An unexpected cause of orthostatic headache: delayed postlaminectomy pseudomeningocele.

摘要

A 41-year-old woman underwent a left L5-S1 hemilaminectomy 7 months prior to the onset of an acute postural headache. MRI brain revealed intracranial hypotension. Two empiric blood patches were unsuccessful. CT myelogram showed a large pseudomeningocele at the surgical site not noted on MRI lumbar spine obtained 2 months postoperatively. Facet instability post-mesial facetectomy likely caused a dural tear on resumption of normal activity. The headache resolved after pseudomeningocele closure. Postoperative pseudomeningocele formation is well-recognized,l but acute orthostatic headache from delayed pseudomeningocele formation at a spinal surgical site has been only once previously described2 and should be considered.