Spontaneous Resolution of a Giant Iatrogenic Lumbar Pseudomeningocele After Spinal Arthrodesis: A Case Report and Literature Review

BACKGROUND: Iatrogenic pseudomeningocele is an uncommon complication of spinal surgery, resulting from incidental durotomy with cerebrospinal fluid leakage. Giant pseudomeningoceles, defined as lesions larger than 8 cm, are rarely reported, and their optimal management remains controversial. CASE PRESENTATION: We report the case of a 45-year-old woman who developed progressive headaches following lumbar spinal arthrodesis. Magnetic resonance imaging demonstrated a large postoperative fluid collection consistent with a giant pseudomeningocele. Although surgical revision was recommended, the patient refused operative management and was treated conservatively. An initial clinical and radiological worsening was observed, followed by gradual spontaneous regression and complete radiological resolution at 2-year follow-up. CONCLUSION: Pseudomeningocele is a rare complication of spinal surgery with no established consensus regarding management, particularly for large or giant lesions. While surgical repair is generally advocated in symptomatic cases, this report suggests that conservative management with strict clinical and radiological follow-up may represent a valid alternative in carefully selected patients.