1
|
Choucha A, Tomczak S, Norri N, Hardwigsen J, Dufour H. Successful Management of Multiple Giant Anterior Sacral Meningoceles Through an Anterior Approach in a Patient With Marfan Syndrome: A Case Report and Literature Review. Cureus 2024; 16:e52724. [PMID: 38384626 PMCID: PMC10880581 DOI: 10.7759/cureus.52724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2024] [Indexed: 02/23/2024] Open
Abstract
Meningoceles refer to the protrusion of meninges filled with cerebrospinal fluid (CSF) through a bone defect. There is scarce literature on the management of multiple giant anterior sacral meningoceles (ASMs). We report the case of a patient with Marfan syndrome presenting with gait disturbances and dizziness triggered by posture changes due to multiple giant ASMs. The patient was managed through an anterior approach involving a multidisciplinary team of surgeons. Care was taken to limit the persistence of CSF leak using an omental pedicled flap. This technique has only been mentioned twice in the literature for such cases. A literature review was conducted focusing on the evolution course and surgical strategy of meningoceles.
Collapse
Affiliation(s)
- Anis Choucha
- Neurosurgery, Assistance Publique-Hopitaux de Marseille (AP-HM), Marseille, FRA
- Laboratory of Biomechanics and Application, Gustave Eiffel University, Aix Marseille University, Marseille, FRA
| | - Sacha Tomczak
- Plastic and Reconstructive Surgery, Assistance Publique-Hopitaux de Marseille (AP-HM), Marseille, FRA
| | - Nicolo Norri
- Neurosurgery, University of Ferrara - Sant'Anna Hospital, Ferrara, ITA
| | - Jean Hardwigsen
- General Surgery, Assistance Publique-Hopitaux de Marseille (AP-HM), Marseille, FRA
| | - Henry Dufour
- Neurosurgery, Assistance Publique-Hopitaux de Marseille (AP-HM), Marseille, FRA
| |
Collapse
|
2
|
Lützen N, Aleman EB, El Rahal A, Volz F, Fung C, Beck J, Urbach H. Sacral Dural Tears as a Cause of Spontaneous Intracranial Hypotension. Clin Neuroradiol 2023; 33:957-964. [PMID: 37261452 PMCID: PMC10654183 DOI: 10.1007/s00062-023-01292-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 04/09/2023] [Indexed: 06/02/2023]
Abstract
PURPOSE Dural tears at the level of the cervical, thoracic, and lumbar spine cause spontaneous intracranial hypotension (SIH) in patients with a spinal longitudinal extradural CSF collection (SLEC); however, sacral dural tears have rarely been reported so far. This study focuses on sacral dural tears as a cause of SIH. METHODS Retrospective data from SIH patients with confirmed sacral dural tears studied between October 2020 and November 2022 were analyzed with respect to demographic, clinical and imaging features. Digital subtraction myelography (DSM) and lumbar epidural blood patch (EBP) were modified by placing the patient in reversed Trendelenburg position. RESULTS Of the SIH patients, 9 (all women; mean age, 38.5 years; mean body mass index, BMI, 22.9) out of 149 had a sacral dural leak (6%) that occurred spontaneously in 7/9, while 2/9 were likely associated with minor trauma. None had a sacral fracture. The mean SIH score was 6.8. All patients showed SLEC on heavily T2-weighted MR myelography (T2-MRM), 4/9 exclusively sacral and 5/9 with partial or complete involvement of the remaining spine. 4/9 had none, but 5/9 had meningeal sacral cysts, 2/5 had large cysts/ectasia. Confirmation of the sacral origin of the leak was provided in 4/9 by T2-MRM, in 2/9 by DSM and 3/9 by CT myelography (CTM) whereas 0/9 revealed the exact site of leak within the sacrum. CONCLUSION Sacral dural tears should be considered as a possible cause for SIH. It is concluded to implement T2-MRM covering the entire sacrum in the standard MRI protocol and propose EBP in the reverse Trendelenburg position as a therapeutic approach.
Collapse
Affiliation(s)
- Niklas Lützen
- Dept. of Neuroradiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Str. 64, 79106, Freiburg, Germany.
| | - Enrique Barvulsky Aleman
- Dept. of Neuroradiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Str. 64, 79106, Freiburg, Germany
| | - Amir El Rahal
- Dept. of Neurosurgery, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Str. 64, 79106, Freiburg, Germany
| | - Florian Volz
- Dept. of Neurosurgery, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Str. 64, 79106, Freiburg, Germany
| | - Christian Fung
- Dept. of Neurosurgery, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Str. 64, 79106, Freiburg, Germany
| | - Jürgen Beck
- Dept. of Neurosurgery, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Str. 64, 79106, Freiburg, Germany
| | - Horst Urbach
- Dept. of Neuroradiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Str. 64, 79106, Freiburg, Germany
| |
Collapse
|
3
|
Nguyen C, Jondeau G. Marfan's syndrome with anterior sacral pseudomeningocele. Oxf Med Case Reports 2022; 2022:omac139. [PMID: 36540839 PMCID: PMC9759944 DOI: 10.1093/omcr/omac139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 10/17/2022] [Indexed: 12/23/2022] Open
Affiliation(s)
- Christelle Nguyen
- Correspondence address. AP-HP.Centre-Université de Paris, Hôpital Cochin, Rééducation et Réadaptation de l’Appareil Locomoteur et des Pathologies du Rachis, 27, Rue du Faubourg Saint-Jacques, 75014 Paris, France. Tel: +33-158-412-945; Fax: +33-158-412-538; E-mail:
| | - Guillaume Jondeau
- Université Paris Cité, Faculté de Santé, UFR de Médecine, Paris, France,AP-HP.Nord-Université Paris Cité, Hôpital Bichat, Centre de Référence pour le syndrome de Marfan et apparentés, VASCERN HCP, Paris, France,INSERM U1148, Laboratory for Vascular Translational Science, Hôpital Bichat, Paris, France
| |
Collapse
|
4
|
Yeh YC, Lin YJ, Yeh CH, Hsieh PS, Wu CT. Anterior sacral meningocele repair assisted by intraoperative intrathecal fluorescence and 3D printing model: illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2021; 1:CASE20159. [PMID: 35855020 PMCID: PMC9245847 DOI: 10.3171/case20159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 01/25/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Marfan syndrome is rarely accompanied by anterior sacral meningocele (ASM) resulting from erosion of the sacrum by dural ectasia. ASM may induce symptoms due to severe mass effects. ASM may also mimic ovarian cysts, and the risk of cerebrospinal fluid (CSF) leakage is high if spontaneous rupture of the cyst occurs. In this study, the authors presented a rare case of ASM with iatrogenic CSF leakage in a 34-year-old woman with suspected Marfan syndrome. OBSERVATIONS The patient initially presented with a giant ASM that was first misdiagnosed as an ovarian cyst. Previously, it had been partially resected, which was followed by iatrogenic CSF leakage. Symptoms of intracranial hypotension, including postural headache and dizziness, developed within 1 month. Brain magnetic resonance imaging (MRI) showed pituitary enlargement, bilateral subdural effusion, and tonsillar herniation. Preoperative computed tomography myelography provided three-dimensional (3D) examination of the deformed sacrum and CSF leakage site. Transabdominal approaches led to primary repair, and repair of the meningocele was achieved by intraoperative fluorescein fluorescence and 3D printed model–guided polymethyl methacrylate bone cement reconstruction. No CSF leakage or recurrent ASM was found at the 1.5-year follow-up visit. LESSONS Intraoperative intrathecal fluorescence and 3D-printed models are useful for ASM repair. Preoperative MRI is helpful for differentiating ASM from other causes of a huge pelvic mass, including ovarian cyst.
Collapse
Affiliation(s)
- Yu-Chaing Yeh
- Department of Neurosurgery, Chang-Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan City, Taiwan
| | - Ya-Jui Lin
- Department of Neurosurgery, Chang-Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan City, Taiwan
- The Graduate Institute of Biomedical Sciences and
| | - Chih-Hua Yeh
- Department of Neuroradiology and
- Department of Neuroradiology and
| | - Pao-Shiu Hsieh
- Division of Colon and Rectal Surgery, Chang Gung Memorial Hospital, Guishan Township, Taoyuan City, Taiwan
| | - Chieh-Tsai Wu
- Department of Neurosurgery, Chang-Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan City, Taiwan
| |
Collapse
|
5
|
Parkin CJ, Wilcox CB, Chalasani V. A rare case of an enormous sacral meningocele causing ureteric obstruction. Urol Case Rep 2021; 38:101703. [PMID: 34026557 PMCID: PMC8121870 DOI: 10.1016/j.eucr.2021.101703] [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: 04/05/2021] [Accepted: 04/28/2021] [Indexed: 11/08/2022] Open
Abstract
Sacral Meningoceles, ductal ectasia and pseudomeningoceles are all rare spinal defects that occur due to errors in collagen biosynthesis in the setting of Marfan's Syndrome. Meningoceles, which are extradural collections of cerebrospinal fluid, can form large pelvic collections which can compress local structures. In rare cases, this can lead to extrinsic ureteric obstruction, which can result in acute renal failure and urosepsis. We present a case of a 35-year old female with Marfan's syndrome, with one of the largest sacral meningoceles reported in the literature, causing acute ureteric obstruction, requiring urgent surgical intervention. Meningoceles are rare and are associated with Marfan's syndrome due to errors in collagen biosynthesis. Management of urinary tract obstruction secondary to external compression from a meningocele requires surgical decompression. This can be in the form of ureteric stent placement or nephrostomy insertion. Referral to a spinal surgeon for definitive management should also be undertaken.
Collapse
Affiliation(s)
- Cameron James Parkin
- Department of Urology, Royal North Shore Hospital, Northern Sydney Local Health District, NSW, Australia.,School of Medicine, The University of Notre Dame, Sydney, NSW, Australia.,North Shore Urology Research Group, Royal North Shore Hospital, NSW, Australia
| | - Chloe B Wilcox
- Department of Urology, Royal North Shore Hospital, Northern Sydney Local Health District, NSW, Australia.,North Shore Urology Research Group, Royal North Shore Hospital, NSW, Australia
| | - Venu Chalasani
- Department of Urology, Royal North Shore Hospital, Northern Sydney Local Health District, NSW, Australia.,North Shore Urology Research Group, Royal North Shore Hospital, NSW, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| |
Collapse
|