Spinal Meningocele Research Articles

A Rare Case of an Isolated Intra-Thoracic Meningocele: Case Report and Review of the Literature

A spinal meningocele is a saccular protrusion of the meninges through a dilated intervertebral foramen or a bony defect of the vertebral column. Intrathoracic meningocele is a rare condition. Only a few cases were related in the literature. It is usually associated with neurofibromatosis type 1. Isolated intrathoracic meningoceles without neurofibromatosis is a very rare entity few cases have been reported in the medical literature. Regardless of the treatment plan cross-sectional imaging techniques such as CT and MRI are essential not only for the diagnosis but also to determine the relationship to the surrounding structures and the exclusion of other neuromas and any skeletal deformities. Surgical excision is the treatment of choice in symptomatic patients.

Surgical outcomes of six bulldogs with spinal lumbosacral meningomyelocele or meningocele.

To report the surgical treatment and outcome of six bulldogs with spina bifida (SB) and meningocele (MC) or meningomyelocele (MMC). Case series. Five French bulldogs and one English bulldog with MC or MMC. Medical records of dogs with spinal MC or MMC diagnosed by MRI at two institutions between 2013 and 2016 were reviewed for surgical treatment and outcomes. Meningocele was diagnosed in two dogs, and MMC was diagnosed in four dogs. A lumbosacral dimple was noted in all dogs along with neurological deficits most commonly consisting of urinary and fecal incontinence (n = 6) and mild/moderate paraparesis (n = 3). Dorsal laminectomy was performed in all dogs to allow dissection of the meningeal sac to the vertebral column defect. In dogs with MMC, nerves were repositioned and protruded meninges were removed prior to suturing remaining meninges. Adhesions and filum terminale were resected in two dogs with suspected tethered cord syndrome. Urinary and fecal incontinence improved in two dogs and remained unchanged in four. Paraparesis improved in two dogs. Surgical treatment resulted in partial improvement of the urinary and fecal incontinence (2/6 dogs) and paraparesis (2/3 dogs) or stable neurological condition (3/6 dogs), with only minor temporary complications. In the absence of published data comparing surgical and conservative treatment of puppies affected by SB and MC or MMC, early surgical treatment can be considered to prevent deterioration of neurological signs and, eventually, facilitate improvement of neurological signs.

The levels of fetuin-a, osteopontin, total antioxidant and oxidant in patients with midline closure defects

Amaç: Orta Hat kapanma Defekti (OHD) yüksek morbidite ve mortalite ile ilişkili doğumsal spinal omurgaların birleşme kusurudur. OHD’li olan hastalarda Fetuin-A, Osteopontin, Total antioksidan ve oksidan seviyeleri bilinmemektedir. Bu çalışmada bu paramatrelerin OHD’li olan hastalarda düzeyleri ve hastalıkla olan ilişkisi araştırıldı.Materyal ve Metot: Çalışmaya, 0-5 yaş grubu arasında OHD olan hastalar (Çalışma grubu, n=80) ve benzer yaşta sağlıklı çocuklar (Kontrol grubu, n=85) olmak üzere 165 olgu alındı. OHD olan olgular Spina Bifida Occulta (Grup I, n=22), Spinal Meningosel veya Miyelomeningosel (Grup 2, n=26) ve Hidrosefalisi olan (Grup 3, n=31) olmak üzere 3 gruba ayrıldı. Dağılımların normal olup olmadığı tek yönlü Kolmogorov–Smirnov testi ile değerlendirildi. Gruplar arası karşılaştırmalarda, ki-kare, student t testi, Mann-Whitney U testi ve Kruskal-Wallis varyans testleri kullanıldı. Tüm olgularda Fetuin-A ve Osteopontin sandviç enzim bağlantılı immün sistemi emici teknolojiye dayanarak ölçüldü, Total Antioksidan Status (TAS) ve Total Oksidan Status (TOS) spektrofotometrik olarak ölçüldü. TOS’un TAS’a oranıyla oksidatif stres indeksi (OSİ) hesaplandı.Bulgular: Hasta ve kontrol grupları arasında TAS düzeyleri benzerdi (p=0.230). TOS ve OSİ düzeyleri hastalarda, Fetuin-A ve Osteopontin değerleri ise kontrol grubunda daha yüksek bulundu (hepsi için, p<0.05). TAS düzeyleri hasta grupları arasında benzer, TOS, Fetuin-A, Osteopontin değerlerinde anlamlı farklıydı (hepsi için p<0.05). TOS, OSİ ve Fetuin-A düzeyleri grup I den III’e doğru giderek azalırken, osteopontin düzeyleri grup I’de en yüksek, grup 2’de ise en düşük olarak bulundu. Sonuç: OHD kapanma defekti, intrauterin dönemde meydana gelir. Embriyogenez aşamasında, ektodermal tabakadan gelişen nöral dokunun ve mezodermal tabakadan gelişen ve spinal kordun etrafını saran kemik ve cildin orta hatta yetersiz kapanması ile sonuçlanan bir malformasyondur. Bu yetersiz kapanma nöral tüpün herhangi bir yerinde meydana gelebilir. Nöral tüpün histogenezi ve organogenezi tamamlanması için biyolojik ve kimyasal aktif maddelere ihtiyaç duyarlar (2). Bu nedenle OHD’li hastaların fizyopatolojisinde, TOS, OSİ, Fetuin-A, Osteopontin değerlerinin rolü olabileceği düşünülmektedir.

EP11.01: Prenatal ultrasound‐based diagnosis of fetal OEIS complex associated with lower limb polymelia and cardiac, hepatic dysplasia

Omphalocele exstrophy imperforate anus spinal defects (OEIS) complex is a type of congenital malformation syndrome involving multiple fetal systems. Its characteristic ultrasonographic features include omphalocele, spinal defects, absence of bladder, and ambiguous anus and genitalia, and it is often accompanied with limb malformations. Here, we report a case of fetal OEIS complex combined with lower limb polymelia and cardiac, hepatic dysplasia at the 24th gestational week diagnosed on prenatal ultrasonography. The ultrasonogram showed an omphalocele on the right side of the umbilical cord entry, spinal meningocele at the lumbosacral portion, bladder absence and ambiguous genitalia. Concurrent multiple malformations included lower extremity multi-limb deformity, feet abnormity, congenital ventricular septal defect, three-lobe liver malformation, ectopic kidneys, and single umbilical artery. Besides characteristic ultrasonographic features of OEIS complex, this case was combined with severe and rare lower limb polymelia and multi-lobe liver deformity. It was easily missed diagnosis when oligoamnios and the liver bulged. This case will strengthen our understanding of such rare deformities and provide reference information for early diagnosis of similar cases. Supporting information can be found in the online version of this abstract Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

An Isolated Spinal Meningocele Discovered Fortuitously on a CT Scan: Case Report

A spinal meningocele is a saccular protrusion of the meninges through a dilated intervertebral foramen or a bony defect of the vertebral column. Intrathoracic meningocele is a rare condition. Only a few cases were related in the literature. It is usually associated with neurofibromatosis type 1. Isolated intrathoracic meningoceles without neurofibromatosis are more uncommon. We report a case of isolated paraspinal meningocele in a 54 old-year-man, for whom the diagnosis was established by computed tomography and magnetic resonance imaging features.

Anterior Sacral Pyocele With Meningitis: A Rare Presentation of Occult Spinal Dysraphism With Congenital Dermal Sinus

The authors describe an interesting case of a hitherto asymptomatic occult spinal defect with a congenital sacral dermal sinus which proved to be the entry point for bacterial meningitis in an otherwise healthy 9-year-old female child. The patient presented with fever and neck stiffness, and a dermal sinus in the lumbosacral region was identified on examination. Cerebrospinal fluid analysis confirmed bacterial meningitis and a spinal magnetic resonance imaging scan revealed a dermal sinus tract with an anterior spinal meningocele, caudal regression syndrome, and a tethered spinal cord. In addition to administration of intravenous antimicrobial agents, surgical exploration of the sacral dermal sinus tract was performed and an anterior sacral pyocele was drained. The pyocele cavity was disconnected from the thecal sac, and the thickened and fatty filum terminale was sectioned. Although congenital sacral dermal sinus manifesting as bacterial meningitis is known, the occurrence of an anterior sacral pyocele has not yet been described in children.

Spinal meningocele due to iatrogenic dural puncture during epidural analgesia for childbirth: 5-year history of headache with a spinal etiology

Patients undergoing epidural injection for labor pains occasionally sustain iatrogenic inadvertent puncture of the dura with or without damage to the underlying neurological structures. This may be associated with CSF leakage, headache, neurological deficit, and infection. Rarely, the headache persists for years. To the authors' knowledge, chronic headache due to acquired spinal meningocele featuring as a duplicated dural sac, as a sequela of traumatic inadvertent dural puncture, has not been previously reported. The authors report a case of a 20-year-old woman with persistent headaches following an epidural injection. Five years later, the persistent headache was found to be due to a large acquired spinal meningocele. The operative removal of the meningocele led to resolution of headaches. This report highlights the importance of considering a spinal condition as a culprit for chronic headache and postulates a mechanism for the formation of the acquired spinal meningocele appearing as a duplicated dural sac. The authors recommend early MR imaging of the spine for any persisting headache that has a history of attempted spinal access. If an acquired spinal meningocele collection is found, exploration with a view to complete removal of the sac should be considered. To the authors' knowledge, this is the first case report depicting a rare, treatable cause of chronic spinal hypotension resulting in headaches.

MRI diagnosis of brachial plexus preganglionic injury

Objective To evaluate MRI in diagnosing brachial plexus preganglionic injury.Methods Twenty cases with brachial plexus preganglionic injury underwent M R scanning before operation.MR imaging was obtained by GE Signa EXCITE 1.5 T scanner.The scanning sequences included SE T1 WI,FSE T2 WI,T2 WI STIR and 3D Fast imaging employing steady state with phase cycled(3D-FIESTA-c).All the patients had exploration of the supraclavicular plexus and electrophysiology examination. And the accuracy, sensitivity and specificity of MRI in diagnosing preganglionic brachial plexus iniury were calculated with the standards of surgical and EMG results.Results Among the 73 pairs of i,jured roots.MR imaging detected the abnormalities in 63 pairs.The accuracy, sensitivity and specificity of MRI in diagnosing preganglionic brachial plexus injury were 86.5/(83/96),86.3/(63/73).87.0/(20/23),respectively.The direct signs of brachial plexus preganglionic injury included (1) lack or mutilation of netwe root in 54 pairs (85.7/),(2)coarsening,bending,stiff course and unable to be traced to the intervertebral foramen continuously in 9 pairs (14.3/).The indirect signs included (1)cystic cerebrospinal fluid gathering in the vertebral canal,posttraumatic spinal meningocele in 46 pairs (73.0/),(2)abnormal shape of nerve sleeve in 13 pairs(20.6/),(3)displacement and deformity of spinal cord in 50 pairs(79.4/),(4)abnormal signal of paravertebral muscles in 1 9 patients.Conclusion MRI can distinctly show the nerve rootlets within the vertebral canal,so it is helpful in making a correct diagnosis of brachial plexus preganglionic injuries. Key words: Brachial plexus neuropathies; Diagnosis; Magnetic resonance imaging

C677T mutation in the MTHFR gene was not found in patients with frontoethmoidal encephalocele in East Java, Indonesia.

Frontoethmoidal encephalocele (FEE) is a neural tube defect (NTD) characterized by a congenital bone defect in the anterior cranium and herniation of the intracranial mass through the defect. The C677T mutation in the 5,10-methylenetetrahydrofolate reductase gene (MTHFR) has been reported as a genetic risk factor for spina bifida. However, the role of the MTHFR in the pathogenesis of FEE remains to be clarified. A hospital-based survey of FEE patients who were referred to the Department of Neurosurgery and Plastic Surgery, Malang General Hospital, East Java, Indonesia was conducted. Genetic screening of MTHFR substitutions in 13 patients and eight mothers from 11 affected families were performed using a combination of polymerase chain reaction (PCR), denaturing high-performance liquid chromatography (DHPLC), and direct sequencing. In total, 130 patients with FEE among 138 NTD patients (94.2%) were identified. The ratios of cranial encephalomeningocele to spinal meningocele (32 : 1) and of FEE to occipital encephalomeningocele (32 : 1) were higher than those in other populations. Five substitutions were detected in the MTHFR: C121T, C677T, C1060T, A1298C, and G1793A. No significant differences were found in the frequency of each nucleotide substitution between patients or mothers and controls. In addition, none of the subjects in this study were homozygous for T at nucleotide position 677. FEE is the most common form of NTD in East Java, Indonesia. Genetic analysis of 11 affected families suggests that the MTHFR gene is not associated with the development of FEE, although the number of FEE families analyzed in this study was very limited.

The initial treatment of meningocele and myelomeningocele lesions in adulthood: experiences with seven patients.

This is a retrospective study of patients having undergone surgical treatment of spina bifida cystica (SBC) lesions in adulthood. The objectives were to assess the clinical, radiological, and surgical characteristics of SBC lesions in adults. There is almost no study assessing these characteristics. Seven adult male patients with SBC lesions, ages between 20 and 23 (mean 21.1), had their primary evaluations between 1995 and 1999 in the Military Hospital, Yzmir, and Gülhane Military Medical Academy, Ankara. A temporary cerebrospinal fluid leak in the patient with the thoracic lesion and a temporary partial urinary incontinence in the patient with the lumbosacral lesion occurred. The most common preoperative complaint was low back pain. This improved in three of four patients (75%) but did not disappear. Although it is rare, an adult with an untreated SBC is a possible entity. These lesions should be included in the differential diagnosis of dorsal midline lesions in adults. Even though they appear as a simple spinal meningocele clinically, preoperative MR imaging and CT are necessary and helpful in the precise diagnosis and surgical planning.

Multiple pseudomeningoceles enlarging within vertebral bodies

A case of spinal meningocele is reported in which erosion of adjacent vertebral bodies and stretching of some roots coexisted. The neurological picture cleared after neurolysis and repair of the anterior thecal continuity.

Dupla meningocele na coluna vertebral

É relatado caso de dupla meningocele de coluna vertebral, respectivamente nas regiões cervico-torácica e tóraco-lombar, no qual ocorreu hidrocéfalo após pneumoventriculografia. Para a compensação do hidrocéfalo foi feita drenagem ventrículo-peritonial.

Effect of weight-bearing on the appearance and development of the secondary calcaneal epiphysis.

The calcaneus ossifies from a primary center for the main body of the bone and from a secondary center for the posterior extremity (4). The secondary center has received considerable medical attention because in normal children it is strikingly dense when compared to the calcaneal body and it shows considerable irregularity of ossification (Fig. 1). Sever (11) related this roentgen appearance with pain and tenderness in the heel and termed it apophysitis of the os calcis. “Sever's disease” became and remained a popular diagnosis (1, 3, 7–9) until 1948 when Hughes (6) concluded that the changes termed Sever's disease were normal and “there is insufficient proof that osteochondrosis is ever the underlying cause of adolescent painful heels.” Caffey (2) re-emphasized mistaking the normality of the roentgen findings for apophysitis, and the condition is receiving less and less attention. Albeit the sclerosis of the calcaneal secondary epiphysis has been recognized as normal, no explanation has been given for the increased density. A preliminary observation that the sclerosis and development of the epiphysis might be related to weight-bearing prompted a roentgenological study of the calcaneus in children with and without normal weight-bearing. The purposes of the study are to determine if the secondary epiphysis is sclerotic in all normal weight-bearing children and to evaluate the relationship of weight-bearing to the sclerosis and developmental ossification of the epiphysis. Material and Method Calcaneal roentgenograms of 289 children were studied: 130 boys and 159 girls, aged four to seventeen years. One hundred and three were examined primarily for this study; the remaining 186 were patients referred to the Department of Radiology for recent trauma to the lower leg, ankle, or foot, but not primarily to the calcaneus. No child had symptoms referable to the calcaneus. Studies were also made of an additional 74 children who did not have normal weight-bearing either unilaterally or bilaterally. Forty-two were boys; 32, girls, with an age distribution ranging from seven to fifteen years. The cause of the non-weight-bearing was neurological in 15 boys and 24 girls and fracture in 27 boys and 8 girls. In the neurogenic disease group were 20 patients with poliomyehtis, 12 with spinal meningocele, and 7 with cerebral palsy. All fractures were of the lower tibial shaft, tibial malleoli, or metatarsals. Each calcaneus was evaluated in respect to (a) the presence of sclerosis of the secondary epiphysis and (b) the appearance and development of the epiphyseal ossification. Presence of Sclerosis The calcaneal epiphysis is not sclerotic when ossification commences in it. Ossification begins in several irregular foci which fuse together within a few months after their appearance. All patients with normal weight-bearing in this study showed sclerosis of the epiphysis by the time the foci fused.

TRANSPALATAL CORRECTION OF BASILAR MENINGOCELE WITH CLEFT PALATE.

IN cranium bifidum, a congenital or traumatic defect of the skull, the cranial contents herniate, causing what is variously called a meningocele, cephalocele, encephalocystocele, etc. In the literature these terms are often used interchangeably. Although, strictly speaking, a cranial meningocele does not contain brain, neural elements are usually found in the wall. Cranial meningocele is much rarer than spinal meningocele and constitutes only 10% of central nervous system hernias. Cranial meningoceles are of two types: the sincipital, which form external tumefactions, and the basal. Located within the nose or pharynx, between 5% and 10% of cranial meningoceles are reported to be of the basal type. Among 546 patients with meningocele at the Boston Children's Hospital, Ingraham and Swan¹found 84 to be cranial, and among these 64 were occipital, 9 were parietal, 6 were frontal, and only 5 (6%) were endonasal. <h3>Endonasal Meningoceles.</h3> —A basal meningocele usually exits from

PLEUROPNEUMONIA ORGANISM MENINGITIS COMPLICATING RUPTURED MENINGOCELE

A case of meningitis due to the pleuropneumonia-type organism occurred in a newborn infant with a spinal meningocele. The source of infection is believed to have been from the maternal birth canal through the dural membrane which ruptured at birth. The infection became apparent after 25 days of penicillin and streptomycin therapy, but responded promptly to terramycin, and the baby made a complete recovery from the infection.

Pelvic Cysts due to Spinal Meningocele, with Notes of a Case.

Pelvic Cysts due to Spinal Meningocele, with Notes of a Case.