181/478. spinal cord compression from traumatic anterior cervical pseudomeningoceles. Report of three cases. Pseudomeningoceles rarely develop after cervical trauma; in all reported cases the lesions have extended outside the spinal canal. The authors report the first known cases of anterior cervical pseudomeningoceles contained entirely within the spinal canal and causing cord compression and neurological injury. The authors retrospectively reviewed the cases of three patients with traumatic cervical spine injuries and concomitant compressive anterior pseudomeningoceles. The lesion was recognized in the first case when the patient's neurological status declined after he sustained a severe atlantoaxial injury; the pseudomeningocele was identified intraoperatively and decompressed. After the decompressive surgery, the patient's severe tetraparesis partially resolved. In the other two patients diagnoses of similar pseudomeningoceles were established by magnetic resonance imaging. Both patients were treated conservatively, and their mild to moderate hemiparesis due to the pseudomeningocele-induced compression abated. The high incidence of anterior cervical pseudomeningoceles seen at the authors' institution within a relatively brief period suggests that this lesion is not rare. The authors believe that it is important to recognize the compressive nature of these lesions and their potential to cause devastating neurological injury. ( info) |
182/478. Healing of large midline wounds in infants: unlike in adults, does conservative approach give better results? Two case reports and review of the literature. The case of two infants with large midline wounds, one with an omphalocele and the other with a lumbosacral wound secondary to ruptured meningocele, is reported wherein the advantages of leaving such wounds in infants to heal spontaneously over surgical intervention are shown. In this report, the cases are discussed and the literature is reviewed. It is concluded that the midline wounds in infants yield better results if left to heal spontaneously. ( info) |
183/478. Resection of anterior orbital meningoencephalocele in a newborn infant. An 11-day-old infant was referred for a large, fleshy swelling at the right medial canthus, which was noticed at birth. CT of the skull showed protrusion of brain tissue within the mass, from which a diagnosis of meningoencephalocele was made. The mass was subsequently resected by a team of physicians represented by ophthalmology, otolaryngology, and neurosurgery. Follow-up showed good cosmetic and functional results. Meningoencephaloceles usually need prompt attention to ensure a good visual and cosmetic result. Imaging before surgery and pathologic analysis are both necessary steps to successful management. prognosis is excellent unless associated with other comorbid conditions such as dandy-walker syndrome, holoprosencephaly, or agenesis of the corpus callosum. ( info) |
184/478. Anaerobic meningitis secondary to a rectothecal fistula arising from an anterior sacral meningocele: report of a case and review of the literature. An anterior sacral meningocele is a diverticulum of the thecal sac protruding anteriorly from the sacral spinal canal into the extraperitoneal presacral space. It is a rare congenital anomaly comprising of a thin wall of fibrous connective tissue, and containing cerebrospinal fluid and, occasionally, adjacent nerve fibers. We report an unusual case of a 48-year-old male who presented with meningitis secondary to a rectothecal fistula arising from an anterior sacral meningocele. ( info) |
185/478. Cervical meningocele causing symptoms in adulthood: case report and review of the literature. Simple meningoceles are infrequent forms of dysraphism and are often benign. These lesions are usually associated with other congenital spinal anomalies, and are typically diagnosed in childhood. Most become symptomatic in childhood because of progressive spinal cord or nerve root tethering. This article describes the case of a 47-year-old man who presented with a sac in his posterior cervical region that had been leaking colorless fluid for 3 months. He was also having difficulty walking and complained of stiffness in his lower extremities. Cervical magnetic resonance imaging revealed a cystic mass in the region of the C4 to C5 laminae. Partial laminectomies were performed (lower portion C4 lamina, upper portion C5 lamina), the sac was totally excised, and tissue tethering the spinal cord were cut. There was no recurrence of symptoms in 12 months of follow-up. Although in cases where a cervical meningocele-myelomeningocele is detected at any time, early treatment is essential to eliminate the high risk of future neurological impairment. This is the first report of an untreated cervical meningocele manifesting symptoms in adulthood. ( info) |
186/478. Lumbosacral nerve root avulsions: MR imaging demonstration of acute abnormalities. Most of the previously reported lumbosacral nerve root avulsions presented with pseudomeningoceles at the time of delayed initial imaging. We report a case of traumatic lumbosacral nerve root injury associated with an isolated femur fracture and demonstrate the evolution of pseudomeningoceles following nerve root avulsions and edema in the perineural fat identified on the initial MR imaging. ( info) |
187/478. Congenital transsphenoidal meningocele: case report and review of the literature. Intrasphenoidal meningoencephalocele is a rare clinical entity. Its origin can be congenital, traumatic, tumoral, or spontaneous. Presenting as cerebrospinal fluid fistula with rhinorrhea, the diagnosis and treatment of this uncommon disease is a real challenge for the otorhinolaryngologist. We report a case of sphenoidal meningocele treated using an endoscopic procedure and review the literature regarding its congenital origin. ( info) |
188/478. Incomplete Currarino triad as an embryological variant. Case report and review of the literature. Currarino triad is a rare embryological complex of congenital caudal anomalies, including anorectal malformation, sacral osseous defect, and presacral mass, that results from abnormal separation of the neuroectoderm from the endoderm. The authors present an unusual case of a patient who had, in addition to the classic features of this syndrome, holocord syringomyelia, low conus medullaris, and tethered cord demonstrated by magnetic resonance imaging. They also discuss the embryological significance of this clinical entity and briefly review the relevant literature. ( info) |
189/478. 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. ( info) |
190/478. Unilateral naso-orbital meningocele and bilateral congenital fistulae of the lacrimal passages. Orbital meningocele is the protrusion of a sac containing cerebrospinal fluid into the orbit, through a defect called cranium bifidum. Although the occipital and frontal basis of the cranial cavity constitute the two most frequent localizations, this pathology may rarely be located in the naso-orbital region. Other developmental anomalies of the eyes may accompany the anomalies of the bony orbit. The case described in the present paper had a right naso-orbital meningocele associated with bilateral fistulae of the lacrimal passages which represents a very rare condition. ( info) |