Surgical repair of a large intrathoracic meningocele associated with neurofibromatosis type 1 after failed cystoperitoneal shunts: illustrative case

Isolated Large Lateral Thoracic Meningocele

Intrathoracic meningocele is a condition characterized by the protrusion of dura mater and cerebrospinal fluid within the thoracic cavity. This can be associated with neurofibromatosis type 1 (NF1) and other connective tissue disorders. Less commonly, it can occur in isolation. We describe one of the few cases of a large thoracic meningocele presenting in an adult without NF1 or another genetically predisposing condition. This case involves a 78-year-old woman who presented with back pain, shortness of breath, and lower limb weakness. The computed tomography (CT) scan reported a pleural effusion, with plans made to drain the fluid. However, magnetic resonance imaging (MRI) revealed a large right-sided lateral thoracic meningocele. This case highlights the diagnostic challenges and potential complications associated with the misdiagnosis of thoracic meningoceles. It also reaffirms MRI as the gold standard for diagnosis.

Neurofibromatosis type 1 with huge intrathoracic meningoceles misdiagnosed as pleural effusion: A case report and literature review

BACKGROUND

Neurofibromatosis type 1 is a genetic disease that affects multiple organs and systems, leading to various clinical manifestations. In Neurofibromatosis type 1, rare intrathoracic meningoceles often occur alongside bone dysplasia. These meningoceles contain cerebrospinal fluid and can be mistakenly diagnosed as 'pleural effusion'.

CASE PRESENTATION

In this case report, we mistakenly identified 'cerebrospinal fluid' as 'pleural effusion' and proceeded with drainage. This error posed significant risks to the patient and holds valuable implications for the future diagnosis and treatment of similar patients.

CONCLUSIONS

In patients with Neurofibromatosis type 1 complicated by spinal deformity, there is a high incidence of intrathoracic meningoceles. Treatment strategies may differ based on the specific features of the lesions, and collaboration among multiple disciplines can significantly improve patient outcomes.

Treatment of an anterior cervicothoracic myelomeningocele together with spine deformity correction in a child: illustrative case

BACKGROUND

Anterior cervicothoracic myelomeningoceles are a rare pathology. In reported cases, treatment has included shunting, isolated resection and repair without deformity correction, or isolated deformity correction without meningocele repair. The authors describe a pediatric patient with an anterior cervicothoracic myelomeningocele presenting with progressive neurological decline, who underwent simultaneous treatment of the myelomeningocele to detether the spinal cord and achieve major correction of the scoliotic deformity.

OBSERVATIONS

A 15-year-old girl was born with C7-T1-T2 hemivertebrae and anterior cervical myelomeningocele at C7-T1. She developed progressive cervical thoracic scoliosis, left hemiparesis initially, and additional right hemiparesis eventually. She underwent surgical repair via C7, T1, and T2 corpectomies with intradural detethering of the spinal cord. The scoliosis was treated with C7-T2 Ponte osteotomies and C2-T5 posterior fixation, followed by anterior reconstruction with a titanium cage and anterior plate from C6 to T3. The myelomeningocele was adequately treated with good correction of the patient's deformity. The patient had postoperative improvement in her strength and solid arthrodesis on postoperative imaging.

LESSONS

The authors describe the successful treatment of an anterior cervicothoracic myelomeningocele and associated scoliosis in a child. This is a unique report of a combined strategy to achieve both deformity correction and detethering of the spinal cord.