Pseudomeningoceles: A role for mechanical compression in the treatment of dural tears

Dural tears are a well-recognized complication of spinal surgery.1,2⇓ When the dura is torn, CSF may be forced through the tear to form an encysted fluid collection (pseudomeningocele) that can displace paravertebral soft tissues and occupy subcutaneous space.3 The major symptom is a severe postural headache that develops minutes after arising from a recumbent position and is relieved minutes after lying down. The pseudomeningocele may also entrap nerve roots,4 become infected5 or ossified,6 or lead to vertebral bone erosion.7 The standard of treatment for persistent CSF leak is open revision surgery for suturing of the dura.1,3⇓ Conservative measures alone, including hydration, prolonged bed rest, and analgesics, are generally not considered adequate to control large CSF leaks with pseudomeningocele formation. Mechanical compression has rarely been used to treat lumbar dural tears. We present a case in which focal compression immediately controlled the …