Hydrocephalus following bilateral dumbbell-shaped c2 spinal neurofibromas resection and postoperative cervical pseudomeningocele in a patient with neurofibromatosis type 1: a case report

Abstract

Study Design Case report. Objective To present a rare case of hydrocephalus following bilateral dumbbell-shaped C2 spinal neurofibromas resection and postoperative cervical pseudomeningocele in a patient with neurofibromatosis type 1 (NF1). Methods The patient's clinical course is retrospectively reviewed. A 37-year-old man affected by NF1 referred to our department for progressive weakness of both lower extremities and gait disturbance. Radiological imaging showed bilateral dumbbell-shaped C2 spinal neurofibromas. After its resection, at the 1-month follow-up evaluation, the patient reported headache and nausea. A CT brain scan showed a postoperative cervical pseudomeningocele and an increase in the ventricular sizes, resulting in hydrocephalus. Results A ventriculoperitoneal shunting was performed using a programmable valve opening pressure set to 120 mmH20. After surgery, the patient's neurological status markedly improved. Conclusion Hydrocephalus must be considered a possible complication of cervical spine tumor resection.

Keywords: cervical spine; dumbbell-shaped neurofibroma; hydrocephalus; neurofibromatosis type 1; postoperative cervical pseudomeningocele; spinal cord tumor.

Fig. 1

Preoperative sagittal (a) and axial (b) T1-weighted gadolinium-enhanced MRI scan showing a bilateral C1–C2 dumbbell-shaped enhancing lesion. MRI, magnetic resonance imaging.

Fig. 2

Operative view showing right neurofibroma removal (a, b) and left tumor excision (c, d) resecting C2 nerve roots, after C1–C2 spinolaminectomy through a posterior approach.

Fig. 3

Postoperative CT brain scan showing a postoperative cervical pseudomeningocele with ventricular size enlarged (a, b) and subsequent resolution of hydrocephalus after a ventriculoperitoneal shunting (c, d). CT, computed tomography.