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PubMed1985

Stab wounds at the craniocervical junction.

Between 1976 and 1984, 11 patients with stab wounds at the craniocervical junction were seen in the Department of Neurosurgery at Groote Schuur Hospital. The injury usually occurred in males, and the left side was predominantly involved. Because of the anatomical features of this region, the penetrating instrument is deflected by the occipital squama into the atlantooccipital or atlantoaxial interspace, and an almost predictable syndrome occurs. The dura mater is penetrated, so that cerebrospinal fluid leakage and meningitis are common complications (meningitis occurred in 5 patients). A meningocele may develop at this site and did occur in 4 patients, but only 2 required surgical repair. Because of the exposed position of the vertebral artery at this level, this vessel was injured in 4 patients; an arteriovenous fistula developed in 2, vertebral artery occlusion occurred in 1, and a false aneurysm developed in another patient. The neurological deficit varied in magnitude, was often transient, affected the upper limbs more than the lower, was asymmetrical (suggestive of lateralized injury), and at times showed a remarkable tendency to recover. Awareness of the existence of this syndrome may help in forestalling complications. The only warning sign may be an insignificant wound in the suboccipital or retromastoid region.

Adolescent↗
PubMed1986

Spinal cord tumors presenting with neural tube defects.

Two primary lumbosacral tumors arising at the site of neural tube defects are presented. One was a teratoma diagnosed in an infant with myelomeningocele. The other was an ependymoma that developed in an adult with meningocele. It is postulated that these cases represent a neoplastic transformation of heterotopic primordial elements that have been incorporated within the defect, supporting the view that overgrowth of neural tissue may be the result rather than the cause of neural tube deformity. Such rare occurrences may be due to interaction between intrauterine teratogenic factors and familial predisposition in affected patients.

Adult↗
PubMed1992

Postlaminectomy lumbar pseudomeningocele: report of four cases.

Pseudomeningocele formation is unusual after a lumbar discectomy. Four patients who developed a pseudomeningocele after lumbar disc surgery are reported. The pseudomeningocele was symptomatic in three patients. The diagnosis of a pseudomeningocele was made by computed tomography in conjunction with myelography in three patients and magnetic resonance imaging in the fourth. All patients underwent surgery for the pseudomeningocele with primary closure of the dural defect (the patient whose meningocele was asymptomatic also had an excision of an extruded disc), and postoperative results were gratifying.

Adolescent↗
PubMed1995

Split notochord syndrome: case report.

Split notochord syndrome includes a cleft of the vertebral column associated with malformation of the central nervous system. Fourteen cases involving the lumbosacral spine have been reported in the literature. We report on a female neonate who had intact function of her lower extremities, a posterior midline lumbar defect bounded by two complete spinal canals that contained two spinal cords. A meningocele, a large bowel fistula, and a mature teratoma protruded through the cleft. The baby is doing well after repair of the anomaly and placement of a ventriculoperitoneal shunt.

Arnold-Chiari Malformation↗
PubMed2000

Bilateral defects of the tegmen tympani associated with brain and dural prolapse in a patient with pulsatile tinnitus.

A pulsating ear drum is a rare otological finding and usually indicates a vascular pathology. We report the case of a woman who presented with pulsatile tinnitus following an upper respiratory tract infection. She was found to have bilateral pulsating tympanic membranes on otological examination, in association with bilateral dehiscence of the tegmen tympani and a spontaneous encephalocele on the right side and a meningocele on the left side, demonstrated on computerized tomography (CT) scan of her temporal bones.

Encephalocele↗
PubMed2002

Spontaneous CSF rhinorrhoea from separate defects of the anterior and middle cranial fossa.

Multiple congenital dehiscence of the skull base is rare and can give rise to spontaneous CSF rhinorrhoea. A search of the world literature revealed only five reports of CSF leak with more than one concomitant skull base defect. When treating a patient with spontaneous CSF rhinorrhoea the possibility of its originating from the middle ear and eustachian tube should be considered. An intrathecal injection of fluorescein is useful in establishing the site of a CSF leak especially when a computed tomography scan (CT) or magnetic resonance image (MRI) has not localized the site. We discuss a case of a 72-year-old lady presenting with CSF rhinorrhoea, who had an anterior skull base defect localized with the help of intrathecal fluorescein and repaired surgically. Subsequent to this she had a further episode of CSF rhinorrhoea that originated from a middle-ear meningocele that was then repaired.

Aged↗
PubMed1988

Cervical myelography of nerve root avulsion injuries using water-soluble contrast media.

Eight cases of cervical nerve root avulsion injury are presented which were investigated by cervical myelography using a water-soluble contrast medium. The previous literature describes the appearances of this lesion using an oil-based agent and has resulted in emphasis being placed on looking for a traumatic meningocele rather than an abnormality of the roots themselves. The excellent definition of the nerve rootlets and axillary pouch that are obtained with a water-soluble contrast medium resulted in more root lesions per patient being detected than with an oil-based medium. There was complete correlation with the surgical findings at all but one root level explored. The appearances of root avulsion injuries and the advantages of using a water-soluble contrast medium are discussed.

Adolescent↗
PubMed1985

Mondini's dysplasia with recurrent meningitis.

This report describes the diagnosis and surgical management of two patients with similar inner ear malformations resulting in recurrent otitic meningitis. Each patient had a meningocele presenting through the oval window associated with Mondini's anomaly. Details of radiographic diagnosis and surgical management strategies will be discussed and long-term follow-up presented.

Ear, Inner↗
PubMed1997

Magnetic resonance myelography in brachial plexus injury.

We used magnetic resonance (MR) myelography in ten patients with injuries to the brachial plexus and compared the findings with those obtained by conventional myelography and postmyelographic CT (CTM). In the presence of complete nerve-root avulsion (seven cases), a post-traumatic meningocele was detected by MR myelography. In injuries to the upper roots (three cases) MR myelography showed abnormal findings with a high signal intensity in the nerve root, obliteration of the damaged nerve root, or enlargement and obliteration of the root sleeve. No pseudomeningoceles were detected in these upper-root injuries by MR myelography and CTM. The overall accuracy of detection of damaged nerve roots or root sleeves was better with MR myelography than with conventional myelography and was similar to that of CTM. MR myelography is non-invasive, relatively quick, requires no contrast medium, provides imaging in multiple projections, and is comparable in diagnostic ability to the more invasive, time-consuming techniques of conventional myelography and CTM.

Adolescent↗
PubMed1983

A new understanding of dorsal dysraphism with lipoma (lipomyeloschisis): radiologic evaluation and surgical correction.

The spinal anomaly designated dorsal dysraphism with lipoma (lipomyeloschisis) consists of skin-covered, focal spina bifida; focal partial clefting of the dorsal half of the spinal cord; continuity of the dorsal cleft with the central canal of the cord above (and occasionally below) the cleft; deficiency of the dura underlying the spina bifida; deep extension of subcutaneous lipoma through the spina bifida and the dural deficiency to insert directly into the cleft on the dorsal half of the cord; variable cephalic extension of lipoma into the contiguous central canal of the cord; and variable ballooning of the subarachnoid space to form an associated meningocele. The variable individual expressions of the anomaly are best understood by reference to their archetypal concept. Careful analysis of radiographic and surgical findings in human lipomyeloschisis and correlation with an animal model of lipomyeloschisis indicate that plain spine radiographs and high-resolution metrizamide computed tomographic myelography successfully delineate the precise anatomic derangements associated with lipomyeloschisis and provide the proper basis for planning surgical therapy of this condition.

Adult↗
PubMed1987

Intraoperative sonography in spinal dysraphism and syringohydromyelia.

The use of intraoperative sonography was analyzed in 24 patients with spinal dysraphism and syringohydromyelia in order to determine the role of real-time sonography in the surgical management of these patients. Specific diagnoses included tethered cord (nine), syringohydromyelia (seven), congenital tumor unassociated with a tethered cord (four), diastematomyelia (three), and occult sacral meningocele (one). Intraoperative sonography determined the exact relationship of congenital tumors to the cord before opening the dura, which allowed a more precise approach to the mass. Intraoperative sonography identified the lower end of the syrinx cavities, which allowed optimal catheter placement. Fibroglial scar tissue, which may compartmentalize these syrinx cavities, was clearly shown, and the efficacy of shunt catheter placement was immediately determined. In diastematomyelia, intraoperative sonography identified the relationship of the hemicords to bony, cartilaginous, and/or fibrous septa and demonstrated the effect on the tethered hemicords of removing these septa and constructing a single dural sac from the two dural sacs that had enclosed the hemicords. Since significant surgical decisions are based on these sonographic observations, the authors urge widespread use of intraoperative sonography in patients with spinal dysraphism and syringohydromyelia.

Humans↗
PubMed1981

Congenital ventriculocisternostomy. Case report.

A case of congenital ventriculocisternostomy is reported. This infant presented with occipital meningocele. Conray ventriculography demonstrated a spontaneous ventriculocisternostomy and stenosis of the aqueduct. The case is discussed and pertinent literature reviewed.

Adolescent↗
PubMed1990

Postlaminectomy ossified extradural pseudocyst. Case report.

A large ossified spurious meningocele accompanied by recurrent lumbar disc herniation occurred 7 years after posterior intervention for laminectomy and discectomy in a 53-year-old man. The cyst wall, histologically composed of mature bone tissue, was sparsely covered with connective tissue and lined with fibrocyte- or fibroblast-like cells on the inside. The ossified pseudocyst was presumed to have originated from a minute defect in the dura mater which occurred at the time of the first operation.

Calcinosis↗
PubMed2004

Neurocutaneous melanosis associated with Dandy-Walker malformation and a meningohydroencephalocele. Case report.

Neurocutaneous melanosis and Dandy-Walker malformation are both forms of rare congenital neurodysplasia. Interestingly, 8 to 10% of patients with neurocutaneous melanosis also harbor an associated Dandy-Walker malformation, indicating that these developmental abnormalities share a common origin. The authors describe a case of neurocutaneous melanosis associated with Dandy-Walker malformation and an occipital meningohydroencephalocele with a giant melanotic nevus. Multiple congenital liver masses were also observed in the infant. The occipital nevus was totally excised, and ventriculoperitoneal and cyst-peritoneal shunts were created to prevent subsequent hydrocephalus. Findings in this case support the possibility that excessive melanocytes hinder normal mesenchymal development, causing Dandy-Walker malformation and an occipital meningocele.

Dandy-Walker Syndrome↗
PubMed2005

Terminal myelocystocele.

OBJECT: The authors describe the cases of eight patients with terminal myelocystoceles and report on their initial diagnoses, neuroimaging findings, surgical procedures, and clinical follow-up examinations. METHODS: There were seven girls and one boy. The initial age at diagnosis ranged from prenatal age (determined by imaging) to 14 years. Operative correction was performed from 6 weeks to 14 years of age. One patient presented with a large prevertebral (intraabdominal) meningocele. Four patients have associated abdominal wall defects and are significantly handicapped. Two are wheelchair bound and the other two ambulate with prosthetic devices; all are incontinent. The four patients without abdominal wall defects are fully ambulatory; one wears an ankle-foot orthosis. One patient has normal bowel and bladder functions, and the other three require intermittent clean catheterization. No patient to date has had clinical evidence of retethering, although a low-set conus medullaris and residual lipoma were visible on postoperative neuroimaging. No patient in this series had hydrocephalus or Chiari malformation. CONCLUSIONS: It is concluded that patients with myelocystoceles without abdominal wall defects have a favorable neurological outcome when compared with those having ventral wall defects.

Abdominal Wall↗
PubMed2000

[Occipital encephalocele and epilepsy].

We report the incidence of epilepsy in 7 patients with occipital encephalocele (meningocele: 6 cases, meningoencephalocystocele: 1 case). Two cases had epilepsy and a case without the history of epileptic seizure had an epileptic pattern on the EEG. All these 3 cases had cortical dysplasia(CD) such as schizencephaly and subcortical gray matter, and two of them were associated with mental retardation. The location of the prominent CD was correlated with the EEG abnormalities and clinical epileptic pattern in each case. Associated hydrocephalus and placement of VP shunt had no significant influence on the occurrence of the epilepsy. Thus, complicated CD is thought to be epileptogenic in patients with occipital encephalocele.

Adolescent↗
PubMed1976

[Possibilities of differential diagnosis for positive ventriculography in children (author's transl)].

On the basis of 112 positive ventriculographies showing enlargement of the ventrical system in children and adolescents and excluding supratentorial processes, the possibilities and limitations of ventriculographic differential diagnosis were presented. Pathognomonic findings were found in inflammatory aquaduct occlusions and in meningoceles combined with hydrocephaly. In neoplastic or otherwise induced ventricular enlargement, statements can be made only in regard to the localization and often to the extent of the process. In spite of these limitations, the advantages of the positive contrast are obvious.

Adolescent↗
PubMed2000

[An unusual thoracic opacity].

We report a case of a paraspinal meningocele in a 37-year-old man with no other clinical manifestation. The diagnosis was established on the basis of the computed tomography and magnetic resonance imaging features.

Adult↗