True cervicothoracic meningocele: A rare and benign condition

Abstract

Cervical meningoceles are rare spinal dysraphism, accounting for approximately 7% of all cystic spinal dysraphism. In spite of the rarity, the clinical course is most of the times benign. The surgical treatment includes resection of the lesion and untethering, when presented. We present a 14-day-old female child with true meningoceles who underwent to surgical excision and dura-mater repair. Retrospect analysis of the literature concerning true cervical meningocele is performed. By reporting this illustrative case, we focus on its classification and its differentiation from other types of cervical spinal dysraphism, such as myelocystocele and myelomeningocele. Although its course is benign, it is mandatory a continuum follow up with periodic magnetic resonance imaging of spinal cord, since late neurological deterioration has been described. Introduction Cervical dysraphism is a very rare condition, performing 3-6% of all the dysraphism found in children and adults. Still more uncommonly seen, the true cervical meningocele is described in about 7% of all cervical dysraphism, according to one of the largest series reported.1-3 Conceptually, meningoceles are posterior midline malformations that consist in a spina bifida containing dura-mater and arachnoid herniated and revealing cerebrospinal fluid as content. More often, the skin adjacent is not disrupted and might be pedunculated. As general rule, no neural contents are tethered to any neural plaque, although some nerves might fluctuate in the cerebrospinal fluid. This last aspect in particular differentiates meningoceles from myelomeningoceles.2,4 Mostly seen in the lumbosacral area, meningoceles are uncommon at the cervical region. Despite its infrequent association with other spinal malformations, late neurological deterioration has been described, justifying the necessity of a long-term follow up.2 Although some cases of cervical dysraphism have been described in the literature, a true meningocele has rarely been seen. One report a single case of true cervical meningocele operated on, with its clinical and surgical details. Additionally, its neurological status up to now is related. Finally, a review of literature is done, stressing the differences between truemeningocele and other forms of cervical dysraphism.