Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “MENINGOCELE”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 775 records · Page 43Linked to original sources

The prenatal diagnosis of the Walker-Warburg syndrome.

On the basis of physical features and autopsy findings, a child with congenital hydrocephalus, bilateral microphthalmia, myopathy, severe developmental retardation and multiple brain malformations was diagnosed to have the Walker-Warburg Syndrome (WWS). During a subsequent pregnancy in this family, a fetus at risk for this autosomal recessive condition was evaluated with serial ultrasound examinations. At 15 weeks of gestation an encephalocele was noted. Disproportionately slow growth of the head compared to the body was noted at 36 weeks. At birth, the diagnosis of WWS was confirmed in the child due to the presence of microcephaly, an encephalocele, a meningocele and bilateral microphthalmia. This is the first reported case of the early prenatal diagnosis of this recently categorized genetic condition, in which the major features are hydrocephalus, multiple central nervous system malformations, microphthalmia with ocular malformations, severe psychomotor retardation, congenital myopathy and a very limited life expectancy.

Abnormalities, Multiple↗

The child with a cephalocele: etiology, neuroimaging, and outcome.

We report a series of 46 children who were treated for one of the diverse forms of cranium bifidum during a period of 22 years. The purpose of the survey was to investigate pathogenetic factors involved in the development of cranial dysraphism and to analyze clinical and pathological factors that influence the patients' outcome. We also investigated the existence of associated intracranial anomalies, in a systematic way, using modern methods of neuroimaging, and related the findings to the patients' final results. The lesions were classified as encephalocele (n = 15), cranial meningocele (n = 3), atretic cephalocele (n = 26), cranium bifidum occultum (n = 1), and exencephaly (n = 1). There was an excess of the atretic form of cephaloceles in our series, a fact that probably reflects geographical variations described for cephaloceles in general. The location of the lesions was occipital in 29 children, parietal in 16, and temporal and frontobasal in one case each. In seven cases there was parental consanguinity. A familial history of malformations of the central nervous system was encountered in eight instances. Associated systemic abnormalities were present in 23 patients, while central nervous system anomalies were found in 36 children. Cephalocele repair was undertaken on 35 occasions. There were no surgical fatalities in the series. The mean follow-up time was of 7 years. Overall mortality for the whole group was of 17/46 or 36%. Twenty of the 29 survivors had no neurological sequelae, but only 18 children exhibited a competitive intelligence level. A good outcome was found to correlate well with: an average head size at birth, a normal initial neurological condition, operability of the lesions, and an absence of disorders of the neuronal migration. Neurological outcome depended also on the occurrence or not of hydrocephalus, while the intelligence level was mainly related to the absence of cerebral tissue within the sac of the malformation.

Abnormalities, Multiple↗

Partial trisomy 8q in half-sisters with distinct dysmorphic patterns not similar to the trisomy 8 mosaicism syndrome.

Two cases of partial trisomy 8q are presented. Common clinical features included severe mental and physical retardation, a prominent and short forehead, widely set mongoloid eyes, broad, flat nose with short septum, short upper lip, misshapen ears, a funnel chest, hypertrichosis of the back, coxa valga, and short fingers with brachymesophalangy and clinodactyly of the little fingers. Moreover, Case 1 had a frontal meningocele and bilateral talipes equinovarus, and Case 2 had a ventricular septal defect. The chromosome aberration in the two girls arose from a maternal balanced translocation, t(8;18) (q2309;p113). Since the major clinical features of mosaic trisomy 8 are absent in the two girls and in other cases of partial trisomy, both for the distal segment of the long arm and for the short arm of chromosome 8, it is concluded that trisomy of the proximal part of the long arm of chromosome 8 causes most of the clinical findings of trisomy 8 mosaicism syndrome.

Abnormalities, Multiple↗

Cranium bifidum in northern Nigeria.

At the Ahmadu Bello University Hospitals in northern Nigeria, 35 girls and 29 boys with cranium bifidum were registered between 1971 and 1985. Only 25% of the patients were brought to the hospital within 24 h of life; 57 had been delivered at home without the mothers having received formal prenatal care. The majority (69%) of the lesions occurred in the occipital region; 52 (81%) were encephaloceles while the others were cranial meningoceles. Resection and repair were performed in 35 patients by general surgeons who had no facilities for vertriculoperitoneal shunts in infants with hydrocephalus. Thirteen children died in the hospital, 3 moved away, and 34 were lost to follow-up at 1 month. Only 3 were seen up to 1 year. Improvement in the care of such patients is expected since a neurosurgical unit has now been established.

Encephalocele↗

Control of the internal anal sphincter (manometric study with human subjects).

Manometric studies of the functions of the internal anal sphincter were performed in 73 children. Twenty-one out of these patients were normal subjects, the others had neurological lesions either central (sacral meningocele, dorsal cord transections) or peripheral (Hirschsprung's disease). It was found that the functions of the internal sphincter do not depend upon mechanical factors and are subject to nervous control. The pathways for control of the basal sphincteric tone are discussed. It is likely that this tone depends not only of the sympathetic pathways, but also of fibers of the sacral outflow. It is shown that the recto-anal inhibitory reflex is specific and independent of peristalsis. Arguments are given to prove that this reflex is an activity proper to the intra-mural plexus which is, however, subject to and regulated by the sacral cord.

Acute Disease↗

Chronic post-traumatic erosion of the skull base.

Delayed post-traumatic erosion of the skull base is reported in three patients who presented as adults with cerebrospinal fluid fistulae and a history of recurrent meningitis. These skull defects were associated with herniation of the subarachnoid space into the diploe of the skull base, the paranasal sinuses and the orbit. This rare complication of head injury is assumed to have occurred as the result of a dural tear at the time of trauma. Its site probably determines whether a resulting meningocele widens the intradiploic space or broaches the cranial floor.

Adult↗

Cephaloceles - experience with 42 patients.

Forty-two patients with 44 cephaloceles treated between 1966 and 1993 are presented. Eighteen lesions were occipital, 2 parietal, 1 at the anterior fontanelle, 11 sincipital, and 12 basal. In recent years computerized tomography (CT) and magnetic resonance imaging (MRI) provided better information on the site and nature of the lesion as well as on associated malformations. Different malformations were associated more frequently with the cranial vault lesions. Cerebrospinal fluid (CSF)-rhinorrhea was the most frequent clinical sign in the basal lesions. Excision of the cele was performed in all but one case. The age at the time of surgical treatment ranged from 1 day to 11 years. Seven patients were shunted. Post-operative complications were persisting CSF-leaks in 5 patients needing operative revision and 2 infections. The outcome was good in the anterior lesions and in the occipital meningoceles.

Child↗

Lumbo-peritoneal shunt in non-hydrocephalic patients. A review of 41 cases.

A population of 41 non-hydrocephalic patients in whom a lumbo-peritoneal shunt (LPS) was inserted for various conditions is reviewed. 19 had persistent cerebro-spinal fluid rhinorrhoea following cranial injury, basal skull surgery or of unknown origin, 3 had recalcitrant benign intra-cranial hypertension, 14 had a persistent bulging craniotomy site after operations for intra-cranial tumours or head trauma, 4 had syringomyelia and 1 had a postoperative cervical meningocele. There was no shunt-related mortality. LPS was effective in treating the initial symptomatology in 31 patients. Further revision or removal of LPS were needed on 9 occasions in 8 patients showing shunt-related mechanical or infectious complications or persistent postural headaches. This report demonstrates the safety of the LPS procedure experienced in another population of 146 patients with communicating hydrocephalus operated on in the meantime. According to the authors' experience, the versatility of the clinical applications of LPS seems well established. LPS should be considered when a CSF diversion is required in patients showing absent or minimal ventricular enlargement in the CT scan.

Adult↗

Bone replacement by ionomer cement in osteoplastic frontal sinus operations.

Ionomer-based cement is a new bone replacement material. After promising results in middle ear and skull base surgery, we started to use Ionocap as an alternative to metal osteosynthesis material. Between 1992 and 1995, 20 men and 9 women were treated with an osteoplastic approach for complicated frontal sinus diseases at Johann Wolfgang Goethe University. Ionocap as bonding material for bone was used in 22 of the patients. The indications for osteoplastic surgery were recurrent frontal rhinosinusitis, mucoceles, skull base fractures, osteomas and meningocele. The surgical procedure using bone cement was found to be much easier and shorter, the functional stability achieved was at least equal and the cosmetic outcome was clearly superior when compared to cases done with metal osteosynthesis. No rejection of the material or osteonecrosis was observed. In no case was the cement placed in direct contact to dura mater. Our findings show that ionomer-based cement can be recommened in osteoplastic frontal sinus surgery, but Ionocap should only be used strictly according to the guidelines of the supplier.

Adolescent↗

Lumbar nerve root avulsions with secondary ipsilateral hip dysplasia in a child.

We report on an 8-year-old child with avulsions of the left L3, L4 and L5 nerve roots and traumatic meningoceles that were not associated with lumbar spine or pelvic girdle fractures. The patient had a history of a road traffic accident. Plain radiographs of the pelvis revealed left hip dysplasia. The magnetic resonance imaging findings of the lumbar spine are illustrated. The pathogenesis of lumbar nerve root avulsions and their association with ipsilateral hip dysplasia are discussed.

Child↗

Developmental nasal midline masses in children: neuroradiological evaluation.

Developmental nasal midline masses in children are rare lesions. Neuroimaging is essential to characterise these lesions, to determine the exact location of the lesion and most importantly to exclude a possible intracranial extension or connection. Our objective was to evaluate CT and MRI in the diagnosis of developmental nasal midline masses. Eleven patients (mean age 4.5 years) with nasal midline masses were examined by CT and MRI. Neuroimaging was evaluated for (a) lesion location/size, (b) indirect (bifid or deformed crista galli, widened foramen caecum, defect of the cribriform plate) and direct (identification of intracranially located lesion components or signal alterations) imaging signs of intracranial extension, (c) secondary complications and (d) associated malformations. Surgical and histological findings served as gold standard. Nasal dermoid sinus cysts were diagnosed in 9 patients. One patient was diagnosed with an meningocele and another patient with a nasal glioma. Indirect CT and MRI signs correlated with the surgical results in 10 of 11 patients. Direct CT findings correlated with surgery in all patients, whereas the direct MRI signs correlated in 9 of 11 patients. In 2 patients MRI showed an intracranial signal alteration not seen on CT. Neuroimaging corrected the clinical diagnosis in 1 patient. One child presented with a meningitis. In none of the patients was an associated malformation diagnosed. Intracranial extension is equally well detected by CT and MRI using indirect imaging signs. Evaluating the direct imaging signs, MRI suspected intracranial components in 2 patients without a correlate on CT. This could represent an isolated intracranial component that got undetected on CT and surgery. In 9 patients CT and MRI matched the surgical findings. The MRI did not show any false-negative results. These results in combination with the multiplanar MRI capabilities, the different image contrasts that can be generated by MRI and the lack of radiation favour the use of MRI as primary imaging tool in these young patients in which the region of imaging is usually centred on the radiosensitive eye lenses.

Adolescent↗

Unusual causes of spinal foraminal widening.

Spinal neural foraminal widening is usually caused by benign lesions, most commonly neurofibromas. Rare lesions can also cause spinal neural foraminal widening. Computed tomography and/or MRI are the modalities of choice for studying the spinal foraminal widening. The present pictorial review describes six rare lesions, namely a lateral thoracic meningocele, a malignant fibrous histiocytoma, a tuberculous abscess, an osteoblastoma, a chondrosarcoma and a malignant tumour of the lung which caused spinal neural foraminal widening.

Chondrosarcoma↗

The spectrum of imaging in Currarino triad.

The aim of this study was to evaluate the spectrum of findings and the efficacy of different imaging modalities in order to formulate recommendations for diagnostic imaging of Currarino triad (ASP syndrome), including screening of relatives. The imaging films of five female patients (age range 6 weeks to 12 months) were analysed retrospectively. The studied material consisted of US and MRI of the lower spine (5 patients each), lumbosacral plain radiography (4 patients), contrast enema (4 patients), urinary US (2 patients), genitography (1 patient) and myelo-CT (1 patient). Depiction of pathological findings with different imaging modalities was reviewed and validated with special respect to their demonstrability by US. Ultrasonography detected the sacral bony defect as well as the presacral pathology (meningocele and/or tumour) and thereby gave the basic diagnosis in all of the cases. It also depicted tethered cord and urinary tract abnormalities correctly. Magnetic resonance imaging gave a more distinct visualization of pre- and intraspinal pathology with additional demonstration of intraspinal lipoma in two cases. Regarding anorectal and genital malformations, radiographic contrast agent studies had been used in all patients. Two blind-ending retrorectal fistulas, depicted by enema, were missed by MRI. Patients with congenital or early infancy obstipation, anorectal malformations and complex urinary tract malformations should have spinal and pelvic sonography first. A plain film of the sacrum is recommended in equivocal cases. The need for MRI and contrast agent studies depends on the individual pathology, whereas presently MRI has made further radiographic imaging increasingly dispensable. A screening program with lumbosacral US or plain radiography for families with Currarino triad should be obligatory.

Abnormalities, Multiple↗

The significance of the percentage of the defect size in spina bifida cystica in determination of the surgical technique.

AIM: Our aim was to classify meningoceles and meningomyeloceles in terms of defect area as a percentage of the thoracolumbar region to make it possible to select the surgical technique accordingly. MATERIALS AND METHODS: Thirty-two cases were included in the study program. Any defect smaller than 8% of the thoracolumbar region was primarily sutured and classed as grade 1. RESULTS: The defects that it was not possible to handle with primary suture because of the broad base and thereby closed with muscle-skin flaps were those occupying more than 8% of the thoracolumbar region and these were classed as grade 2. It was not possible to perform primary repair of any defect occupying more than 8% of the thoracolumbar area. CONCLUSION: The use of combined latissimus dorsi+gluteus maximus muscle-skin flaps was found to be safe in broad-based meningomyelocele defects, as they provide wider closures and permanent bolstering of the meningomyelocele defect, thus protecting the region against multiple trauma.

Female↗

Prenatal diagnosis of diastematomyelia.

INTRODUCTION: Diastematomyelia, also termed split cord malformation, is a form of occult spinal dysraphism characterized by a cleft in the spinal cord. Prenatal diagnosis of this anomaly is possible by ultrasonography (US), and fetal MRI can be used to diagnose the type of diastematomyelia precisely. Diastematomyelia can be isolated or associated with other dysraphisms, segmental anomalies of the vertebral bodies, or visceral malformations (horseshoe or ectopic kidney, utero-ovarian malformation, and anorectal malformation). We present three cases of fetal diastematomyelia investigated using a multimodal prenatal work-up (US, MRI, 3D-CT). CASES: The first case, detected at 20 weeks' gestation, had a lumbar meningocele. At 30 weeks' gestation, direct US visualization revealed the division of the spinal cord into two hemicords. This patient illustrates an isolated type II diastematomyelia with a favorable prognosis. The second case, detected at 22 weeks' gestation, presented with disorganization of bony process of the vertebral column with a midline echogenic bony spur, asymmetrical hemicords, and a foot malposition. Fetal MRI at 26 weeks' gestation and CT/3D reconstructed at 32 weeks' gestation confirmed a type I diastematomyelia with orthopedic malposition. The third case, detected at 22 weeks' gestation, presented with widening of the lumbar canal and scoliosis. Prenatal work-up (US, MRI) disclosed other visceral malformations (pelvic kidney), which led to the assumption of a complex polymalformative syndrome. The pregnancy was terminated. Fetopathologic examination disclosed even more visceral malformations (anal atresia and unicorn uterus).

Adult↗

Epilepsy in patients with spina bifida in the lumbosacral region.

This study aimed to assess the relevance of epilepsy and spina bifida in the lumbosacral region. We evaluated 75 patients with spina bifida admitted to the Kyushu University Hospital from 1980 to 2004. Patients were classified as having meningocele (MC, 4 cases), myelomeningocele (MMC, 6), myeloschisis (MS, 45), and lumbosacral lipoma (LL, 20). Nine cases had epileptic disorders, and all showed MS. Meticulous neuroradiological investigations revealed cerebral abnormalities such as polymicrogyria or hypogenesis of the corpus callosum in all epileptic cases. Locations of cerebral abnormalities topographically correlated with areas of interictal EEG abnormalities. Although all epileptic cases had ventriculoperitoneal (VP) shunt for hydrocephalus before the onset of epilepsy, interictal EEG abnormalities could not be explained by location of the VP shunt. In all LL patients, neither history of epilepsy nor cerebral abnormalities were noted on magnetic resonance imaging (MRI). Epileptogenesis in spina bifida patients seemed to correlate with coexisting cerebral abnormalities in MS patients rather than with the VP shunt. However, not all spina bifida patients associated with cerebral abnormalities had epilepsy, and not all cerebral abnormalities were epileptogenic, suggesting that epilepsy in spina bifida patients was multifactorial.

Adolescent↗

Neuroradiological investigations in cervical root avulsion.

Cervical myelography in combination with CT myelography is not fully reliable to demonstrate a partial or complete cervical root avulsion. MRI scanning can demonstrate large traumatic meningoceles or additional lesions, such as intramedullary or extradural haematomas, but not a root avulsion. In experimental conditions MR microscopy enables visualization of the avulsed root separated from the spinal cord. The anterior funiculus shows transverse tracts left behind by the avulsion at the original site of the motor fibres. However, the small bore of the current high field magnets and the very long acquisition time makes this method, as yet, unsuitable for application in man.

Brachial Plexus↗