Spinal cord compression from traumatic anterior cervical pseudomeningoceles

Report of three cases

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✓Pseudomeningoceles rarely develop after cervical trauma; in all reported cases the lesions have extended outside the spinal canal.

The authors report the first known cases of anterior cervical pseudomeningoceles contained entirely within the spinal canal and causing cord compression and neurological injury. The authors retrospectively reviewed the cases of three patients with traumatic cervical spine injuries and concomitant compressive anterior pseudomeningoceles. The lesion was recognized in the first case when the patient’s neurological status declined after he sustained a severe atlantoaxial injury; the pseudomeningocele was identified intraoperatively and decompressed. After the decompressive surgery, the patient’s severe tetraparesis partially resolved. In the other two patients diagnoses of similar pseudomeningoceles were established by magnetic resonance imaging. Both patients were treated conservatively, and their mild to moderate hemiparesis due to the pseudomeningocele-induced compression abated.

The high incidence of anterior cervical pseudomeningoceles seen at the authors’ institution within a relatively brief period suggests that this lesion is not rare. The authors believe that it is important to recognize the compressive nature of these lesions and their potential to cause devastating neurological injury.

Abbreviations used in this paper: CSF = cerebrospinal fluid; MR = magnetic resonance; SCI = spinal cord injury; SEH = spinal epidural hematoma.

Article Information

Address reprint requests to: Nicholas Theodore, M.D., Neuroscience Publications, Barrow Neurological Institute, 350 West Thomas Road, Phoenix, Arizona 85013. email: neuropub@chw.edu.

© AANS, except where prohibited by US copyright law.

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Figures

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    Case 1. Sagittal (left) and axial (right) T2-weighted MR images showing the anterior cervical pseudomeningocele (arrows) compressing the spinal cord.

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    Case 1. Left: Intraoperative sagittal fluoroscopic image obtained after decompression of the pseudomeningocele. Right: Note the extent of the radiopaque dye in the epidural space after decompression.

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    Case 2. Sagittal (A) and axial (B) T2-weighted MR images revealing the anterior pseudomeningocele (arrows) compressing the spinal cord. Sagittal T2-weighted MR image (C) demonstrating spontaneous resolution of the pseudomeningocele and the resulting hyperintensity (arrow) in the cord parenchyma.

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    Case 3. Sagittal T2-weighted MR image demonstrating the pseudomeningocele anterior to the spinal cord along the entire cervical region (arrows).

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