In this condition protrusion of meninges occurs through the defect in the neural arch. Such protrusion contains only cerebrospinal fluid. So it gives rise to a cystic swelling.
Usually the duramater stops at the margin of the defect and usually the pia and arachnoid protrude. The overlying skin remains intact.
It is common in the lumbosacral region. Meningocele also occurs in the skull, where it is more common in the occipital region or at the root of the nose.
Clinical Features
- It is present since birth
- It is a cystic swelling, that means fluctuation test is positive
- It is a highly translucent swelling
- It is compressible
- Expansile impulse is present when the child cries or coughs
- The overlying skin is normal and free
- On careful palpation the edge of the bony defect is palpable
- Neurological manifestations are usually absent (cf. meningo-myelocele, where neurological manifestations are usually present).
- This condition may be associated with hydrocephalus and this combination is known as Arnold-Chiari syndrome.
- X-ray is confirmatory and will show the bony defect
Complication
- Infection
- Rupture
Treatment
Operation should be performed as early as possible, but child’s condition and strength should be sufficient to withstand operation. This operation is often performed within a few days of birth. If the operation is delayed are:
- The skin and the sac are opened with incisions perpendicular to each other. This will minimize the chance of postoperative C.S.F. leakage.
- The redundant part of the sac is excised
- The margins of the excised sac are sutured together in the midline
- To strengthen the bony gap, the adjacent erector spinae muscle and the overlying fasciae are approximated over the gap with the help of lateral release incisions (to minimize tension in the suture line).
- The skin is closed.
Popularity: 1% [?]
Related posts:
About Dr Arun Pal Singh
