A hospital-based analysis of pseudomeningoceles after elective craniotomy in children: what predicts need for intervention?

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OBJECTIVE

In pediatric patients, the development of a postoperative pseudomeningocele after an elective craniotomy is not unusual. Most will resolve with time, but some may require intervention. In this study, the authors analyzed patients who required intervention for a postoperative pseudomeningocele following an elective craniotomy or craniectomy and identified factors associated with the need for intervention.

METHODS

An institutional operative database of elective craniotomies and craniectomies was queried to identify all surgeries associated with development of a postoperative pseudomeningocele from January 1, 2010, to December 31, 2017. Demographic and surgical data were collected, as were details regarding postoperative events and interventions during either the initial admission or upon readmission. A bivariate analysis was performed to compare patients who underwent observation with those who required intervention.

RESULTS

Following 1648 elective craniotomies or craniectomies, 84 (5.1%) clinically significant pseudomeningoceles were identified in 82 unique patients. Of these, 58 (69%) of the pseudomeningoceles were diagnosed during the index admission (8 of which persisted and resulted in readmission), and 26 (31%) were diagnosed upon readmission. Forty-nine patients (59.8% of those with a pseudomeningocele) required one or more interventions, such as lumbar puncture(s), lumbar drain placement, wound exploration, or shunt placement or revision. Only race (p < 0.01) and duraplasty (p = 0.03, OR 3.0) were associated with the need for pseudomeningocele treatment.

CONCLUSIONS

Clinically relevant pseudomeningoceles developed in 5% of patients undergoing an elective craniotomy, with 60% of these pseudomeningoceles needing some form of intervention. The need for intervention was associated with race and whether a duraplasty was performed.

ABBREVIATIONS ETV = endoscopic third ventriculostomy.
Article Information

Contributor Notes

Correspondence Paul Klimo Jr.: Semmes Murphey, Memphis, TN. pklimo@semmes-murphey.com.INCLUDE WHEN CITING Published online January 31, 2020; DOI: 10.3171/2019.11.PEDS19227.Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.
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References
  • 1

    Chotai SGuidry BSChan EWSborov KDGannon SShannon C: Unplanned readmission within 90 days after pediatric neurosurgery. J Neurosurg Pediatr 20:5425482017

    • Search Google Scholar
    • Export Citation
  • 2

    Cochrane DDGustavsson BPoskitt KPSteinbok PKestle JR: The surgical and natural morbidity of aggressive resection for posterior fossa tumors in childhood. Pediatr Neurosurg 20:19291994

    • Search Google Scholar
    • Export Citation
  • 3

    Felbaum DRMueller KAnaizi AMason RBJean WCVoyadzis JM: Preservation of the myofascial cuff during posterior fossa surgery to reduce the rate of pseudomeningocele formation and cerebrospinal fluid leak: a technical note. Cureus 8:e9462016

    • Search Google Scholar
    • Export Citation
  • 4

    Gnanalingham KKLafuente JThompson DHarkness WHayward R: MRI study of the natural history and risk factors for pseudomeningocoele formation following postfossa surgery in children. Br J Neurosurg 17:5305362003

    • Search Google Scholar
    • Export Citation
  • 5

    Gnanalingham KKLafuente JThompson DHarkness WHayward R: Surgical procedures for posterior fossa tumors in children: does craniotomy lead to fewer complications than craniectomy? J Neurosurg 97:8218262002

    • Search Google Scholar
    • Export Citation
  • 6

    Gopalakrishnan CVDhakoji AMenon GNair S: Factors predicting the need for cerebrospinal fluid diversion following posterior fossa tumor surgery in children. Pediatr Neurosurg 48:931012012

    • Search Google Scholar
    • Export Citation
  • 7

    Hadanny ARozovski UNossek EShapira YStrauss IKanner AA: Craniectomy versus craniotomy for posterior fossa metastases: complication profile. World Neurosurg 89:1931982016

    • Search Google Scholar
    • Export Citation
  • 8

    Hosainey SAMLassen BHelseth EMeling TR: Cerebrospinal fluid disturbances after 381 consecutive craniotomies for intracranial tumors in pediatric patients. J Neurosurg Pediatr 14:6046142014

    • Search Google Scholar
    • Export Citation
  • 9

    Hutter Gvon Felten SSailer MHSchulz MMariani L: Risk factors for postoperative CSF leakage after elective craniotomy and the efficacy of fleece-bound tissue sealing against dural suturing alone: a randomized controlled trial. J Neurosurg 121:7357442014

    • Search Google Scholar
    • Export Citation
  • 10

    Kinaci AAlgra AHeuts SO’Donnell Dvan der Zwan Avan Doormaal T: Effectiveness of dural sealants in prevention of cerebrospinal fluid leakage after craniotomy: a systematic review. World Neurosurg 118:368376.e12018

    • Search Google Scholar
    • Export Citation
  • 11

    Kshettry VRLobo BLim JSade BOya SLee JH: Evaluation of non-watertight dural reconstruction with collagen matrix onlay graft in posterior fossa surgery. J Korean Neurosurg Soc 59:52572016

    • Search Google Scholar
    • Export Citation
  • 12

    Lassen BHelseth EEgge ADue-Tønnessen BJRønning PMeling TR: Surgical mortality and selected complications in 273 consecutive craniotomies for intracranial tumors in pediatric patients. Neurosurgery 70:9369432012

    • Search Google Scholar
    • Export Citation
  • 13

    Lee CKMokhtari TConnolly IDLi GShuer LMChang SD: Comparison of porcine and bovine collagen dural substitutes in posterior fossa decompression for Chiari I malformation in adults. World Neurosurg 108:33402017

    • Search Google Scholar
    • Export Citation
  • 14

    Legnani FGSaladino ACasali CVetrano IGVarisco MMattei L: Craniotomy vs. craniectomy for posterior fossa tumors: a prospective study to evaluate complications after surgery. Acta Neurochir (Wien) 155:228122862013

    • Search Google Scholar
    • Export Citation
  • 15

    Mehendale NHSamy RNRoland PS: Management of pseudomeningocele following neurotologic procedures. Otolaryngol Head Neck Surg 131:2532622004

    • Search Google Scholar
    • Export Citation
  • 16

    Menger RConnor DE JrHefner MCaldito GNanda A: Pseudomeningocele formation following Chiari decompression: 19-year retrospective review of predisposing and prognostic factors. Surg Neurol Int 6:702015

    • Search Google Scholar
    • Export Citation
  • 17

    Peduzzi PConcato JKemper EHolford TRFeinstein AR: A simulation study of the number of events per variable in logistic regression analysis. J Clin Epidemiol 49:137313791996

    • Search Google Scholar
    • Export Citation
  • 18

    Prell JScheller CAlfieri ARampp SRachinger J: Midline-craniotomy of the posterior fossa with attached bone flap: experiences in paediatric and adult patients. Acta Neurochir (Wien) 153:5415452011

    • Search Google Scholar
    • Export Citation
  • 19

    Roth JBenvenisti HConstantini S: Watertight dural closure in pediatric craniotomies—is it really necessary? World Neurosurg 114:e743e7462018

    • Search Google Scholar
    • Export Citation
  • 20

    Sherrod BAJohnston JMRocque BG: Risk factors for unplanned readmission within 30 days after pediatric neurosurgery: a nationwide analysis of 9799 procedures from the American College of Surgeons National Surgical Quality Improvement Program. J Neurosurg Pediatr 18:3503622016

    • Search Google Scholar
    • Export Citation
  • 21

    Smith GAStrohl MPManjila SMiller JP: Incidence, management, and outcome of symptomatic postoperative posterior fossa pseudomeningocele: a retrospective single-institution experience. Oper Neurosurg (Hagerstown) 12:2983042016

    • Search Google Scholar
    • Export Citation
  • 22

    Steinbok PSinghal AMills JCochrane DDPrice AV: Cerebrospinal fluid (CSF) leak and pseudomeningocele formation after posterior fossa tumor resection in children: a retrospective analysis. Childs Nerv Syst 23:1711752007

    • Search Google Scholar
    • Export Citation
  • 23

    Tu ATamburrini GSteinbok P: Management of postoperative pseudomeningoceles: an international survey study. Childs Nerv Syst 30:179118012014

    • Search Google Scholar
    • Export Citation
  • 24

    Wynants LBouwmeester WMoons KGMoerbeek MTimmerman DVan Huffel S: A simulation study of sample size demonstrated the importance of the number of events per variable to develop prediction models in clustered data. J Clin Epidemiol 68:140614142015

    • Search Google Scholar
    • Export Citation
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