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We present a 65 year old, relatively asymptomatic man, who was found to have an intrasacral meningocele with tethered cord syndrome on Magnetic Resonance Imaging (MRI). Incidental detection of this entity at such an old age is very unusual.
In this article the Authors describe a case of intrathoracic meningocele. That was diagnosed in a young asymptomatic woman after surgical resection. After a complete and accurate review of the literature, the Authors underline the rarity of the find while they also note the association of this pathology with Von Recklinghausen's neurofibromatosis. They also discuss etiology and clinical diagnostic aspects as well. In conclusion the Authors insist that with new diagnostic imaging techniques available today it is possible to accurately diagnose this disease preoperatively in most patients. This fact along with improved therapeutic regimens makes surgical excision almost free from the complications that were at one time observed.
Published cases of cervical dysraphic lesions are rare. Their estimated proportion is about 5% of the entire group of spinal dysraphism. Four cases are reported, representing 2 types of lesion: 2 meningoceles with a simple fibrous band fixing the posterior aspect of the cord to the skin and 2 meningomyelocystoceles with other associated anomalies (hydromyelia, hydrocephalus, Chiari II, Peter's ocular anomaly). The clinical presentation is that of a soft posterior cervical mass without marked neurological impairement. The surgical treatment is simple, consisting in the resection of the lesion, intradural exploration to untighten the cord if fixed by a fibrous band, and drainage of the hydrocephalus. Neurological outcome is generally good immediately but may need sometimes secondary surgical exploration.
We present a 35-year-old male patient with an eight-year history of endoscopic nasal polypectomy followed by five episodes of meningitis (4 episodes in the past 3 years). His major complaints were right-sided nasal obstruction, frequent watery nasal discharge, headache, and fever. Physical examination revealed a mass in the right nasal cavity. Computed tomography and magnetic resonance imaging demonstrated a defect in the cribriform plate and an ethmoidal meningocele. The patient was referred to the neurosurgery department for surgical reparation.
The paper is concerned with clinical and x-ray analysis, performed in 10 patients (9 women and 1 man) aged 40 to 50, with meningocele, a congenital abnormality. The final diagnosis of this disease was made possible only by means of transthoracic needle biopsy of cerebrospinal fluid, which was effectively performed in 5 patients.
The case of a 38-year-old woman is reported who developed manifest incontinence of urine following spontaneous parturition on two occasions. An extensive sacrococcygeal meningocele was identified. The paper refers to special features of such clinical after-manifestations.
Thirteen patients with dilated intraorbital optic nerve sheaths with an expanded, patulous cerebrospinal fluid (CSF) space were studied with high-resolution computed tomography (CT) or magnetic resonance imaging (MRI). Eleven patients had bilateral findings. Headache or visual complaints, or both, were present in all patients. Signs of optic nerve dysfunction were present in eight patients. Three patients had visual acuity worse than 20/200. Cerebrospinal fluid pressure was mildly elevated in two patients. Three patients underwent a surgical procedure; visual acuity improved in one. The authors propose the term meningocele for this condition and suggest MRI with fat-suppression techniques and off-axis sagittal views as the radiographic procedure of choice.
Forty-two cases of neuromyelopathy after lower thoracic lumbosacral myelomeningocele or meningocele repairment were reported. The repaired ages were from newborn to 6 years old. Subsequently progressive paralysis of lower extremities with incontinence of bowel and urination were seen after the primary operation. It may be due to "tethered spinal cord syndrome" or postoperative adhesion. Removal of the scar of adhesions over the lower thoracic and lumbosacral region and neurolysis were performed. Following 3-30 months after operation we found out that recovery of bowel function in 38 cases (90.5%). Active urination was recovered in 13 cases (31%) and improved in 22 cases (52.4%). Motor dysfunction and paresthesis of the lower extremities were alleviated in 19 (73.1%) of the 27 cases. No case revealed aggravation of symptom due to operative procedure.
Anterior sacral meningocele is a rare congenital meningeal cyst herniating through a bony defect in the sacrum. Since its description by Bryant in 1837, only 154 cases have been reported in the world literature. The application of ultrasound and C.T. scan following myelography is discussed.
We have presented a case of a 28-year-old woman with an intrasacral meningocele. Diagnosis of this case was aided by the use of MRI. The literature regarding this problem has been reviewed.
The authors present a case of intranasal meningocele in 38-year-old patient. Clinical picture, diagnostics, treatment and postoperative course are described.
The Authors refer the case of a man who was successfully operated for a meningocele, consisting of two separate sacs in the right iliopsoas muscle. Etiopathogenetic features of the two sacs are discussed.
The authors report 11 cases of anterior sacral meningocele, cystic mass connected with lumbar sac through a sacral bony defect: 2 children and 9 adults. Clinic presentations are analysed. Examination including, X ray, ultrasonography, scanner is discussed. The authors believe that these lesions must be treated surgically because a risk of rupture in the rectum with important meningitis exists. There is also a septic risk if an error of diagnosis ends at a puncture. The transacral approach is easy and it gives the best results.
The author gives a detailed description of diagnosis and differential diagnosis of a thoracic lateral meningocele associated with known neurofibromatosis (von Recklinghausen's disease), using plain roentgenography, myelography and computed tomography.
On the basis of the example of two observations symptomatology and therapy of the ventral sacral meningocele are discussed. Besides the clinical diagnosis, the combination of myelography and computer tomography show the greatest informative value. The therapy should be a surgical one with the aim of the extirpation or elimination of the cellular bag.
The authors describe their original method of fascio-aponeurotic plasty of the bone defect in meningocele in children. The method was used in 25 children and gave positive results.
Traumatic meningoceles in the lumbosacral region are extremely uncommon. Water-soluble contrast myelography has proved to be ideal for the diagnosis.
Anterior sacral meningocele is a rare affection (150 cases published) that is frequently misdiagnosed with resulting inappropriate, always dangerous treatment. Diagnosis should however be simple to establish on the finding of a fluid hypogastric mass attached to the sacrum with associated radiologic anomalies of the sacrum. Two cases are reviewed and diagnostic and surgical therapy features discussed.