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Management of postoperative pseudomeningoceles: an international survey study

  • A.J. Raimondi ISPN Award
  • Published:
Child's Nervous System Aims and scope Submit manuscript

Abstract

Background

Pseudomeningoceles are common complications after posterior fossa and intradural spinal surgery and are often asymptomatic. Management guidelines are lacking, and anecdotally, we have encountered radically different suggested treatments varying from observation to immediate surgical intervention. The goal of this study was to determine the prevailing opinions among neurosurgeons on the management of this condition.

Methods

Neurosurgeons from around the world were invited via an International Society for Pediatric Neurosurgery (ISPN) and Neurosurgery ListServ e-blast to participate in a 33-question survey on the management of pseudomeningoceles, presented as simulated scenarios after posterior fossa and spinal intradural surgery.

Results

Two hundred forty-one responses were obtained. Pseudomeningoceles after posterior fossa tumor resection, in the absence of hydrocephalus, were typically managed nonoperatively for 7 to 14 days before re-exploration. Only 0.5 % of the surgeons would offer upfront repair of the pseudomeningocele. In the presence of hydrocephalus, 48 % of the neurosurgeons intervene initially with cerebrospinal fluid (CSF) diversion and would change therapy if the lesion did not resolve in 2 to 4 days. Ninety percent of the surgeons manage spinal pseudomeningoceles nonoperatively for 7–14 days before re-exploration is considered. The most common steps taken to prevent pseudomeningoceles are watertight closure, tissue glues, and duroplasty.

Conclusion

The present zeitgeist suggests that, in the absence of hydrocephalus, initial observation is appropriate for cranial and spinal pseudomeningoceles. Operative revision should be reserved for failure of conservative treatment. If hydrocephalus is present, consideration should be made for CSF diversion. This study may serve as a guideline regarding acceptable management.

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Acknowledgments

We would like to acknowledge and thank the following: the ISPN education committee for supporting this study; Dr. Douglas Cochrane, ISPN communications chairman for inviting members of the ISPN to participate; the organizing committee of the ISPN in Mainz for inviting attendees to participate; and Dr. Ganesalingam Narenthiran for inviting members of the ListServ to participate. We are grateful to have had their support for this study.

One hundred forty respondents elected to have their institutions acknowledged in the body of this manuscript. We are very appreciative of all of our respondents. In no particular order they are as follows: University of British Columbia; University Medical Centre, Utrecht; BC Children’s Hospital; Riley Hospital for Children at IU Health; Maastricht University Medical Centre; Waikato Neurosurgery Unit; IWK Health Centre, Dalhousie University; University of Minnesota; Sydney Children’s’ Hospital, Randwick; Winnipeg Children’s Hospital, University of Manitoba; Virgen de la Arrixaca University Hospital, Murcia; National Center for Child Health and Development; Children’s Hospital of Colorado; Luzerner Kantonsspital Division of Neurosurgery; Aditya Birla Memorial Hospital, Pune; Chiba University Graduate School of Medicine; Kanchi Kamakoti Childs Trust Hospital; Gulhane Military Medical Academy; Severance Children’s Hospital Division of Pediatric Neurosurgery, Yonsei University College of Medicine; New York University; University Hospital, Frankfurt; Children’s Hospital of Eastern Ontario; Lurie Children’s Hospital of Chicago; University of Jordan; Leeds Children’s Hospital at Leeds General Infirmary; Erasmus Medical Center, University Medical Centre Rotterdam; Armed Forces Hospital; Children’s Cancer Hospital; Anna Meyer Pediatric Hospitale Department of Neurosurgery, Firenze; Sao Paulo University College of Medicine; A Gemelli Hospital Pediatric Neurosurgery; Seoul National University Children’s Hospital; VU University Medical Center, Amsterdam; University Medical Center, Groningen; Rikshospitalet Oslo University Hospital; Children’s National Medical Centre; Catholic University, Rome; Hospital Regional de Alta Especialidad del Bajio; Klinikum Kassel; Neurosurgical Clinic University Hospital, Heidelberg; Department of Neurosurgery, Ludwig-Maximilians-University of Munich; University Hospital Leuven, Belgium; Recep Tayip Erdogan University Rize; Department of Pediatric Neurosurgery at Children’s Medical Center, University Hospital Brno; Birmingham Children’s Hospital; Selcuk University Faculty of Medicine, Department of Neurosurgery, Konya; Sydney Children’s Hospital; SUNY Upstate Golisano’s Children’s Hospital; Taipei Veterans General Hospital; Montefiore Medical Center; Mitera Children’s Hospital, Athens; Atkinson Morley’s Hospital; Virgen del Rocio University Hospitals; Children’s Hospital Los Angeles; Hospital Pediatrico Martagao Gesteira; Boston Children’s Hospital; RVI Newcastle; Celal Bayar University; Scientific Center of Reconstructive and Restorative Surgery of Siberian Branch of RAMS; Washington University, St Louis Children’s Hospital; Dana Children’s Hospital, Tel Aviv; Sheffield Teaching Hospitals, Sheffield Children’s Hospitals; National Children’s Hospital of Costa Rica; Oulu University Hospital; Sheffield Children’s Hospital; Department of Neurosurgery at St Olavs University Hospital; Hospital Carlos Haya, Malaga; Dell Children’s Medical Center; Universidad de Cartagena; Centre Guerra Mendez; Clinical Department of Medicine, Innsbruck Medical University; Dayton Children’s Hospital, Dayton; Children’s Hospital, Sankt Augustin; Vanderbilt University Medical Center; Osaka National Hospital; National Taiwan University Children’s Hospital; Hospital Nacional de Pediatria JP Garrahan; Hospital Universitario de Maracaibo Service; Fortis Hospital, Mumbai; Alexandria University, Egypt; Soroka University Medical Center; Tel-Aviv Medical Center; Children’s Hospital New Orleans, Louisiana; Sheikh Kalifa Medical City, UAE; Neurologic Clinic; Royal Manchester Children’s Hospital; Dana Children’s Hospital; Institute for Medical Research, A Lanari University of Buenos Aires; Pediatric Neurosurgery, Department of Neurosurgery, University of Leipzig; Children’s Hospital of Pittsburgh, University of Pittsburgh Medical Center; Fundacio Santafe de Bogota, Columbia; Park Clinic, Kolkata; Prince of Wales Hospital, Chinese University of Hong Kong; Children’s National; Madurai Medical College, Madurai; Riley Hospital for Children at Indiana University Health; The Townsville Hospital, Queensland; Faculty of Medicine, Universitas Airlangaa, Soetomo General Hospital, Surabaya; Stanford University; Bombay Hospital; Great Ormand Street Hospital, London; Clinical Centre of Siberia; Duke University; Narayana Institute of Neurosciences, Bangalore; Columbia University; HMG Al Qassim Hospital; Birmingham Children’s Hospital UK; Red Cross Children’s Hospital; Hospital Universiyaroi 12 de Octubre, Madrid; Medica Superspeciality Hospital; Santobono-Pauspilipon Children’s Hospital, Naples; Cincinnati Children’s Hospital; Indrapastha Apollo Hospital, New Delhi; Children’s Hospital of Wisconsin; Frenchay Hospital, Bristol; Nemours Children’s Hospital; Royal Children’s Hospital, Melbourne; Hopital Necker-Enfants Malades; University of Western Ontario; Medical College of Wisconsin; Nizam’s Institute of Medical Sciences; University of Texas Health Science Center, Houston; University of Calgary; Henrick-Heine University, Department of Neurosurgery, Dusseldorf; Monash Health, Melbourne; Adelaide Women’s and Children’s Hospital; University of Malaya, Kuala Lumpur. We thank all participants in this study and appreciate their ongoing support of our research efforts.

Conflict of interest

The authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article.

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Authors and Affiliations

  1. Division of Neurosurgery, University of British Columbia, Vancouver, Canada

    Albert Tu & Paul Steinbok

  2. Pediatric Neurosurgery, Institute of Neurosurgery, Catholic University Medical School, Rome, Italy

    Gianpiero Tamburrini

  3. Division of Pediatric Neurosurgery, British Columbia Children’s Hospital, University of British Columbia, 4480 Oak Street, Room K3-159, Vancouver, BC, V6H 3 V4, Canada

    Paul Steinbok

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  1. Albert Tu
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Correspondence to Albert Tu.

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Tu, A., Tamburrini, G. & Steinbok, P. Management of postoperative pseudomeningoceles: an international survey study. Childs Nerv Syst 30, 1791–1801 (2014). https://doi.org/10.1007/s00381-014-2501-9

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