Abstract
and a large neural tube defect suggestive of a large thoracic myelomeningocele. A subsequent MRI suggested a meningocele containing no neural elements. At US, we confirmed a large thoracic meningocele with spinal cord tethering to the overlying skin. Fetal MRI confirmed the findings and a limited dorsal myeloschisis was suspected. Elective caesarean section was performed at 38 weeks. Postnatal examination confirmed a large dorsal midline fluid filled mass at the level of T7-T12 covered by a thin layer of normal skin. The structure transilluminated easily without evidence of neural tissue within. No neurological deficits were found on neonatal examination. Post partum MRI confirmed the diagnosis of limited dorsal myeloschisis. The infant underwent surgery on day 2 to remove the exophytic lesion and to release the tethered neural tissue. His post operative course was uncomplicated and he was discharged home well 10 days later. Despite the markedly abnormal prenatal appearance of LDM, with a large meningocele and a tethered fibroneural stalk, it is associated with a good prognosis. Prenatal differentiation between meningomyelocele and LDM is therefore essential for appropriate couselling. The role of fetal MRI is invaluable to aid in the diagnosis. Children born with such a lesion usually have no neurological deficit and a normal neurological outcome can be expected. However, neurological deterioration can occur in the absence of timely corrective surgery to release the tethered spinal cord and remove the exophytic skin lesion.
Published Version
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