Pseudomeningocele-Related Hydrocephalus After Spinal Tumor Resection: Case Report and Systematic Review of Pathophysiology and Treatment Options.

OBJECTIVE

To describe a rare case of postoperative pseudomeningocele-associated hydrocephalus following cervical spinal tumor resection and to analyze the possible pathophysiological mechanisms and optimal management strategies through a systematic review of the literature.

METHODS

A case of a 44-year-old woman who developed cervical pseudomeningocele and tetraventricular hydrocephalus after C2 schwannoma resection was retrospectively reviewed. Clinical course, imaging findings, surgical management, and outcomes were analyzed. In parallel, a systematic review was conducted according to Preferred Reporting Items for Systematic Review and Meta-Analysis ProtocolsPRISMA-P guidelines using PubMed, EMBASE, and Scopus databases with the terms "pseudomeningocele" AND "hydrocephalus." Adult postoperative spinal cases reporting both conditions were included.

RESULTS

Following schwannoma resection, the patient developed a chronic cervical pseudomeningocele associated with syringomyelia, cerebellar tonsillar herniation, ventricular enlargement, headache, and cognitive symptoms. Surgical drainage and dural repair were performed in 2022. Despite transient postoperative enlargement of the cerebrospinal fluid (CSF) collection, subsequent imaging demonstrated progressive spontaneous resolution of both pseudomeningocele and hydrocephalus, accompanied by complete clinical recovery. The systematic review identified eight eligible case reports. Surgical repair of the dural defect resulted in resolution of pseudomeningocele in all treated cases and was consistently associated with radiological or clinical improvement of hydrocephalus. Ventriculoperitoneal shunting alone frequently failed to resolve the pseudomeningocele.

CONCLUSIONS

Postoperative spinal pseudomeningocele may play a key etiopathogenetic role in the development of hydrocephalus through mechanisms involving CSF flow obstruction and altered CSF absorption dynamics. Chronic CSF leakage and intracranial hypotension may contribute to a malresorptive form of hydrocephalus. Surgical repair of the dural defect appears to represent the most effective therapeutic strategy for achieving resolution of both conditions.