Management of Pseudomeningocele Following Posterior Fossa Tumor Surgery in Children: A Single-Institution Experience in Egypt

Abstract Background: Management of pseudomeningocele follow-ing posteri orfossa tumor surgery in children has different conservative and surgical options. The aim of this study was to assess the management of pseudomeningocele developing after posterior fossa tumor surgery in children at a single institutionin Egypt. Aim of Study: Is to assess the different ways of manage-ment of pseudomeningocele developing after posterior fossa tumor surgery in children. Patients and Methods: This was a retrospective study of30 children with pseudomeningocele developed after pos-terior fossa tumor resection, operated in the period from April 2016 and April 2021 in the Neurosurgery Department, Abu El Reesh Japanese Hospital, Egypt. Data were reviewed for the concerned children in the study including the age at presentation, the sex, and the mode of onset, course, and duration of the pseudomeningocele following posterior fossa tumor surgery. Results: The mean age was 7.7±3.5 (range, 1-16) years old. There were 18 males (60%) and 12 females (40%). The dura was closed primarily watertight without a graft in nine children (30%). Pericranium graft was used for dural closure in 12 children (40%), while a synthetic graft was used in nine children (30%). Twenty-four children (80%) had high grade tumors. Twenty-five children (83.3%) had midline posterior fossa surgeries. Three patients (10%) were diagnosed to have meningitis due to CSF leak. Seven children (23.3%) responded to conservative measures; their pseudomeningoceles were less than 50cc. Twenty-three patients (76.7%) required surgical intervention;their pseudomeningoceles were more than 50cc. They were managed by ventriculoperitoneal shunt (21 chil-dren),lumboperitoneal shunt (one patient), and debridement and duraplasty (one patient). Conclusion: Pseudomeningocele following posterior fossa tumor surgery in children is not a rare complication, but could be a self limiting problem. Its management usually starts with conservative measures then proceeds according to the response of the patient. Some factors can predict the need for surgical intervention in these cases as large size of the pseudomenin-gocele, anatomical, and pathological criteria of the posterior fossa tumor.