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PubMed2005

Lumbo-peritoneal shunting improved spinal cord compression due to a large anterior sacral meningocele.

OBJECTIVE: Lumbo-peritoneal shunt was used as an alternative treatment in a large anterior sacral meningocele, a rare congenital malformation, is illustrated. CLINICAL PRESENTATION: A 48-year-old female patient presented with a two-month history of progressive paraparesis, leg pain and numbness of both legs. The investigation demonstrated spina bifida with a huge sac of meningocele, protruding anteriorly into the pelvic cavity. On two previous surgical operations for closure, the fistula through the posterior transsacral approach failed 20 years ago at another hospital, but her symptoms had subsided spontaneously without explanation. She came to Thammmasat Hospital with an episode of spinal cord compression for 2 months. MANAGEMENT: Because of the old surgical scar and high pressure of the meningocele, a lumbo-peritoneal shunt was selected to drain the cerebrospinal fluid from the meningocele to the peritoneal cavity. CONCLUSION: Lumbo-peritoneal shunting is an optional treatment for a large sacral meningocele, especially in a large fistula with unsuccessful surgical closure.

Cerebrospinal Fluid Shunts↗
PubMed1985

Meningoceles and the tethered cord syndrome.

This study shows that there is a relationship between simple meningocele and the tethered cord syndrome. Two groups of patients were examined: the first comprised patients presenting with neurological abnormality at some period after initial closure of a simple meningocele, and the second group (18 patients) had elective myelography after closure of a simple meningocele in the neonatal period (in 17 of the 18 cases). Of these 18 cases. 10 showed an intradural abnormality, and all underwent surgery confirming their myelographic diagnosis. The conclusion is drawn that after closure of a simple meningocele in the neonatal period, patients should have elective myelography in the first 12 months of life to determine whether or not the tethered cord syndrome is likely to develop during the period of growth.

Adolescent↗
PubMed1987

Cervical meningocele and associated spinal anomalies.

Simple meningoceles are infrequent forms of dysraphism and are often benign. They have been associated with other spinal anomalies. The uncommon cervical meningocele may have a higher propensity to be associated with other spinal anomalies. Four patients with cervical meningocele are presented with radiographic evaluation and clinical course. Multiple abnormalities were documented radiographically and operatively, including hydrocephalus, Chiari malformation, hydromyelia, lipomeningomyelocele, tethered cord, thickened filum terminale, diastematomyelia, Klippel-Feil syndrome, and thoracic hemivertebrae. Prior to the development of any late neurological abnormality from associated spinal anomalies, magnetic resonance imaging is recommended early in a child born with a simple meningocele.

Abnormalities, Multiple↗
PubMed1990

A case of Dandy-Walker malformation associated with occipital meningocele, microphthalmia, and cleft palate.

We present a case of Dandy-Walker malformation associated with occipital meningocele, microphthalmia, and cleft palate. Small numbers of cases of Dandy-Walker malformation with occipital meningocele have been described in the literature, but to our knowledge, non of these also had microphthalmia or cleft palate. This association suggests that time of intrauterine origin of Dandy-Walker syndrome was in the sixth or seventh embryonic week. In the diagnosis, both CT cisternography and direct neurosonography over the occipital meningocele was useful for the demonstration of a posterior fossa cyst which communicated with the fourth ventricle and the occipital meningocele.

Abnormalities, Multiple↗
PubMed2003

[Anterior sacral meningocele in pregnancy].

Anterior sacral meningocele is a rare condition characterized by the herniation of meningeal membranes and cerebrospinal fluid through a defect in the anterior aspect of the sacrum. We present the case of a 26-year-old patient with an anterior sacral meningocele which had been discovered during gynaecologic surgery because of a cystic pelvic mass. Subsequently, the patient underwent two pregnancies. The management of a pregnancy complicated by a coexisting anterior sacral meningocele presents a challenging problem for the obstetrician. Because of the high maternal mortality due to rupture of the meningocele under labor, primary cesarean delivery is indicated as soon as fetal lung maturity is established and was performed in our patient in both pregnancies in the 35 week, without complications for mother and children.

Adult↗
PubMed1999

Anterior sacral meningocele completely occupied by an epidermoid tumor.

A 2-year-old girl presented with an anterior sacral meningocele completely occupied by an epidermoid tumor. Preoperative magnetic resonance imaging had shown the meningocele with contents of the same intensity as cerebrospinal fluid. Surgery via a posterior sacral approach disclosed the tumor beneath an unexpected membrane inside the meningocele. Additionally, the presence of pus inside epidermoid tumor suggested that possible episodes of asymptomatic meningitis or other infection might have occurred before treatment, these being the major complication in anterior sacral meningocele. Therefore, we recommend that surgical treatment should be performed at the earliest possible stage in childhood, once the diagnosis is established, and dural plasty carried out to prevent infectious complications.

Child, Preschool↗
PubMed2000

Sternberg's canal--cause of congenital sphenoidal meningocele.

We present a case of a 29-year-old female complaining of right-sided watery nasal discharge. Radiological investigations identified an intrasphenoidal meningocele. The origin of the meningocele was pinpointed to the right parasellar region and was confirmed surgically. The parasellar bony defect appeared to be due to persistence of the lateral craniopharyngeal canal (Sternberg's canal). Therefore, we assume a congenital origin for the intrasphenoidal meningocele found in the patient. Acquired bony defects of the sphenoid sinus are unlikely at the fusion planes of the different sphenoid bone components. Knowledge of the complex ontogeny of the sphenoid bone is an important key to differentiating between congenital and acquired sphenoid sinus meningoceles.

Adult↗
PubMed1990

Sequestrated meningoceles of scalp: extracranial meningeal heterotopia.

Sequestrated meningocele of the scalp has seldom been reported and is difficult to diagnose. Clinically it resembles dermoid cyst, hemangioma, or alopecia; radiographs and computed tomographic scans reveal no cranial bone defect, and surgery discloses no communication with the cranial cavity. Histologically, the lesion is characterized by a loose arrangement of connective tissue in dermis and subcutis, associated with flattened cells around collagen fibers (meningothelial cells). Most examples are very vascular, sometimes mimicking angioma, and about one third contain small necrotic foci. The meningothelial nature of the lesion is shown by its architectural similarity to communicating meningocele, and its identical immunoperoxidase reactions with vimentin and epithelial membrane antigen. In the 12 cases reported herein, most lesions were small (1 to 1.5 cm), and all but one were noted at birth but usually not resected until the patient had reached age 1 to 4, and one not until the patient was 31 years of age. Five lesions were not midline. We have been unable on histologic grounds to determine whether meningoceles are communicating or sequestrated. Compared with 20 communicating meningoceles, the sequestrated lesions were usually smaller, found in slightly older patients, and much less likely to be associated with hydrocephalus. The local excision of scalp lesions in children should include a search for a small intracranial connection.

Adult↗
PubMedDate not supplied

Examination of meningocele induced by the antitumor agent DE-310 in rat fetuses.

The antitumor drug, DE-310, is the slow release form of the camptothecin derivative DX-8951. We investigated a toxicological profile of meningoceles in SD rat fetuses, whose mothers received intravenous DE-310 at several doses, and the time course changes of histology. DE-310 induced a meningocele in the posterior fontanelle of live fetuses by the four-time administration of 0.3 mg/(kgday) or more during the organogenetic period, or by a single administration of 1.0 mg/kg, particularly, between days 7 and 13 of gestation with an incidence of 100%. The meningocele was caused by the principal ingredient DX-8951. The earliest histological change was focal congestion between the skin and cerebrum, followed by the formation of a space covered by thinned epidermis with necrosed basal cells, hemorrhage in the surrounding connective tissues, cerebrum and ventricles, cavitation of the cerebrum, and incomplete formation of the skull bones and subarachnoid space. DE-310 was characterized as preferentially inducing meningocele (meningoencephalocele in severe cases) in rat fetuses.

Abnormalities, Drug-Induced↗
PubMed2003

Anterior endoscopic treatment of a huge anterior sacral meningocele: technical case report.

OBJECTIVE AND IMPORTANCE: Anterior endoscopic treatment of a huge anterior sacral meningocele, a rare example of spinal dysraphism, is described. CLINICAL PRESENTATION: A 43-year-old woman presented with severe headache and fever, increasing abdominal pain, and a several-year history of right lower-extremity radicular pain. She exhibited meningeal irritation signs and Currarino's triad. Lumbosacral myelograms and magnetic resonance imaging scans revealed a huge anterior sacral cyst connected with the spinal subarachnoid space. INTERVENTION: A straight rigid endoscope was introduced into the meningocele through a small abdominal incision. The fistula between the meningocele and the spinal subarachnoid space was obliterated with multiple fat grafts harvested from the abdomen. CONCLUSION: An anterior endoscopic procedure is an alternative for the treatment of a huge anterior sacral meningocele.

Adult↗
PubMed1991

Occipital meningoceles in patients with the Dandy-Walker syndrome.

Occipital cephaloceles in the Dandy-Walker syndrome are not rare. To date, 28 cases have been reported. We report on 8 cases of associated occipital meningocele, totalling 16% of all patients with the Dandy-Walker syndrome in our series. In all patients, communication existed between the posterior fossa cyst and the occipital meningocele. In 2 patients, the occipital meningocele disappeared after cerebrospinal fluid shunting and never required surgical repair. It appears that the cranial defect had ossified and resulted in self-closure. Poor intellectual development in persons with the Dandy-Walker syndrome is associated with the presence of other central nervous system and systemic abnormalities and not with occipital meningoceles alone.

Cerebrospinal Fluid Shunts↗
PubMed2002

Intrathoracic giant meningocele developing hydrothorax: a case report.

A 67-year-old woman with neurofibromatosis type 1 presented with progressive dyspnea. Radiologic evaluation and magnetic resonance imaging revealed progression of a giant meningocele associated with hydrothorax. Laminoplasty with incision of the meningocele and dural plasty was performed, although nerve rootlets were killed. Microsurgical incision of the neck of the meningocele is a favorable operation even in large meningoceles such as the present case.

Aged↗
PubMed2001

Open thoracic meningocele associated with amniotic band syndrome.

We present a case of an infant born with an open thoracic meningocele secondary to an amniotic band. Although there have been several case reports of encephalocele, anencephaly, closed meningocele and a case of tethered cord associated with amniotic band syndrome (ABS), there has yet to be a report of an open meningocele associated with ABS. The patient remained neurologically intact after the repair of his meningocele. His postoperative course was complicated by meningitis with subsequent hydrocephalus necessitating ventriculoperitoneal shunt placement.

Amniotic Band Syndrome↗
PubMed1980

Anterior sacral meningocele: two case reports and discussion of surgical approach.

Virtually all patients with anterior sacral meningocele have a pelvic mass with symptoms and signs relating to pressure of the mass on adjacent structures. Constipation is a universal complaint; urinary incontinence is common. A headache often develoips when the patient stands, due to lowered spinal fluid pressure as the meningocele sac fills. A scimitar-shaped sacrum on anterioposterior plain roentgenograms of the spine is pathognomonic. The coccyx may be absent, and the lower sacral laminate may be absent or incomplete. Myelography confirms the diagnosis and should be done with large volumes of iophendylate in order to fill the sac. Only approximately 130 anterior sacral meningoceles have been reported in the literature. This article presents 2 more cases, both seen at the North Carolina Baptist Hospital. The surgical approach to both was through a sacral laminectomy; the communicating stalk was ligated and the meningocele was removed. One patient was 11 years old and had a large suprapubic pelvic mass found on routine examination. She is neurologically normal postoperatively. The other was 7 years old and had had fecal incontinence since birth. That incontinence is less severe postoperatively and the patient is neurologaically normal.

Child↗
PubMed1989

[Anterior sacral meningocele. Case report].

A 53-year-old male presented with an abdominal mass and urinary disturbance. Plain pelvic X-rays revealed a scimitar deformity of the sacrum. Computed tomography (CT) of the abdomen and lumbosacral spine showed a 13 X 17 X 17 cm, hypodense, cystic mass. Metrizamide myelography disclosed a bony defect at the S2 level through which contrast material entered the pelvic cyst, confirming the diagnosis of anterior sacral meningocele. Magnetic resonance imaging demonstrated the extent of the abdominal mass and its communication with the thecal sac through the anterior sacral defect. The patient underwent surgery via the transabdominal approach. The mass was extremely adherent to the intestine and it was difficult to reach the stalk of the sac. The wall of the meningocele was resected to the extent possible, and was tightly sutured following a meningocele-peritoneal shunting procedure. Postoperatively, the patient was neurologically normal, but 4 months later he was readmitted because of headaches and clouding consciousness. CT showed bilateral chronic subdural hematomas. Following their evacuation, the patient recovered uneventfully. The clinical and neuroradiological features and the surgical approaches to anterior sacral meningoceles are discussed.

Hematoma, Subdural↗
PubMed1993

Treatment of anterior sacral meningocele--case report.

A 30-year-old female presented with a long history of dysmenorrhea and severe constipation. Radiological evaluation and magnetic resonance imaging revealed findings characteristic of an anterior sacral meningocele. Surgical treatment through the posterior transsacral approach failed, because the neck and orifice of the meningocele were too large to perform a simple neck ligation. A second operation successfully resected the connecting dural stalk of the meningocele and reconstructed the thecal sac. Microsurgical reconstruction of the thecal sac through the transsacral approach is a favorable option even for a large meningocele with a wide neck and ostium.

Adult↗
PubMed1999

Suboccipital meningocele presenting as a huge retropharyngeal mass in a patient with neurofibromatosis Type 1. Case report.

The authors report an extremely rare case of neurofibromatosis Type 1 (NF1) with a suboccipital meningocele presenting as a huge retropharyngeal mass. A 73-year-old woman with typical cutaneous manifestations of NF1 presented with nasal obstruction and dysphagia due to a retropharyngeal mass. Magnetic resonance imaging revealed a huge mass lesion extending from the right occipital bone defect to the retropharynx through the right paravertebral region. Computerized tomography scanning after intrathecal administration of contrast material confirmed that the mass was a meningocele protruding through a right occipital bone defect. The authors attempted to ligate this meningocele, most of which was excised via a suboccipital approach, but a second transcervical operation was required. Finally, the meningocele resolved and the patient was discharged without symptoms.

Aged↗
PubMed2002

Resolution of Chiari malformation after repair of a congenital thoracic meningocele: case report and literature review.

OBJECTIVE AND IMPORTANCE: Many theories have been proposed regarding potential causative factors for Chiari malformations. An unusual case is described in which regression of a congenital Chiari malformation was observed after repair of a thoracic meningocele without direct surgical intervention to decompress the craniocervical junction. This supports the importance of an in utero craniospinal pressure gradient as a potential cause for congenital, but reversible, cerebellar herniation. CLINICAL PRESENTATION: A newborn baby was observed to have a thoracic meningocele. Magnetic resonance imaging scan revealed a concomitant Chiari malformation. No neurological deficits were present at initial examination. INTERVENTION: The patient underwent surgical closure of the thoracic meningocele and untethering of the spinal cord at the site of the dural defect. A postoperative magnetic resonance imaging scan obtained 3 months after the operation revealed complete resolution of the cerebellar herniation. CONCLUSION: The resolution of the Chiari malformation in this child may have resulted from restoration of normal cerebrospinal fluid flow and elimination of the meningocele-related cerebrospinal fluid pressure gradient between the intracranial and intraspinal compartments.

Arnold-Chiari Malformation↗