Repair Of Meningocele Research Articles

Treatment of an anterior cervicothoracic myelomeningocele together with spine deformity correction in a child: illustrative case.

Anterior cervicothoracic myelomeningoceles are a rare pathology. In reported cases, treatment has included shunting, isolated resection and repair without deformity correction, or isolated deformity correction without meningocele repair. The authors describe a pediatric patient with an anterior cervicothoracic myelomeningocele presenting with progressive neurological decline, who underwent simultaneous treatment of the myelomeningocele to detether the spinal cord and achieve major correction of the scoliotic deformity. A 15-year-old girl was born with C7-T1-T2 hemivertebrae and anterior cervical myelomeningocele at C7-T1. She developed progressive cervical thoracic scoliosis, left hemiparesis initially, and additional right hemiparesis eventually. She underwent surgical repair via C7, T1, and T2 corpectomies with intradural detethering of the spinal cord. The scoliosis was treated with C7-T2 Ponte osteotomies and C2-T5 posterior fixation, followed by anterior reconstruction with a titanium cage and anterior plate from C6 to T3. The myelomeningocele was adequately treated with good correction of the patient's deformity. The patient had postoperative improvement in her strength and solid arthrodesis on postoperative imaging. The authors describe the successful treatment of an anterior cervicothoracic myelomeningocele and associated scoliosis in a child. This is a unique report of a combined strategy to achieve both deformity correction and detethering of the spinal cord.

Repair of Occipital Meningocele with Switch Cranioplasty.

Repair of Occipital Meningocele with Switch Cranioplasty.

The Incidence and Treatment of Cerebrospinal Fluid Leakage Following Repair of Congenital Spinal Pathologies

Objective: The study's goal is to find out how often individuals with myelomeningocele and TCS repair have leakage of cerebrospinal fluid. Study Design: Cross-sectional Place and Duration: Women medical college Abbottabad and Children hospital and the institute of child health, Multan, during from the period July, 2021 to Dec, 2021. Methods: There were 55 participants of both sexes in this research. Those being treated ranged in age from 5 to 20 years old. After obtaining written permission, we collected demographic data on each patient, including their age, gender, and BMI measurements. There were patients who had TCS repair as well as those who had undergone myelomeningocele repair procedures. It was determined how often cerebrospinal fluid leaks occurred in patients. SPSS 22.0 was used to analyze all of the data. Results: Among 55 cases, majority were males 32 (58.2%) and 23 (41.8%) were females. Included patients had mean age 9.5±6.14 years. Frequency of CSF leak was found among 18 (32.7%) patients. The mean duration of CSF leaks was 13.11±10.34 days. In 18 patients of CSF leaks, Frequency of MMC repair was 11, TCS release was found in 3 patients and meningocele repair in 4 patients. With the use of tincture benzoyl-enhanced primary wound healing in three patients with CSF leaks during surgery, the HCP postoperative signs were resolved. HCP was found in two further patients after their sutures mended with benzoyl tinctures, and they were placed in the shunt. Conclusion: In this research, we found that CSF leaks are more common in patients having myelomeningocele and TCS repair. Skin-healing tincture benzoyl will help these people. Keywords: Cerebrospinal fluid leak (CSF), Tether cord syndrome (TCS), Myelomeningocele (MMC)

Cerebrospinal Fluid Leak after Repair of Congenital Spinal Pathologies, Incidence and Management

Objective: To know the incidence of CSF leak and role of tincture benzoyl in the management of CSF leak after the repair of congenital spinal deformities like myelomeningocele, meningocele and tethered cord syndrome.Materials and Methods: All patients who were operated for congenital spinal surgeries in the form of MMC, Meningocele and TCS by a single surgeon were followed for a minimum of 3 months. Patients with already CSF leak/ruptured MMC prior to surgery were not part of the study. The particulars like gender and type of surgery, days since first surgery, associated infection, hydrocephalus and type of management were noted on a proforma.Results: A total of 73 patients with spinal dysraphism were operated during the study period and of them about 13 patients returned with problems of the CSF leak. The mean duration and duration since the CSF leak was from 6 days to 16 days. Among them, 10 patients had an MMC repair and one patient had TCS release, while 2 patients were having meningocele repair. The patients were stitched and one patient was re-operated two times for repair of CSF leak. Two patients had a CSF leak along with post op signs of HCP that settled by placing a shunt along with primary repair of the wound reinforced with tincture benzoyl in a single setting. Conclusion: CSF leak is a common complication following repair of spinal dysraphism and most patients can be managed with the application of tincture benzoyl alone or after simple skin reinforcement.

Spinal dysraphism.

Defects of the spinal cord results from abnormal closure of the neural folds in the earlier weeks of development. If closure fails anywhere from the cervical region to caudal region it is called as spina bifida, most commonly involving the lumbosacral region. Meningocele is the simplest form of neural tube defect characterised by cystic dilation of meninges containing cerebrospinal fluid without any neural tissue. In India, it affects about 1.9 per 1000 births. Not having enough folate (vitamin B9) in the diet plays a significant role besides genetic factor, obesity, poorly controlled diabetes and anti-seizure medications. Standard treatment is surgery after birth. We present a case of a newborn female baby, term normal vaginal delivery, with normal birth weight, with a mass protruding from lower back region. Baby’s mother gave antenatal history of failing to take folate (vitamin B6) and irregular visits to the hospital. On examination, a small, moist, spherical sac measuring roughly 4 x 4 cm, protruded through the gap in the spine. This sac contained a portion of the spinal cord membrane (meninges) and some spinal fluid. Baby was examined thoroughly for any other abnormalities. Baby was planned for meningocele repair on the same day as there were no other complications. Post-natal advice and counselling to protect child’s skin, preventing sores, special diet to prevent obesity, was given to the mother and discharged the next day. Child was referred to a neurologist and urologist for further management and prevent any complications that may arise.

Wednesday, September 26, 2018 3:35 PM – 5:05 PM How to Avoid Complications: 96. Incidence of staphylococcus aureus infection after elective spine surgeries in US hospitals

BACKGROUND CONTEXT National estimates of Staphylococcus aureus infections after elective spinal surgeries based on microbiology results are limited. PURPOSE We assessed 180-day S. aureus cumulative incidence after elective spinal surgeries in real-world hospital settings and projected the US national burden of such infections. STUDY DESIGN/SETTING Observational study of the US Premier Healthcare Database (PHD). PATIENT SAMPLE Adults ≥18 years with spinal surgery performed during an elective inpatient or hospital-based outpatient encounter from 6/1/2010 to 6/30/2015. Elective admissions were defined according to hospital UB-04 forms. Encounters with first procedures >2 days after admission, emergency department charges, or without availability of 180-day continuous postprocedure reporting by the facility were excluded. Spinal surgeries included laminectomy (N=19,281 inpatient; 24,712 outpatient), fusion-primary (N=65,135 inpatient; 7,555 outpatient), fusion-revision (N=3,828 inpatient; 112 outpatient), and “other” spinal surgery (vertebral fracture repair, lesion excision, meningocele repair, chordotomy) (N=3,670 inpatient; 8,953 outpatient), which were defined using ICD-9-CM procedure and CPT codes according to established National Hospital Surveillance Network (NHSN) groupings and other procedure codes. If greater than one surgery was performed, one procedure per discharge was assigned according to highest expected NHSN infection risk. OUTCOME MEASURES Outcomes included overall and invasive S. aureus infections within 180-days of elective spinal surgery. Microbiology results and ICD diagnosis codes were used to define invasive (eg, bloodstream, deep wound and organ/space SSI) and overall (ie, invasive, superficial SSI, UTI, and respiratory) infections. METHODS Postsurgical S. aureus infection incidence estimates were calculated using data from 181 representative PHD hospitals reporting microbiology results. To estimate the national infection burden, surgery-specific S. aureus incidence proportions were multiplied by the number of nationally projected inpatient elective surgeries (overall and by category), calculated using surgery counts in the entire PHD (N=665 hospitals) and established weights based on hospital characteristics. RESULTS Among 91,914 inpatient elective spinal surgeries, overall and invasive S. aureus infection incidence within 180-days was 1.10% and 0.50%, respectively. The “other spine” category had the highest infection incidence (1.83% overall; 1.04% invasive), followed by fusion-revision (1.62% overall; 0.76% invasive), laminectomy (1.09% overall; 0.49% invasive), and fusion-primary (1.03% overall; 0.45% invasive). Nationally, this translated to an estimated annual 4,539 S. aureus infections (2,054 invasive) among 413,673 elective inpatient spinal surgeries. Following 41,332 hospital-based outpatient elective spinal surgeries performed at microbiology-reporting PHD hospitals, 180-day overall and invasive S. aureus incidence was 0.73% and 0.32%, respectively. CONCLUSIONS To our knowledge, this is the most comprehensive estimate of US postsurgical S. aureus infection incidence among elective spinal surgeries based on real-world microbiology data. These results may help guide targeted infection prevention efforts. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Benefit of Intraoperative Neurophysiological Monitoring in a Pediatric Patient with Spinal Dysmorphism, Split Cord Malformation, and Scoliosis

ABSTRACTIntraoperative neurophysiological monitoring (IONM) consists of a group of neurodiagnostic techniques that assess the nervous system’s functional integrity during surgical operations. A retrospective analysis of a pediatric female patient was conducted who underwent 12 operations for the correction of scoliosis, tethered cord, and split spinal cord wherein IONM played an important role. From age 3 to 6, she underwent six procedures including a release of the tethered cord, resection of the filum terminale, removal of a T11–T12 bony spur, release of L3 adhesions, repair of subcutaneous meningocele, and correction of scoliosis with a vertical expandable prosthetic titanium rod (VEPTR) technique without the use of IONM. However, a multimodality IONM protocol with somatosensory evoked potentials, transcranial electrical motor evoked potentials (TCeMEP), and an electromyogram was utilized during the later procedures. At age 6 (the seventh procedure), a VEPTR expansion was performed, with loss and recovery of the lower extremity motor evoked potentials. The postoperative magnetic resonance imaging (MRI) showed a partial split cord malformation with retethering of the spinal cord. We repaired her split cord malformation and tethered cord while employing IONM. Using IONM for her operation was crucial because a sudden significant loss of TCeMEP resulted in a cancellation of the procedure; the MRI showed a thick remnant attached to the spinal cord. If the procedure was performed without IONM, we could have missed the underlying pathology, an error that may have resulted in paraplegia. We strongly recommend using IONM during high-risk surgical procedures to help significantly reduce the risk of permanent postoperative complications.

ID3020 Stem cell transplantation for incurable diseases in children

Background: Stem cell transplantation has been widely performed to treat many different diseases in adults. However, its indication is still limited in children. Since 2014, we have been doing stem cell transplantation for various incurable diseases in children. The aim of our report is to evaluate safety and efficacy of stem cell transplantation for incurable diseases in children.
 Results
 From 2014-2017, stem cell transplantation has been performed for different conditions including :
 
 Cerebral palsy due to oxygen deprivation, cerebral palsy related to neonatal icterus , Cerebral palsy after meningitis/encephalitis , cerebral palsy after brain trauma ,
 Brain damage due to drowning
 Autism
 Liver cirrhosis due to biliary atresia
 Bowel and urinary dysfunction after meningocele repair
 Brongchopulmonary dysplasia
 Intestinal neural dysplasia
 
 There were no death related to stem cell transplantation. No severe side effects occurred. Early outcomes are promising.
 Conclusion : Stem cell transplantation is safe and effectiveness in treatment of different incurable diseases in children

Conus medullaris dermoid tumour. Uncommon presentation of conus medullaris dermoid as an exophytic mass lesion

Abstract Authors report an extremely uncommon case dorsally exophytic conus dermoid in a three-years old boy, who underwent meningocele repair locate at lumbosacral region at an age of one month. The boy presented with low backache and difficulty in passing urine. Magnetic resonance imaging evaluation of spine revealed presence of a large exophytic mass located dorsally in the conus and the features suggestive of dermoid. He underwent surgical intervention during surgery lesion was dorsally exophytic containing cheesy material with hairs, excision of dermoid along capsule was carried our successfully. Pertinent literature and management of exophytic conus dermoid is discussed briefly.

Symptomatic Multiple Level Lateral Meningoceles with Intraspinal Meningocele: A Case Study and Its Surgical Management

Lateral meningocele is rare disorder of unknown etiology that represents herniation of leptomeninges through enlarged neural foramina. Most patients are asymptomatic and do not need treatment. A symptomatic case with neurologic deficit requires well-planned surgical approach. We report a case of 9-year-old boy who presented with mid backache and progressive asymmetric paraparesis with urinary incontinence. The patient did not appear to have any neurologic disorder. Magnetic resonance imaging (MRI) of spine revealed bilateral multiple thoracic and lumbar paraspinal cerebrospinal fluid (CSF) intensity cystic lesions projecting from the neural foramen and extending laterally suggesting multiple bilateral meningoceles. He was surgically treated, meningocele repair was done, and thecoperitoneal shunt was inserted. Postoperatively he improved symptomatically. Bilateral multiple lateral meningoceles are very rare entity and those who are surgically treated are few. We emphasize our innovative surgical approach to this case.

Re: Prenatal ultrasound evaluation of segmental level of neurological lesion in fetuses with myelomeningocele: development of a new technique. E.Carreras, A. Maroto, T. Illescas, M. Meléndez, S. Arévalo, J. L. Peiró, C. G. García-Fontecha, M. Belfort and A. Cuxart. Ultrasound Obstet Gynecol 2016; 47: 162-167.

Linked Comment: Ultrasound Obstet Gynecol 2016; 47: 162–167 Following the results of the MOMS trial (Management of Myelomeningocele Study), the option of fetal treatment has gained acceptance, particularly in cases in which termination of pregnancy is not considered to be an option. As with other revolutionary techniques and treatments, prenatal surgical treatment of meningocele is still controversial and poses interesting clinical and ethical dilemmas. Currently, more than 10 centers in the Americas and Europe are working in the field and, although incomplete, the published results appear promising. The Barcelona Vall d'Hebron group describe in the present study their novel experience in ultrasound assessment of the segmental level of insult in 18 fetuses with open neural tube defect (ONTD) that subsequently underwent surgery. The segmental neurological level was assigned according to the most distal active muscles present, as demonstrated by systematic observation of the lower-limb movements. The correlation between the quality of movement observed following fetal surgery and after delivery was good, but there was no improvement in the level of function when comparing pre- and post-surgery results. Interestingly, the number of patients opting for prenatal repair was an impressive 21 out of their initial population of 71 (30%) pregnant women carrying fetuses with myelomeningocele. If these results can be reproduced in a large cohort and, more importantly, if the post-surgery and postnatal results can be shown to be better than those obtained at the preoperative examination, this technique will provide further reassurance regarding the benefits of in-utero meningocele repair. As mentioned, the numbers are low, but promising. An important limitation of the study that will need to be addressed in future studies concerns the reproducibility and possibility of interobserver variability; these issues were not addressed in the current study. The Barcelona group performed for the first time a prospective evaluation of the segmental level of damage and were able to compare their results with the results of motor activity tests performed after delivery. They showed that, following surgery, there was no worsening in the level of damage and that the operation was likely to have stopped progression of damage. It is expected that they and other groups working in this field will continue to improve the method. I believe that now, as many centers have reached a good level of performance in fetal ONTD repair, it is time to create an international database that will ultimately include repeat motor assessments of fetuses before and after fetal surgery.

Surgical Management of Spontaneous and Traumatic Anterior Skull Base Meningoceles: Technique and Pitfalls

Objectives: A majority of anterior skull base meningoceles are often managed via the endoscopic endonasal approach (EEA) for the excision and repair of the cerebrospinal fluid (CSF) leak, in addition to the reconstruction of the skull base defect. The aim of the study was evaluation of an institutional case series to identify specific risks and strategies for successful management of anterior skull base meningoceles. Methods: Case series review of all surgical cases involving repair of any anterior skull base meningocele spanning 3 years. Results: A total of 18 patients were managed surgically for repair of meningocele with or without CSF rhinorrhea. All patients had postoperative follow-up to one year. EEA was used in 17 patients, and one had a combined transcranial with endoscopic approach. Four patients had meningoceles with a larger than 1.0-cm bony skull base defect. Large spontaneous meningoceles along the ethmoid were likely to include cerebrovascular structures within their intranasal component. Nasal airway obstruction was the initial presenting symptom in all large spontaneous ethmoid meningoceles, rather than CSF rhinorrhea (present in all large traumatic ones). Conclusions: The endoscopic technique is a safe and effective approach to repair of anterior skull base defects involving both ethmoid and sphenoid regions. Successful repair of lateral sphenoid wall defects depends on gaining sufficient access via incorporating extended approaches, such as trans-pterygopalatine approach. Preoperative angiography may be warranted, especially in spontaneously appearing anterior skull base meningoceles with a bony defect larger than 1.0 cm.

Familial Currarino syndrome associated with Hirschsprung disease: Two cases of a mother and daughter

Currarino syndrome with Hirschsprung disease (CS-HD) is extremely rare. We present the first family with CS-HD. Case 1: A 28-year-old woman was admitted with severe abdominal distension and dyspnea. She was diagnosed with anal stenosis, hemisacrum, anterior sacral meningocele (ASM), tethered cord (TC), and short-segment aganglionosis. She underwent the modified Duhamel operation after meningocele repair and cord detethering. A bicornuate uterus, bilateral ovarian dermoid cysts, and small rectal duplication were also noted intraoperatively. Case 2: The daughter of case 1 was admitted for abdominal distension and anal stenosis at the age of 17days. Studies revealed a hemisacrum, ASM, TC, presacral mass, atrial septal defect, polyp in the right nasal cavity, right vesicoureteral reflux, and short-segment aganglionosis. She underwent the modified Soave operation at the age of 1year and 4months after meningocele repair, cord detethering, and resection of the presacral mass (epidermoid cyst). In both cases, the aganglionic segments were confirmed by preoperative rectal suction biopsy and postoperative pathological examination on full-thickness rectal specimens. Some causal genes for Currarino syndrome (CS) and Hirschsprung disease (HD) are currently investigated. Thus far, 10 CS-HD cases have been reported, including 6 cases of familial CS. However, all the patients had sporadic HD. Recent reports suggest that anomalies of the enteric nerve system contribute to postoperative constipation in CS cases.

Post meningocele repair urinary ascites in a neonate—a rare presentation

A full-term female neonate with a large lumbosacral meningocele developed sudden abdominal distension and urinary retention after meningocele repair. An erect abdominal radiograph showed homogeneously opacified areas with a paucity of intestinal gas. Abdominal ultrasound revealed ascites with multiple internal echoes. With a provisional diagnosis of hollow viscus perforation, an emergency laparotomy was performed, which failed to reveal any leak from the urinary tract. However, fluid analysis confirmed the diagnosis of urinary ascites. The patient developed repeated episodes of urinary retention after catheter removal. She was started on clean intermittent catheterization (CIC) to ensure adequate bladder drainage. At 6 months of follow-up, ultrasound of the urinary tract, voiding cystourethrogram, and magnetic resonance imaging of the spine were all within normal limits. The CIC was discontinued, and the patient was observed. At present, she is voiding normally with a good stream. Failure to establish normal micturition after meningocele repair and CIC requirements suggested a neurogenic cause. Bladder rupture, secondary to spinal shock resulting in bladder atonia, could not be ruled out. The perforation (leading to urinary ascites) could be owing to bladder atonia and spinal shock rather than detrusor sphincter dyssynergia.

Don’t Hold Your Breath

A 50-year-old athletic man presented with two weeks of debilitating “sinus” headache, continuous left nostril drainage, persistent cough, with no history of head trauma. His nasal discharge was unilateral, worse with coughing or leaning forward (Fig. 1), with one clear drop every 2–3 seconds. Analysis demonstrated beta-2 transferrin, a transferrin isoform found almost exclusively in cerebrospinal fluid (CSF). Brain MRI showed no cribriform or ethmoid sinus fractures. Endoscopy revealed a small bony defect in his left nasal cribriform plate (Fig. 2), with active CSF drainage, causing his rhinorrhea. After endoscopic meningocele repair, his symptoms completely resolved. Further review revealed that our patient was a former US Marine who exercised aggressively, bench-pressing 200-300lbs daily, but with poor technique—holding his breath while lifting. Normal intracranial pressures (ICPs) range from 5–15cmH20 when laterally recumbent1. Patients with CSF leaks, regardless of etiology, have ICPs of 26–33cmH20, suggesting correlations between intracranial hypertension and CSF leak2. When fifteen patients were placed in left lateral recumbent positions and asked to bear-down against a closed glottis (Valsalva), every patient achieved ICPs of 25cmH20 or greater, with one reaching 47cmH203. People performing frequent Valsalva maneuvers, including weightlifting without exhaling, elevate their ICPs to pressures associated with spontaneous CSF leaks. Smaller leaks may spontaneously heal. Large, symptomatic or continuous leaks should be repaired to prevent meningitis. Large or rapidly draining defects may be visualized during endoscopy. Smaller defects are localized with dyes injected into CSF. We presume that our patient’s Valsalva maneuvers during weightlifting elevated his ICP, eroded his meninges, eventually causing an meningocele and spontaneous CSF rhinorrhea. Figure 1 His nasal discharge was unilateral, worse with coughing or leaning forward. Figure 2 Endoscopy revealed a small bony defect in his left nasal cribriform plate.

Stem Cells as a Therapeutic Modality in Pediatric Malformations

Aim The aim of this study was to explore stem cell use in congenital anomalies. Patients and Methods During July 2005 through July 2006, autologous stem cells were used in 29 patients: 12 with liver cirrhosis and 17 with meningomyelocele. Stem cells were injected into the hepatic artery and the portal vein or into the hepatobiliary radicals for liver cirrhosis, or into the spinal cord and caudal space for meningomyelocele. Preoperative status served as the control condition. Observations and Results The ages of patients with liver cirrhosis ranged between 1.5 and 9 months (mean, 4.12 months). The etiology was extra hepatic biliary atresia (EHBA) versus neonatal cholestasis and choledochal cyst in 8; 2 and 2 patients, respectively. Five patients died due to ongoing cirrhosis. Follow-up at 3 to 12 months (N = 7) showed absence of cholangitis (4/7), yellow stools (5/7), decreased liver firmness (3/7), improved liver function (6/7), and better appetite (6/7). Hepatobiliary scan was excretory in 6 of 7 with improved uptake in 4 of 7. Histopathology demonstrated comparative improvement in fibrosis among 3 patients. Meningomyelocele patients were between 0 and 1 month, 1–5 months, and 1–4 years in 5, 8, and 2 cases respectively. Five had a history of rupture. Three had undergone meningocele repair in the past with neurological deficits. Redo surgery for a tethered cord was performed in 1 patient. Follow-up at 3 to 11 months in 14 cases showed improved power in 7 with dramatic recovery in 3 (22%) and status quo in 7 (50%). Conclusion Initial stem cell use in liver cirrhosis and meningomyelocele has suggested beneficial results. However, long-term evaluation in randomized controlled trials is essential to draw further conclusions.

Therapeutic use of stem cells in congenital anomalies: A pilot study

<b>Introduction:</b> Stem cells with potential to transform into healthy cells and repair damaged cells may prove beneficial in various congenital malformations. <br><b> Aim: </b> To explore the use of stem cells in liver cirrhosis and meningomyelocele. <br><b> Materials and Methods:</b> During July 2005 to July 2006, stem cells were used in 27 patients; 12 with liver cirrhosis and 15 with meningomyelocele. Autologous stem cells were injected during definite surgery into hepatic artery and portal vein or hepatobiliary radicles for liver cirrhosis or spinal cord and caudal space for meningomyelocele. The pre-operative status of the patient served as control for that patient. <br><b> Results: </b> The patients with liver cirrhosis were between 1.5 and 9 months (mean 4.12 months). Liver cirrhosis was due to extra hepatic biliary atresia (EHBA); neonatal hepatitis and choledochal cyst in 8; 2 and 2 patients, respectively. About five patients expired due to late presentation and ongoing cirrhosis. Follow up results evaluated at 3-12 months (n=7) showed absence of cholangitis (4/7); yellow stools (5/7); decreased liver firmness (3/7); improved liver functions (6/7) and improved appetite (6/7). Hepatobiliary scan was excretory in 6/7 with improved uptake in 4/7. Histopathology repeated after stem cells demonstrated comparative improvement in fibrosis in three. The meningomyelocele patients were between 0 and 1 month; 1-5 months, and 1-4 years in 5; 8 and 2 cases, respectively. 5 had history of rupture. 3 had undergone meningocele repair in past with neurological deficits. Redo surgery for tethered cord was done in 1. Follow up (3-11 months) in 14 cases showed improved power in 4 (28%), dramatic recovery in 3 (22%), and status quo in 7 (50%). One patient is still under observation. <br><b> Conclusion: </b> Initial use of stem cells in EHBA and meningomyelocele has shown beneficial results. However, long-term evaluation with randomized-controlled trials is essential to draw further conclusions.

Congenital lumbosacral lesions with late onset in adult life.

Seven adult patients with congenital lumbosacral lesions and clinical onset in adult life are reported. All also had an abnormally low and tethered spinal cord. A thickened filum terminale and a spinal lipoma are the most common lesions in adults, whereas others, including diastematomyelia, fibrous adhesions, previous meningocele repair and dermal sinus are more rare. Although water-soluble myelography visualizes the abnormally low conus well and may diagnose a diastematomyelia and a thickened filum, computerized tomography, CT myelography and magnetic resonance may provide a better diagnostic definition of the other abnormalities. Surgical treatment should be performed in all adult patients with progressive symptoms. Transection of the thickened filum or of fibrous adhesions and the removal of a spinal lipoma, diastematomyelia septum or dermal sinus tract, result in remission of the pain and improvement of the sensorimotor deficits, or at least prevent the progression of the neurological troubles.

Dermoid tumours occurring at the site of previous meningocele repair

Two cases of dermoid tumours following meningocele repair have been reported because of the rarity of the condition and paucity of literature. It should be stressed that a dermoid tumour should be considered in the differential diagnosis of neurological deterioration in patients with a repaired meningocele.