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Chao AS, Jhang LS, Hsieh PCC. Prenatal Diagnosis and Outcomes of Cervical Meningocele and Myelomeningocele. J Med Ultrasound 2024; 32:21-24. [PMID: 38665341 PMCID: PMC11040477 DOI: 10.4103/jmu.jmu_51_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 05/03/2023] [Indexed: 04/28/2024] Open
Abstract
Prenatal diagnosis of myelomeningocele remains challenging for obstetricians, ultrasonographers, and radiologists, although the increased maternal serum alpha-fetoprotein level aids in the confirmative diagnosis. Fetal cervical myelomeningocele and meningocele are very rare and unique types of myelomeningocele. Prenatal diagnosis of cervical myelomeningocele and meningocele should include the differential diagnosis and association of many intracranial and spino-skeletal pathogenetic variants and genetic diseases, including subependymal nodular heterotopia and Klippel-Feil syndrome. In this report, a comprehensive review of fetal cervical myelomeningocele with its prenatal diagnosis and long-term outcomes is presented.
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Affiliation(s)
- An-Shine Chao
- Department of Obstetrics and Gynecology, New Taipei Municipal Tucheng Hospital, New Taipei, Taiwan
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital and University, Taoyuan, Taiwan
| | - Lan-Sin Jhang
- Department of Obstetrics and Gynecology, New Taipei Municipal Tucheng Hospital, New Taipei, Taiwan
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital and University, Taoyuan, Taiwan
| | - Peter Ching-Chang Hsieh
- Department of Obstetrics and Gynecology, New Taipei Municipal Tucheng Hospital, New Taipei, Taiwan
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital and University, Taoyuan, Taiwan
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Safari H, Jahangiri Babadi A, Alizadeh P, Ajudani R, Hamidi S. Huge unrepaired myelocystocele, progressive sac enlargement in later stages of life: a case report. Br J Neurosurg 2022:1-4. [PMID: 36074342 DOI: 10.1080/02688697.2022.2118235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 03/22/2022] [Accepted: 08/23/2022] [Indexed: 11/02/2022]
Abstract
BACKGROUND Spinal dysraphism is characterized by failure of fusion at dorsal midline structures through the embryonic developmental stages. A terminal myelocystocele consists of a skin-covered lumbosacral spina bifida and meningocele that directly continuous with the spinal subarachnoid space. OBSERVATION A 43-year-old woman who was diagnosed at birth with myelocystocele in the lower segments of the lumbar spine. She was not operated in the early stages of life. At the 43th years of her old, during 9-months, the sac began to progressively increase in size. In our initial examination before surgery, an extremely large skin-covered myelocystocele sac was observed in the thoracolumbar with a diameter of approximately 60 * 70 * 40 cm. patient operated and sac repaired. More than 20 liter of cerebrospinal fluid drainaged from cyst during surgery. LESSONS The mechanism of cyst enlargement is not well understood. Progressive and severe increase in size of unrepaired myelocystocele sac is possible in old ages even without cerebral hydrocephalus.
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Affiliation(s)
- Hosein Safari
- Department of Neurosurgery, Ahvaz Anesthesiology and Pain Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Armin Jahangiri Babadi
- Department of Neurosurgery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Pooyan Alizadeh
- Department of Neurosurgery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Reza Ajudani
- Department of Neurosurgery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Soroor Hamidi
- Department of Neurosurgery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Berchi Kankam S, Ashrafi M, Tayebi Meybodi K, Sotoudeh Anvari M, Habibi Z, Nejat F. Lumbosacral non-terminal myelocystocele associated with teratoma: case report and review of literature. Childs Nerv Syst 2022; 38:1229-1232. [PMID: 34515813 DOI: 10.1007/s00381-021-05361-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 09/05/2021] [Indexed: 10/20/2022]
Abstract
Non-terminal myelocystoceles are commonly found in the cervical or thoracic spinal region. Their sac can rarely be associated with tumor. A rare case of an infant with a lumbosacral non-terminal myelocystocele and accompanying mature teratoma is reported in whom the tumor was attached to the placode not as a part of the sac.
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Affiliation(s)
- S Berchi Kankam
- Department of Pediatric Neurosurgery, Children's Medical Center, Tehran University of Medical Sciences, Tehran, 1419733151, Iran
| | - M Ashrafi
- Department of Pediatric Neurosurgery, Children's Medical Center, Tehran University of Medical Sciences, Tehran, 1419733151, Iran
| | - K Tayebi Meybodi
- Department of Pediatric Neurosurgery, Children's Medical Center, Tehran University of Medical Sciences, Tehran, 1419733151, Iran
| | - M Sotoudeh Anvari
- Department of Pediatric Pathology, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Z Habibi
- Department of Pediatric Neurosurgery, Children's Medical Center, Tehran University of Medical Sciences, Tehran, 1419733151, Iran
| | - F Nejat
- Department of Pediatric Neurosurgery, Children's Medical Center, Tehran University of Medical Sciences, Tehran, 1419733151, Iran.
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Mehrotra A, Singh S, Gupta S, Pandey S, Sardhara J, Das KK, Bhaisora KS, Srivastava AK, Jaiswal AK, Behari S. Cervicothoracic Spinal Dysraphism: Unravelling the Pandora's Box. J Pediatr Neurosci 2020; 14:203-210. [PMID: 31908661 PMCID: PMC6935989 DOI: 10.4103/jpn.jpn_28_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 06/23/2019] [Accepted: 09/04/2019] [Indexed: 11/04/2022] Open
Abstract
Introduction Cervicothoracic spinal dysraphism (CTSD) is relatively rare with reported incidence of 1%-6.5%. The entity has a separate spectrum of associations with other anomaly such as split cord malformation, Chiari malformation, and corpus callosum agenesis as compared with its lumbosacral counterpart. In this study, we have highlighted the associated anomalies (AAs). To the best of our knowledge, this study is one of the largest series reported before. Materials and Methods In this study, we included the patients with spinal dysraphism operated between December 2007 and December 2017 at the Department of Neurosurgery. All patients underwent neurological and radiological examinations followed by surgical excision of the sac and exploration of the intradural sac. Neurological, orthopedic, and urological abnormalities were analyzed in our retrospective description. The last available follow-up in hospital records was taken for outcome assessment. Results Of 34 cases, 18 were women and 16 were men. Seven of nine patients in cervical group had AAs, whereas 22 of 25 patients in dorsal group had AA. In this study, we taken 6 patients with Chiari malformation, 4 with corpus callosum agenesis, 7 with hydrocephalus, and 16 with split cord malformation. The follow-up ranges from 1 year to 11 years with a mean of 59.45 months. Conclusion The management strategy and association with other congenital anomalies separate CTSD as different clinical entity as compared with their lumbosacral counterparts. These patients show relatively favorable outcome with regard to neurological, orthopedic, and urological symptoms. Early surgical intervention after proper radiological and clinical evaluation is recommended.
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Affiliation(s)
- Anant Mehrotra
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGI), Lucknow, Uttar Pradesh, India
| | - Suyash Singh
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGI), Lucknow, Uttar Pradesh, India
| | - Shruti Gupta
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGI), Lucknow, Uttar Pradesh, India
| | - Satyadeo Pandey
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGI), Lucknow, Uttar Pradesh, India
| | - Jayesh Sardhara
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGI), Lucknow, Uttar Pradesh, India
| | - Kuntal K Das
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGI), Lucknow, Uttar Pradesh, India
| | - Kamlesh S Bhaisora
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGI), Lucknow, Uttar Pradesh, India
| | - Arun K Srivastava
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGI), Lucknow, Uttar Pradesh, India
| | - Awadhesh K Jaiswal
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGI), Lucknow, Uttar Pradesh, India
| | - Sanjay Behari
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGI), Lucknow, Uttar Pradesh, India
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Chandra RVV, Kumar PM. Cervical myelocystocele: Case report and review of literature. J Pediatr Neurosci 2011; 6:55-7. [PMID: 21977091 PMCID: PMC3173918 DOI: 10.4103/1817-1745.84410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Dysraphisms involving cervical region are very rare and there are very few series describing their follow-up in literature. Here, we report a 6-year-old boy who underwent postnatal “cosmetic” repair of posterior cervical cystic lesion and presented to us with a large recurrence with syringohydromyelia and tethering. Tethered cord should be suspected in the presence of meningocele and intact neurology. Treatment protocols of such complicated cervical spinal dysraphisms should include intradural exploration and detethering, with an aim to prevent neurological deterioration in future.
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Affiliation(s)
- Ramesh V V Chandra
- Department of Neurosurgery, GSL Medical College and General Hospital, Rajahmundry, India
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Lotfi M, Iranpour P, As'adi K. Cervical meningocele associated with subependymal nodular heterotopia. Clin Imaging 2011; 35:214-6. [DOI: 10.1016/j.clinimag.2010.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2010] [Accepted: 04/15/2010] [Indexed: 11/28/2022]
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OCHIAI H, KAWANO H, MIYAOKA R, NAGANO R, KOHNO K, NISHIGUCHI T, SHIMAO Y. Cervical (Non-terminal) Myelocystocele Associated With Rapidly Progressive Hydrocephalus and Chiari Type II Malformation -Case Report-. Neurol Med Chir (Tokyo) 2010; 50:174-7. [DOI: 10.2176/nmc.50.174] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | - Ryo MIYAOKA
- Department of Neurosurgery, Miyazaki Prefectural Hospital
| | - Rie NAGANO
- Department of Pediatrics, Miyazaki Prefectural Hospital
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Huang SL, Shi W, Zhang LG. Characteristics and surgery of cervical myelomeningocele. Childs Nerv Syst 2010; 26:87-91. [PMID: 19693514 DOI: 10.1007/s00381-009-0975-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2009] [Revised: 07/21/2009] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Cervical myelomeningocele (CMMC) is a rare entity in neurosurgical practice, which presents different clinical characteristics compared with other more common lumbosacral variant. Since not much about this lesion has been reported in the literature, this study, herein, demonstrates by cases the clinical characteristics, methods, and techniques of surgical treatment of CMMC in children. METHODS A total of 10 children (six boys and four girls) with CMMC were recruited in this study. Their ages ranged from 9 days to 8 years with a median age of 3 months. All patients underwent neurological and radiological examinations. One was found to have had a mild unilateral arm weakness, and others were neurologically intact. Of these 10 patients, five had other associated neurological or orthopedic anomalies, including mild ventriculomegaly in two, cervical diastematomyelia in one, Chiari II malformation and hydrocephalus in one, and sacral spina bifida occulta in one. Surgical excision of the lesion with intradural exploration of the sac to release any potential adhesion bands was performed for all. RESULTS No complications, such as cerebrospinal fluid leakage and infection, had been found after operation. During the follow-up of 1-7 years (mean of 3.9 years), all cases did not suffer from aggravation of nervous symptoms. None of the patients deteriorated postoperatively, and the one with left arm weakness improved following surgery. In the two children with mild ventriculomegaly, cerebral ventricle returned to be normal after surgery. CONCLUSIONS The management strategies of CMMC are early surgical treatment with standard microneurosurgical techniques to prevent the development of neurological defects. It is safe and effective to adopt surgery excision of the lesions with intradural exploration of the sac to release any potential adhesion bands.
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Affiliation(s)
- Sheng-Li Huang
- Department of Neurosurgery, The Second Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an, China
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Denaro L, Padoan A, Manara R, Gardiman M, Ciccarino P, d'Avella D. Cervical myelomeningocele in adulthood: case report. Neurosurgery 2008; 62:E1169-71; discussion E1171. [PMID: 18580788 DOI: 10.1227/01.neu.0000325883.98246.64] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Cervical myelomeningocele is an extremely rare condition, accounting for only 1 to 5% of all neural tube defects. These lesions are usually diagnosed in childhood. Here, we report a case of a cervical myelomeningocele diagnosed and treated in adulthood. CLINICAL PRESENTATION A 52-year-old man presented with a 3-year history of progressing weakness and paresthesia in his upper limbs. Physical examination revealed a posterior midline neck mass covered with normal skin. Magnetic resonance imaging showed a soft-tissue mass tethering the cord by a stalk extending from the dorsal spinal cord to the dome of the lesion. Syrinx was evident cranially and caudally to the origin of the posterior stalk. INTERVENTION Surgical resection of the sac and intradural exploration were performed. The subdural space was explored, and the tethered structures were released. Histological examination showed small foci of meningothelial cells with psammoma bodies and rare thin fascicle of glial tissue dispersed in hyaline tissue. Immunohistochemical stains against glial fibrillary acidic protein and S100 confirmed the presence of bands of astrocytic tissue. The patient demonstrated early improvement of neurological deficits. Six months after surgery, he was asymptomatic and magnetic resonance imaging showed resolution of the syrinx. CONCLUSION We believe the syrinx in this patient was caused by a blockade of flow in the central canal and around the spinal cord as a result of the tethered cord. The untethering procedure resulted in the collapse of the syrinx followed by resolution of neurological deficits.
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Affiliation(s)
- Luca Denaro
- Department of Neurosurgery, Catholic University School of Medicine, Rome, Italy.
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Rodríguez-Cano L, Bartralot R, García-Patos V, Mollet J, Malagelada A, Castells A. Cervico-thoracic lipoma associated with occult syringohydromyelia. Pediatr Dermatol 2007; 24:E76-8. [PMID: 17958787 DOI: 10.1111/j.1525-1470.2007.00447.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Cutaneous lesions in the midline may be hallmarks of an occult spinal dysraphism. They rarely may occur in the cervical and thoracic regions. We report a 9-year-old girl with a cervico-thoracic lipoma associated with an underlying syringohydromyelia. Early detection of potentially complicated conditions can prevent the occurrence of irreversible neurologic damage.
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Affiliation(s)
- L Rodríguez-Cano
- Department of Dermatology, Hospital Vall d'Hebron, Barcelona, Spain.
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Salomão JF, Cavalheiro S, Matushita H, Leibinger RD, Bellas AR, Vanazzi E, de Souza LAM, Nardi AG. Cystic spinal dysraphism of the cervical and upper thoracic region. Childs Nerv Syst 2006; 22:234-42. [PMID: 15937687 DOI: 10.1007/s00381-005-1161-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2004] [Indexed: 01/02/2023]
Abstract
BACKGROUND Cystic dysraphic lesions of the cervical and upper thoracic region are rare and only a few series have been published about the topic. These malformations can be divided into categories that include both myelocystoceles and the so-called cervical meningoceles or myelomeningoceles. METHODS A retrospective study of 18 patients was conducted. RESULTS In 17 patients a squamous or a cicatricial epithelium of variable thickness covered the dome of the lesions, while the base was covered with full-thickness skin. In one case the skin was entirely normal. Four patients displayed associated CNS malformations and three more had systemic congenital anomalies. All patients underwent surgical exploration and the length of time between birth and surgery ranged from 6 h to 9 months. The most frequent surgical finding, seen in 14 patients, was a stalk connecting the dorsal surface of the spinal cord to the cyst. In three patients the findings were consistent with myelocystocele. Only in one case was a true meningocele found. Hydrocephalus and Chiari II malformation were not as consistently associated as in myelomeningoceles. Neurological signs and symptoms were not so marked as in myelomeningoceles and were found in the follow-up of four patients. In two of them there was a non-progressive deficit, probably expressing an imperceptible involvement of the nervous system in the first year of life. The histopathological findings were of three types: neuroglial stalks, fibrovascular stalks and myelocystoceles. CONCLUSIONS Cystic dysraphisms of the cervical and upper thoracic region differ clinically and structurally from meningomyelocele and have a more favorable outcome. We believe that these malformations have not been properly labeled and propose a classification based on the structures found inside the cyst.
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Affiliation(s)
- J Francisco Salomão
- Section of Pediatric Neurosurgery, Department of Pediatric Surgery, Fernandes Figueira Institute, Oswaldo Cruz Foundation MS-Fiocruz, Av. Rui Barbosa, 716, Rio de Janeiro, Brazil.
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Salomão JF. Cervical meningocele in association with spinal abnormalities. Childs Nerv Syst 2005; 21:4-5; author reply 6. [PMID: 15455250 DOI: 10.1007/s00381-004-1047-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2004] [Indexed: 11/28/2022]
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