Epidural blood patch for treatment of a large suboccipital pseudomeningocele

Abstract

Pseudomeningocele complication is a challenging and common neurosurgical problem. Posterior cranial fossa surgery is reported to have higher pseudomeningocele postoperative complication rates compared to supratentorial surgery. Treatment of posterior fossa pseudomeningoceles can be cumbersome and various techniques have been described ranging from conservative measures to re-operation. We describe a case of a 27 year old woman who developed a large symptomatic suboccipital pseudomeningocele following posterior fossa decompression surgery; this was successfully treated by an epidural blood patch.  The current body of literature regarding the treatment of posterior fossa pseudomeningocele is limited. Whilst the use of an epidural blood patch for pseudomeningocele treatment is not novel, this is the first case of standard epidural blood patch, performed in the lumbar region, for treatment of a posterior fossa pseudomeningocele. Epidural blood patch is a minimally invasive technique that is underutilized. This paper demonstrates the use of epidural blood patch as an alternative method for treatment of a large suboccipital pseudomeningocele and summarizes the current literature. It is hoped this paper will highlight the epidural blood patch as a potentially effective treatment option that should be considered when managing posterior fossa pseudomeningocele complications prior to escalation to surgical revision.