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A case of an intrathoracic meningocele associated with vertebral scalloping, enlarged intervertebral foramina and scoliosis in neurofibromatosis without spinal or nerve root rumors is described. A markedly attenuated dura mater anteriorly was present at autopsy and may have predisposed to meningeal herniation and scalloping.
Anterior sacral meningoceles are congenital lesions that consist of a spinal fluid-filled sac in the pelvis communicating by a small neck with the spinal subarachnoid space through a defect in the sacrum. The three patients with this disorder presented here had characteristic symptoms snd physical findings: chronic constipation, a pelvic mass, and almost unmistakable roentgenographic changes, but diagnosis was delayed from 11 months to 21 years in all three. After prolonged and complicated treatment, the primary lesions have been surgically eradicated and function is generally satisfactory.
The authors review the literature and report a case that illustrate the large spectrum of clinical presentation of the anterior-sacral meningocele. It is analized the presently available diagnostic procedures and it is emphasized the importance of the plain film and mielography in the correct diagnosis of this lesion.
The account of an anterior sacral meningocele, the clinical manifestation of which were cephalagia and urinary disorders. Radiologically, apart from partial agenesia of the terminal sacral segments, an IVU showed a crossed renal ectopia with horse-shoe kidney and a spectacular vesical displacement caused by extrinsic compression. The tomo-scan brought into evidence a voluminous, spreading pelvic processus attached to the spinal canal through a hiatus in the neuro-sacral arch. Clinically, semeiology was primarily a matter of the local effects caused by displacement of the abdomino-pelvic organs ; secondarily it concerned the neurological disorders resulting from compression of the nerve roots included in the cystic wall. As well as the "scimitar" appearance of the sacrum-considered to be pathognomonic - the radiological triad comprises a visualization of the communication between the spinal canal and the kystic pouch - obtained by myelography, preferably gaseous, in association with tomography, and lastly a demonstration by tomo-scan of the hiatus in the neuro-sacral arch. A trans-sacral surgical approach with elimination of the kyst by means of closing off the neck without total excision of the pouch is the most indicated treatment.
A case of intrasacral meningocele associated to L4-L5 discal rupture is described. The possibility for this kind of malformation to be asymptomatic is emphasized.
A case is reported of a new-born infant presenting with a voluminous laterofacial tumor which had literally blown up the right side of the face. The tumor was found to be a meningocele. Treatment was applied in such a way as to cause the least surgical trauma possible and to use the natural flexibility of the tissues in an infant of this age. The rare nature of this localization is emphasized.
A 19-month-old boy suffered eight episodes of bacterial meningitis. During the ninth episode a meningocele of the basioccipital clivus communicating with the nasopharynx was discovered. Identification of the organism causing the episodes of meningitis was not helpful in pointing to the site of this congenital anatomic defect. Surgical closure of the defect has prevented further recurrences.
Three cases of the extremely rare lesion, anterior sacral meningocele, are reported. Its mode of presentation, pathology and possible methods of treatment are reviewed.
2 patients with broad spinal canal, positive radiographic symptoms of spinal expansion but negative clinical symptoms are documented. Intraspinal meningocele with paraspinal extension could be confirmed by Pantopaque myelography and CT. An inborn mesenchymal developmental error is assumed as the cause of this malformation.
A case of intrasacral meningocele with low back pain and sciatica as the presenting manifestations in a 47-year-old male is reported. Magnetic resonance imaging established the diagnosis. Surgical treatment was successful.
This report describes the CT and MR findings in one patient with a spontaneous middle ear meningocele and a second patient with a middle ear meningoencephalocele possibly related to a large intracranial mass. High-resolution CT defined anatomic relation and bone destruction, and MR aided in tissue characterization.
The article presents results of complex examinations of 50 children with meningocele of lumbosacral localization. All these patients were operated upon. The operation was preceded by clinical, electroencephalographic and X-ray examinations. Special attention was given to the degree of injuries of the caudal portions of the spinal cord and ist roots, to findings of spondylography, myelography with roentgen-negative and roentgen-positive contrast substances, pneumoencephalography and EEG.
An 8-month-old neutered male Manx-type cat was evaluated because of clear fluid that had been draining from a skin mass dorsocaudal to the sacrum for 1 week. Neurologically, the cat had poor postural reactions and poor withdrawal reflexes in the hind limbs. Ultrasonography of the dorsal sacral area revealed a 3-cm-long hypoechoic tract extending from the skin mass cranioventrally to the area of the sacrum. The tract appeared to contain a circular mass. Results of myelography and computed tomography helped to confirm the diagnosis of a meningocutaneous tract containing a mass. Surgical exploration was performed and the tract was excised. Histologic changes were similar to those in human beings with tethered spinal cord syndrome and an intradural lumbosacral lipoma. Surgery was indicated in this cat to prevent progression of neurologic signs associated with tethered cord syndrome and to prevent problems associated with loss of CSF through a fistulated meningocele.
A case of occult intrasacral meningocele in a 22-year-old female is reported. The clinical and radiological features of this condition are discussed. Its relationship to other cystic sacral conditions is considered. The pathogenesis of this lesion is not perfectly clear.
A case of transethmoidal meningocele presenting seizure attack is reported. A 59-year-old man was admitted to our hospital because of seizure attack. On admission, he was neurologically free without right olfactory dysfunction. T2-weighted image of MRI showed high intensity signal area in right frontal base, and this signal increase herniated into the ethmoidal sinus. Then 3 DCT image clearly showed right frontal base bony defect. After admission, we compared brain activity in this patient during a seizure attack and resting state using SPECT. And we found increased activity in right frontal base using 99mTc HM-PAO. So it was suspected that indicated the focus of the seizure. During the operation a unilateral bony defect and hypoplastic olfactory nerve were observed, but there was no herniated brain tissue. The association of seizure with frontobasal meningoencephalocele is reported only two cases. In one of two cases, it is presumed that reactive gliosis was epileptogenesis. On the other hand, the relationship of the temporal meningoencephalocele to the genesis of temporal lobe seizure is suggested by the extension of gliosis to the amygdalohippocampal lesion. In our case, it is possible that reactive gliosis or scar of the cyst wall may be the focus of seizure. In terms of diagnosis, 3 DCT is useful to identify the bony defect. It makes easy to diagnose the front-basal encephaloceles.
Meningoceles, encephaloceles, and meningo-encephaloceles may develop through defects associated with congenital anomalies or through defects produced by tumor, trauma, or surgery. Their initial management, surgical indications, and repair techniques are not universally accepted. We undertook this study to compare the contributions of different surgical techniques and materials to the success of endoscopic repairs of acquired meningo-encephaloceles. We also examined whether characteristics of the patient, the meningo-encephalocele, or the adjunctive treatment influenced the outcome of the repair.We retrospectively reviewed the clinical charts of all patients undergoing transnasal endoscopic repair of acquired meningo-encephaloceles at our academic hospitals. We encountered 17 patients with meningo-encephaloceles of the anterior fossa and parasellar area; 15 were repaired immediately using transnasal endoscopic techniques. Two persistent leaks associated with hydrocephalus were repaired during a second endoscopic attempt, which was rapidly followed by ventriculoperitoneal shunting. Location and size of the skull base defect, its etiology, and the technique and choice of material used for repair did not significantly affect surgical outcomes. However, the presence of hydrocephalus was significantly related to poor surgical outcomes.
A 32-year-old female presented with a history of intermittent, severe lower back pain, exacerbated by pregnancy and persisting for several years. Magnetic resonance (MR) imaging showed a sacral mass as a low signal intensity area on the T1-weighted image and a high signal intensity area on the T2-weighted image, consistent with a cystic structure containing cerebrospinal fluid. A tethered cord attached to the thecal sac was also confirmed. Sacral laminectomy revealed thinned sacral vertebral laminae, but no neuronal elements existed within the cyst. The cyst was attached to the distal thecal sac by a small fistula. The thecal sac was explored, revealing a thick filum terminale, which was transected. The severe pain resolved postoperatively. This type of meningeal cyst, often called "occult intrasacral meningocele," is best diagnosed by MR imaging. Surgery to obliterate the fistulous tract is the optimum treatment. Total removal of the cyst is unnecessary, but evaluation of other associated congenial abnormalities is important.
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