Pseudomeningocele after traumatic nerve root avulsion. A novel technique to close the fistula

Abstract

Traumatic brachial plexus complete avulsions and the subsequent formation of pseudomeningoceles are a well-known entity that usually remains asymptomatic. Pseudomeningocele is due to the dural sleeve encasing the damaged roots and the spinal liquid that may accumulate locally or in the supraclavicular soft tissues. The pseudomeningocele, added to the associated lesion of the plexus and usually the surrounding vessels, may become difficult to manage. We describe the novel management of a traumatic pseudomeningocele using an endovascular technique.

Keywords: pseudomeningocele; root avulsion; traumatic brachial plexus.

Figure 1

Preoperative neuroradiological findings. Coronal myelogram (A) and MRI using FIESTA (fast imaging employing steady state) (B) acquisition sequence reveal a lateral pseudomeningocele arising from the right T1-T2 intervertebral foramen. We can also see the cerebrospinal fluid arising from the foramen in an axial view (C).

Figure 2

A,B) Fluoroscopic coronal images showing the wire built with coils and Glubran^®.

Figure 3

A,B) Fluoroscopic coronal images of the second procedure showing the wire built with coils and Onyx. C) MRI showing complete occlusion of the pseudomeningocele.