Retained medullary cord with sacral subcutaneous meningocele and congenital dermal sinus.

Abstract

A retained medullary cord (RMC) is a rare closed spinal dysraphism with a robust elongated cord-like structure extending continuously from the conus medullaris to the dural cul-de-sac that is caused by late arrest of secondary neurulation. Five patients with RMC extending to an associated sacral subcutaneous meningocele have been reported. We report an additional patient with RMC, in whom a congenital dermal sinus (CDS) was found in the caudal portion of the RMC. At the age of 3days, the patient underwent surgery consisting of meningocele excision and cord untethering, and CDS was noted histologically in the proximal cut end of the RMC. During a second surgery at the age of 5months, after determining the exact border of the nonfunctional RMC and the true conus by neurophysiological mapping, we removed the entire length of the remnant RMC, including newly developed epidermoid cysts in the CDS. Although the exact pathoembryogenesis of concurrent RMC and CDS is unknown, an associated subcutaneous meningocele, caused by failure of primary neurulation, could be involved. Surgeons should be aware of the possibility of the coexistence of CDS when dealing with RMCs that extend out to the extradural space.