Communicating Hydrocephalus Secondary to Pseudomeningocele following Cervical Spine Surgery: A Case Report

Pseudomeningocele (PMC) after spinal surgery involves cerebrospinal fluid (CSF) continuously leaking from a compromised dura mater and accumulating subcutaneously. PMC is a rare postcervical spine surgery that can be spontaneously resolved; therefore, asymptomatic cases are often observed. This report presents a case of communicating hydrocephalus resulting from PMC following posterior decompression at the craniocervical junction. A 77-year-old man with advanced dementia and a history of C2-T3 posterior fixation was admitted after a head injury, presenting quadriplegia at the MMT2 level. Magnetic resonance imaging (MRI) revealed severe spinal cord compression at C1/2. A posterior decompression of the craniocervical junction was performed. However, dura mater damage occurred during surgery, and the damaged area was repaired with artificial dura mater and fibrin glue. One month postsurgery, subcutaneous swelling was observed and an MRI identified PMC. As the patient was asymptomatic, observation was chosen. Four months postsurgery, the patient exhibited drowsiness and vomiting. An MRI was conducted, revealing the presence of communicating hydrocephalus. Ventricular drainage and ventriculoperitoneal shunt were performed, and the hydrocephalus and PMC improved. Dural injury during spinal surgery is a relatively common complication; but, if inadequately repaired, CSF leakage may persist and lead to PMC. Persistent leakage of CSF into the PMC may have hindered CSF absorption, leading to communicating hydrocephalus. Severe cognitive impairment and quadriplegia may have hindered neurological evaluation and delayed the detection of the hydrocephalus, and more careful follow-up would have been desirable.