Anterior cervical pseudomeningocele causing syncope after spinal surgery: A case report

• Published in: International journal of surgery case reports Vol. 91; p. 106789
• Main Authors: Ehsanian, Reza, Ali, Arshad, Singh, Harminder, McKenna, Stephen L., Mian, Mariam N.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01-02-2022; Elsevier
• Subjects: Case Report; Ossification of posterior longitudinal ligament; Pseudomeningocele; Syncope; Syncope; Ossification of posterior longitudinal ligament; Pseudomeningocele
• ISSN: 2210-2612; 2210-2612
• DOI: 10.1016/j.ijscr.2022.106789

Pseudomeningocele formation from incidental durotomy is a known risk in spine surgery. We present a case of incidental durotomy leading to anterior neck pseudomeningocele, compressing the carotid body (CB) resulting in syncopal episodes. To our knowledge, this is the first case report implicating syncopal episodes to CB compression via a pseudomeningocele.
A mid sixty-year-old patient with history of obesity, hypertension, and diabetes presented with gait impairment and hand weakness. Ossification of posterior longitudinal ligament (OPLL) was diagnosed with computed tomography imaging (CT) and magnetic resonance imaging (MRI). Elective surgery was completed with an anterior and posterior approach for decompression and fusion. Hospital course (San Jose, CA, USA) was complicated by respiratory depression and incomplete tetraplegia. On post-operative day (POD) six, CT revealed anterolateral soft tissue neck swelling; subsequent CT and MRI showed fluid collection expansion, with associated syncopal episodes on POD thirty-nine. Despite interventional radiology drainage, the fluid collection and symptoms returned five days later. The patient ultimately underwent durotomy revision and repair with muscle patch.
This case highlights the challenges in managing anterior cervical dural tears resulting in pseudomeningocele. Risk factors include anterior cervical corpectomy and decompression, as well as an underlying diagnosis of OPLL. Untreated dural tears may develop into pseudomeningoceles which can contribute to life-threatening outcomes.
This case report presents the serious consequences of incidental durotomy, the unique post-surgical complication of syncope due to compression of the CB from a pseudomeningocele, and the challenges of managing a persistent pseudomeningocele.
•Dural tears may develop into pseudomeningoceles with life-threatening implications, early surgical repair may be warranted.•We recommend against an anterior approach in patients with OPLL, because of the high risk for durotomy and CSF leak.•In patients who have normal cervical lordosis and OPLL, a posterior cervical decompression and fusion is preferred.•In kyphotic deformity, a posterior approach may be inadequate, and an anterior approach may be unavoidable.•It is important to counsel patients preoperatively that a durotomy may be encountered during decompression.