not been truly determined, especially when PMCs are described occasionally in the process of radiological follow-up. We retrospectively analyzed surgical outcomes and imaging findings after CDS depending upon the occurrence and thickness of PMCs. A total of 76 adult patients who underwent CDS were analyzed. The clinical and radiological outcomes of patients with a pseudomeningocele (wPMC) were evaluated and compared to those of patients without a pseudomeningocele (w/oPMC). Radiological morphometric measurements were performed and compared between groups. Comparisons of the maximal PMC thickness were made within the wPMC group. PMCs were recognized in 27 (35.5%) patients, of whom 3 (11.1%) required reoperation. Differences in satisfactory result rates regarding gestalt assessment and Chicago Chiari Outcome Scale were statistically insignificant between the w/oPMC and wPMC groups ( We found no significant relationships between PMC presence or thickness and clinical or radiological outcomes. However, postoperative changes within the posterior fossa associated with PMCs resemble brain sagging, which occurs in intracranial hypotension. Therefore, extradural cerebrospinal fluid escape may also be responsible for symptoms in some patients with PMCs after CDS.
Sections du résumé
Background
UNASSIGNED
Pseudomeningoceles (PMCs) as abnormal collections of cerebrospinal fluid are quite common findings on follow-up MRI after Chiari decompression surgery (CDS). However, the importance of their identification has not been truly determined, especially when PMCs are described occasionally in the process of radiological follow-up. We retrospectively analyzed surgical outcomes and imaging findings after CDS depending upon the occurrence and thickness of PMCs.
Methods
UNASSIGNED
A total of 76 adult patients who underwent CDS were analyzed. The clinical and radiological outcomes of patients with a pseudomeningocele (wPMC) were evaluated and compared to those of patients without a pseudomeningocele (w/oPMC). Radiological morphometric measurements were performed and compared between groups. Comparisons of the maximal PMC thickness were made within the wPMC group.
Results
UNASSIGNED
PMCs were recognized in 27 (35.5%) patients, of whom 3 (11.1%) required reoperation. Differences in satisfactory result rates regarding gestalt assessment and Chicago Chiari Outcome Scale were statistically insignificant between the w/oPMC and wPMC groups (
Conclusions
UNASSIGNED
We found no significant relationships between PMC presence or thickness and clinical or radiological outcomes. However, postoperative changes within the posterior fossa associated with PMCs resemble brain sagging, which occurs in intracranial hypotension. Therefore, extradural cerebrospinal fluid escape may also be responsible for symptoms in some patients with PMCs after CDS.
Identifiants
pubmed: 36034387
doi: 10.3389/fsurg.2022.895444
pmc: PMC9406808
doi:
Types de publication
Journal Article
Langues
eng
Pagination
895444Informations de copyright
Copyright © 2022 Balasa, Kunert, Bielecki, Kujawski and Marchel.
Déclaration de conflit d'intérêts
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Références
Neurosurgery. 1998 Oct;43(4):945-8
pubmed: 9766325
Acta Neurol Belg. 2020 Feb;120(1):9-18
pubmed: 31215003
Oper Neurosurg (Hagerstown). 2016 Sep 1;12(3):298-304
pubmed: 29506116
World Neurosurg. 2016 Apr;88:7-14
pubmed: 26732952
World Neurosurg. 2016 Apr;88:688.e1-688.e7
pubmed: 26704196
J Neurosurg Pediatr. 2015 Feb;15(2):161-77
pubmed: 25479580
Acta Neurochir (Wien). 1996;138(7):788-801
pubmed: 8869706
Acta Neurochir (Wien). 2002 Oct;144(10):1005-19
pubmed: 12382129
J Neurosurg Pediatr. 2012 Aug;10(2):142-9
pubmed: 22747093
Childs Nerv Syst. 2004 May;20(5):329-31
pubmed: 14966660
Childs Nerv Syst. 2011 Jan;27(1):35-40
pubmed: 20890606
Acta Neurochir Suppl (Wien). 1988;43:29-31
pubmed: 3213653
Neurosurgery. 2012 Mar;70(3):656-64; discussion 664-5
pubmed: 21849925
Childs Nerv Syst. 2007 Feb;23(2):171-4; discussion 175
pubmed: 17047966
J Neurosurg Spine. 2017 Jun;26(6):760-764
pubmed: 28362213
J Neurosurg. 2013 Nov;119(5):1159-65
pubmed: 24010974
Neurosurg Focus. 2003 Sep 15;15(3):E3
pubmed: 15347221
Neurosurgery. 2008 Mar;62(3 Suppl 1):156-60; discussion 160-1
pubmed: 18424981
Neurosurgery. 2001 Jun;48(6):1246-53; discussion 1253-4
pubmed: 11383726
Acta Neurochir (Wien). 2002 Jul;144(7):649-64
pubmed: 12181698
J Neurosurg. 2012 Nov;117(5):942-6
pubmed: 22978540
Neurosurg Focus. 2003 Dec 15;15(6):ECP2
pubmed: 15305844
J Neurosurg. 2015 Feb;122(2):262-72
pubmed: 25380104
Neuroimaging Clin N Am. 2019 Nov;29(4):581-594
pubmed: 31677732
Br J Neurosurg. 2003 Dec;17(6):530-6
pubmed: 14756480
World Neurosurg. 2018 Sep;117:e595-e602
pubmed: 29933087
J Neurosurg Spine. 2019 Nov 1;31(5):619-628
pubmed: 31675698
J Neurosurg. 1994 Jan;80(1):3-15
pubmed: 8271018
Otolaryngol Head Neck Surg. 2004 Sep;131(3):253-62
pubmed: 15365545