Suboccipital pseudomeningocele treatment

Suboccipital pseudomeningocele treatment options (up to 67% require permanent cerebrospinal fluid drainage ¹⁾):

1. noninvasive measures: expectant management, fluid restriction diet, head wrapping, keeping HOB elevated, acetazolamide. Steroids 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…) ²⁾ especially if the pseudomeningocele doesn’t communicate. Symptoms usually resolve with prompt discontinuation of lumbar drainage ³⁾ ⁴⁾. 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)

¹⁾

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

²⁾ , ³⁾

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

⁴⁾

Roland PS, Marple BF, Meyerhoff WL, et al. Complications of lumbar spinal fluid drainage. Otolaryngol Head Neck Surg. 1992; 107:564–569