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A hospital-based analysis of pseudomeningoceles after elective craniotomy in children: what predicts need for
Sebastian P Norrdahl1, Tamekia L Jones2,3,4, Pooja Dave5
11College of Medicine and.
Insights
Postoperative pseudomeningocele in pediatric patients after craniotomy is common. Intervention for pseudomeningocele was linked to race and duraplasty, not other factors.
Area of Science:
- Neurosurgery
- Pediatric Surgery
- Cerebrospinal Fluid Dynamics
Background:
- Postoperative pseudomeningocele is a known complication following elective craniotomy in pediatric patients.
- While many pseudomeningoceles resolve spontaneously, a significant portion may necessitate medical or surgical intervention.
Purpose of the Study:
- To analyze pediatric patients who required intervention for a postoperative pseudomeningocele after elective craniotomy or craniectomy.
- To identify specific factors associated with the need for intervention in these cases.
Main Methods:
- Retrospective review of an institutional operative database for elective craniotomies/craniectomies (2010-2017).
- Data collection included demographics, surgical details, postoperative events, and interventions.
- Bivariate analysis compared patients managed with observation versus those requiring intervention.
Main Results:
- 84 (5.1%) clinically significant pseudomeningoceles occurred in 1648 procedures.
- Nearly 60% of pseudomeningoceles required intervention (e.g., lumbar puncture, drain, shunt).
- Race and the performance of duraplasty were significantly associated with the need for intervention.
Conclusions:
- Clinically relevant pseudomeningoceles develop in approximately 5% of pediatric elective craniotomies.
- The need for pseudomeningocele intervention is associated with patient race and the use of duraplasty.
- These findings may inform risk stratification and management strategies for pediatric neurosurgical patients.
Objective:
In pediatric patients, the development of a postoperative pseudomeningocele after an elective craniotomy is not unusual. Most will resolve with time, but some may require intervention. In this study, the authors analyzed patients who required intervention for a postoperative pseudomeningocele following an elective craniotomy or craniectomy and identified factors associated with the need for intervention.
Methods:
An institutional operative database of elective craniotomies and craniectomies was queried to identify all surgeries associated with development of a postoperative pseudomeningocele from January 1, 2010, to December 31, 2017. Demographic and surgical data were collected, as were details regarding postoperative events and interventions during either the initial admission or upon readmission. A bivariate analysis was performed to compare patients who underwent observation with those who required intervention.
Results:
Following 1648 elective craniotomies or craniectomies, 84 (5.1%) clinically significant pseudomeningoceles were identified in 82 unique patients. Of these, 58 (69%) of the pseudomeningoceles were diagnosed during the index admission (8 of which persisted and resulted in readmission), and 26 (31%) were diagnosed upon readmission. Forty-nine patients (59.8% of those with a pseudomeningocele) required one or more interventions, such as lumbar puncture(s), lumbar drain placement, wound exploration, or shunt placement or revision. Only race (p < 0.01) and duraplasty (p = 0.03, OR 3.0) were associated with the need for pseudomeningocele treatment.
Conclusions:
Clinically relevant pseudomeningoceles developed in 5% of patients undergoing an elective craniotomy, with 60% of these pseudomeningoceles needing some form of intervention. The need for intervention was associated with race and whether a duraplasty was performed.
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