Management of Pseudomeningoceles after Surgery or Trauma

Pseudomeningocele, a post-operative or post-traumatic cerebrospinal fluid (CSF) collection from a dural defect, is an underrecognized complication following spinal or cranial surgery. Incidence varies from 0.07 to 2% in lumbar and up to 23% in posterior fossa procedures. While many resolve spontaneously, symptomatic cases can cause headaches, radiculopathy, or infection, necessitating stepwise management. Diagnosis relies on magnetic resonance imaging findings of fluid continuity with the subarachnoid space. Asymptomatic, small pseudomeningoceles are managed conservatively through bed rest, abdominal binder, analgesics, and serial imaging. Persistent or enlarging lesions require CSF diversion (lumbar drainage), epidural blood patch, or aspiration. Surgery is indicated for refractory cases or complications, emphasizing watertight dural repair using non-absorbable sutures, duraplasty with autologous fascia or synthetic graft, and myofascial flap reinforcement. This structured, evidence-based algorithm integrates conservative, interventional, and surgical strategies to guide clinicians in effectively managing postoperative and post-traumatic pseudomeningoceles.