Post-operative gigantic lumbar pseudomeningocele: A case report

Postoperative pseudomeningocele is a rare, but still existing, complication after spinal surgeries. It may be asymptomatic or presented with back pain, radicular pain or headaches. Many pseudomeningoceles resolve spontaneously, others require revision surgery with dural repair. We present a female patient who underwent duroplasty treatment for a massive postoperative lumbar pseudomeningocele measuring 22.57 cm in length after broad laminectomy. A 71-year-old female with previous thoracolumbar T10-L5 instrumentation surgery, underwent a L2-5 broad laminectomy due to severe canal stenosis at the L2-5 level. Intraoperatively, an accidental spotted durotomy occurred at the level of L4-5. Primary repair was not feasible, so artificial dura was placed. Postoperatively the patient presented with cerebrospinal fluid (CSF) leak, which was treated with external lumbar drain and bedrest. Three months later, our patient presented to our outpatient clinic with a large 15 cm long bulging mass at the surgical site without any neurological deficit. A lumbar CT scan was conducted and a gigantic lumbar pseudomeningocele of 22.57 cm length and 6.29 cm width from the level of T11 to S2 was observed. We performed a revision surgery with duroplasty and there was no recurrence of CSF leak or pseudomeningocele after 7 months follow-up.