Post-Traumatic Pseudomeningocele Following Cervical Spine Injury: Diagnosis and Multidisciplinary Management

Purpose/Objectives
Pseudomeningocele is an abnormal cerebrospinal fluid (CSF) collection resulting from a dural defect, often occurring after trauma or surgery. Unlike a true meningocele, it lacks an epithelial lining and can cause symptoms such as pain, dysphagia, or neurological deficits due to mass effect.
Methods and materials

A 22-year-old female was involved in a motor vehicle accident in August 2024, sustaining fractures of the C5-C6 vertebrae, which led to asymmetric tetraparesis. She underwent emergency cervical spine osteosynthesis with PYRAMESH and plating. Additionally, a C5-C6 corpectomy was performed, along with the insertion of a vertebral implant and anterior fusion of C4-C7 using a plate and screws. In the early postoperative period, she developed a progressively enlarging right-sided neck mass, accompanied by dysphagia and worsening pain. MRI of the cervical soft tissues performed in November 2024 revealed a large pseudomeningocele spanning from C3 to the intervertebral disc gap between Th2-Th3. The collection exerted a mass effect, displacing the esophagus, trachea, and right thyroid lobe, as well as shifting the cervical blood vessels, with a more pronounced effect on the right sternocleidomastoid muscle and carotid space. Ultrasound-guided aspiration confirmed the presence of CSF within the lesion. A multidisciplinary team recommended surgical repair. In December 2024, the patient underwent dural defect closure with a microvascular flap and simultaneous lumbar CSF drainage at the L3/L4 level. Postoperatively, she experienced a transient focal seizure affecting the left side of her face and arm, but an EEG revealed no epileptic activity. Subsequently, she developed respiratory distress and difficulty clearing secretions. A CT scan revealed left lung atelectasis. Initially refusing bronchoscopy, she later consented, and the procedure led to significant improvement. Bronchoscopy samples grew Acinetobacter baumannii, prompting targeted antibiotic therapy. Follow-up imaging a few days later showed no further complications.

Result

This case highlights the importance of a multidisciplinary approach in managing post-traumatic complications. MRI and CT scans played a crucial role in diagnosing and assessing complications such as pseudomeningocele and respiratory distress. Timely surgical intervention and appropriate postoperative care were key to achieving a favorable outcome. The case underscores the significance of imaging in guiding both surgical decisions and follow-up management.