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Omentomyelopexy for the Treatment of a Persistent Lumbar Pseudomeningocele: A Case Report With Technical Note
Svetozar Stanković1,2, Ljubodrag Minić1,2, Jadranka Stanković2,3
1Clinic for Neurosurgery, Military Medical Academy, Belgrade , Serbia.
Background And Importance:
Pseudomeningoceles are extradural accumulations of cerebrospinal fluid. In most cases, they appear as a complication of spinal operations. Omentomyelopexy is a surgery in which an autologous omentum flap is implanted over the dural opening. We describe a case of persistent pseudomeningocele treated with omentomyelopexy.
Clinical Presentation:
A 37-year-old man sustained a T12-L1 AO B3 fracture during a motorcycle accident. He underwent posterolateral fusion and then neurological rehabilitation. Two years later, however, his condition worsened, and he experienced progressive weakness-he was diagnosed with an intramedullary cyst, which was treated with laminectomy, arachnolysis and cystotomy. A pseudomeningocele developed afterward, and the patient underwent multiple reoperations in the following years, none of which were effective. Omentomyelopexy, a complex procedure aimed to facilitate cerebrospinal fluid absorption and subsequent formation of a permanent membrane, was offered to the patient as a "last resort." After undergoing omentomyelopexy, his pseudomeningocele resolved.
Conclusion:
Although it should be reserved for exceptionally pertinent cases, omentomyelopexy is a viable option for managing persistent pseudomeningocele. However, further research is needed to better understand the effects and benefits of omentomyelopexy in this context.
Insights
Omentomyelopexy successfully treated a persistent pseudomeningocele, a rare complication following spinal surgery. This complex procedure offers a viable option for managing challenging cases of cerebrospinal fluid accumulation.
Area of Science:
- Neurosurgery
- Spinal Surgery
- Cerebrospinal Fluid Dynamics
Background:
- Pseudomeningoceles are extradural cerebrospinal fluid collections, often arising post-spinal surgery.
- Omentomyelopexy involves implanting an omental flap to cover dural defects.
- Persistent pseudomeningoceles pose significant management challenges.
Observation:
- A 37-year-old male with a T12-L1 AO B3 fracture developed a persistent pseudomeningocele after multiple failed surgical interventions.
- The patient presented with progressive neurological deficits attributed to the pseudomeningocele.
- Omentomyelopexy was performed as a final treatment option.
Findings:
- The omentomyelopexy procedure effectively resolved the patient's persistent pseudomeningocele.
- Post-operative recovery showed resolution of cerebrospinal fluid accumulation.
- The surgery facilitated the formation of a stable membrane over the dural opening.
Implications:
- Omentomyelopexy is a feasible, albeit complex, surgical solution for refractory pseudomeningoceles.
- This technique may offer a valuable alternative when conservative or standard surgical methods fail.
- Further investigation is warranted to establish the long-term efficacy and indications for omentomyelopexy.
