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Repair of Postoperative Cervical Pseudomeningocele with the Use of Bone Morphogenetic Protein
Dejan Slavnic1, Robert Mccabe1, Doris Tong1
1Neurosurgery, Ascension Providence Hospital, Michigan State University, College of Human Medicine, Southfield, USA.
Abstract:
Recurrent cerebrospinal fluid (CSF) leak carries significant morbidity and mortality. A 25-year-old Caucasian male developed a symptomatic pseudomeningocele eight days after surgical resection of a cervical schwannoma. With no improvement after lumbar drain placement, the dural sleeve defect over the left C3 nerve root was repaired with suturable DuraGen® (Integra LifeSciences, Plainsboro, NJ, USA). Muscle and fat graft were then laid over the repair site and covered by Tisseel® (Baxter Healthcare, Deerfield, IL, USA). Recombinant human bone morphogenetic protein-2 (rhBMP-2) was applied via extra-small sponge laid over the graft. At 15-month clinical and 16-month radiographic follow-up, the patient had complete resolution of symptoms without any evidence of infection, ectopic bone formation, excessive inflammation, neoplasm, or recurrent CSF leak. This case demonstrates the successful use of BMP in the treatment of recurrent symptomatic cervical pseudomeningocele after tumor resection. We believe that the pro-inflammatory effects of rhBMP-2 lead to early scarring of dural defect and resolution of CSF leak.
Insights
This case study highlights the successful treatment of a recurrent cerebrospinal fluid (CSF) leak using recombinant human bone morphogenetic protein-2 (rhBMP-2). The innovative approach led to complete symptom resolution and prevented further CSF leaks after surgery.
Area of Science:
- Neurosurgery
- Regenerative Medicine
- Biomaterials
Background:
- Recurrent cerebrospinal fluid (CSF) leaks post-surgery present significant clinical challenges.
- Cervical schwannoma resection can lead to complications like pseudomeningoceles and CSF leaks.
- Effective management of dural defects is crucial to prevent morbidity and mortality.
Observation:
- A 25-year-old male developed a symptomatic pseudomeningocele eight days after cervical schwannoma resection.
- Initial treatment with a lumbar drain was ineffective.
- A dural sleeve defect at the C3 nerve root was surgically repaired using DuraGen®, muscle/fat graft, and Tisseel®.
Findings:
- Recombinant human bone morphogenetic protein-2 (rhBMP-2) was applied to the repair site.
- The patient experienced complete clinical resolution of symptoms at 15 months and radiographic resolution at 16 months.
- No adverse events such as infection, ectopic bone formation, or recurrent CSF leak were observed.
Implications:
- This case demonstrates the potential efficacy of rhBMP-2 in treating recurrent symptomatic cervical pseudomoceles.
- rhBMP-2 may promote dural scarring, aiding in the resolution of CSF leaks.
- Further research into rhBMP-2's role in managing complex dural defects is warranted.
