Repair of Delayed Meningeal Cyst after Spinal Surgery with Paraspinal Muscle Flap under Microscope
Zhi-Wei Wang1, Xi-Wen Fan1, Zheng Wang1
1Department of Spine Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, PR China.
Background:
Delayed meningeal cyst (DMC) is a rare complication after spinal surgery that is often ignored by clinicians, and its in-depth research is infrequent. In particular, no consensus has been reached about its surgical treatment. We found that patients with a DMC failed after conservative treatment, epidural blood patch, subarachnoid drainage, and initial attempts to eliminate the meningeal cyst. Therefore, we introduce the application of a paraspinal muscle flap repair under a microscope for the treatment of DMC.
Methods:
In this study, 13 patients who were repaired by a paraspinal muscle flap under a microscope for DMC from January 2007 to January 2017 were retrospectively reviewed. Their ages were 18-68 years old (mean age 48.7 years). The course of the disease ranged from 3 weeks to 28 months after the operation for the primary disease, with an average of 10.6 months. Length >5 cm was called a large DMC and length >8 was called a giant DMC. By analyzing the effect of surgical treatment, we summarized the treatment experience of DMC and evaluated the risk factors for the formation of DMC.
Results:
All patients were treated with paraspinal muscle flap repair under a microscope, and they healed well after the operation. There was no cerebrospinal fluid leakage or other operation-related complication. The mean follow-up was 16.5 months. Reexamination of the spine MRI showed no recurrence of the DMC.
Conclusions:
The application of paraspinal muscle flap under a microscope combined with glue, bedrest, and CSF drain, was an effective option for the patients with DMC.
Insights
Delayed meningeal cysts (DMCs) after spinal surgery are challenging. Paraspinal muscle flap repair under a microscope offers an effective treatment option, showing no recurrence in a recent study.
Area of Science:
- Neurosurgery
- Spinal Surgery
- Microsurgery
Background:
- Delayed meningeal cysts (DMCs) are rare post-spinal surgery complications.
- Limited research and no consensus exist on DMC surgical treatment.
- Previous treatments like conservative management and drainage failed in studied patients.
Purpose of the Study:
- To introduce and evaluate the efficacy of paraspinal muscle flap repair under a microscope for treating DMCs.
- To summarize treatment experiences and identify risk factors for DMC formation.
Main Methods:
- Retrospective review of 13 patients with DMCs treated via paraspinal muscle flap repair under a microscope.
- Patients aged 18-68 years, with disease courses ranging from 3 weeks to 28 months.
- Classification of DMCs as large (>5 cm) or giant (>8 cm) based on length.
Main Results:
- All 13 patients achieved successful healing with the paraspinal muscle flap repair.
- No cerebrospinal fluid leakage or surgery-related complications were observed.
- Mean follow-up of 16.5 months showed no recurrence of DMCs on spine MRI.
Conclusions:
- Paraspinal muscle flap repair under a microscope is an effective treatment for DMCs.
- Combination therapy including glue, bedrest, and CSF drain enhances treatment outcomes.
- This technique provides a viable surgical option for patients with failed conservative treatments.
