Suboccipital pseudomeningocele treatment [Neurosurgery Wiki]

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====== Suboccipital pseudomeningocele treatment ======

[[Suboccipital pseudomeningocele]] treatment options (up to 67% require permanent [[cerebrospinal fluid drainage]]
((Culley DJ, Berger MS, Shaw D, et al. An Analysis of Factors Determining the Need for Ventriculoperitoneal Shunts After Posterior Fossa Tumor Surgery in Children. Neurosurgery. 1994; 34:402–408))):

1. noninvasive measures: expectant [[management]], [[fluid restriction diet]], head wrapping, keeping [[HOB]]
elevated, [[acetazolamide]]. [[Steroid]]s may be used if [[aseptic meningitis]] is suspected

2. percutaneous aspiration: “tap and wrap.” Risks introducing [[bacteria]], causing [[infection]]

3. direct surgical exploration with multilayer re-closure

4. [[lumbar drainage]]: effective only if pseudomeningocele communicates with the subarachnoid space.

✖ May produce acute [[posterior fossa syndrome]] (H/A, [[nausea]], vomiting, ataxia...)
((Manley GT, Dillon W. Acute posterior fossa syndro- me following lumbar drainage for treatment of sub-occipital pseudomeningocele. Report of three cases. J Neurosurg. 2000; 92:469–474))
especially if the pseudomeningocele doesn’t communicate. Symptoms usually resolve with prompt discontinuation of lumbar drainage
((Manley GT, Dillon W. Acute posterior fossa syndro- me following lumbar drainage for treatment of sub-occipital pseudomeningocele. Report of three cases. J Neurosurg. 2000; 92:469–474))
((Roland PS, Marple BF, Meyerhoff WL, et al. Complications of lumbar spinal fluid drainage. Otolaryngol Head Neck Surg. 1992; 107:564–569)).
Other potential complications: vagal nerve palsy, tonsillar herniation, subdural hematoma, kinking of PCA → stroke. Drainage options:

a) [[External lumbar cerebrospinal fluid drainage]] (temporary)

b) [[Lumboperitoneal shunt]] (permanent)

5. [[Ventricular drainage]] 

a) [[EVD]] (temporary) 

b) [[shunt]] (permanent)