Large cervical meningocele in a newborn

Abstract

A male newborn was referred to our neurosurgery department for posterior cervical swelling. He was born at 39 weeks of gestation via cesarean section and was 17 days old. He was a unique child from a nonconsanguineous marriage. Pregnancy was regularly followed-up. A large cystic mass was observed on morphology ultrasonography performed at week 22 of gestation. Ultrasound during the first trimester and 16 weeks of gestation revealed no anomalies (Supplementary Fig. S1). Although the neonate had no neurological deficit or macrocrania, he carried a large and soft cutaneous tumefaction at the posterior cervical spine. A cerebrospinal magnetic resonance scan revealed a large meningocele at C4 through a small defect in the posterior arch (Fig. 1). No other anomalies in the central nervous system were detected. Abdominal and renal ultrasound and routine laboratory test results were normal. Surgery was conducted, and cerebrospinal fluid (CSF) was gently extracted using a needle; then, excision of the meningocele was performed (Fig. 2). The postoperative course was uneventful, and cutaneous healing was satisfactory, without CSF leak. The infant is now 8 months old and has normal growth and psychomotor development. A check-up MRI has been scheduled.Fig. 2a: Perioperative photograph showing the meningocele dissected from the cutaneous layer and the orifice in the posterior spinal canal. b: Surgical wound after closure.View Large Image Figure ViewerDownload Hi-res image Download (PPT) Cervical dysraphism is rare, accounting for 1%–5% of all neural tube defects [[1]Kıymaz N. Yılmaz N. Güdü B.O. Demir İ. Kozan A. Cervical spinal dysraphism.Pediatr Neurosurg. 2010; 46: 351-356Crossref PubMed Scopus (0) Google Scholar]. Cervical meningoceles are characterized by a cystic spinal dysraphism without a neuroglial stalk or an ependymal cyst, which differentiates them from myelomeningoceles and myelocystoceles [[2]Habibi Z. Nejat F. Tajik P. Kazmi S.S. Kajbafzadeh A.M. Cervical myelomeningocele.Neurosurgery. 2006; 58: 1168-1175Crossref PubMed Scopus (0) Google Scholar]. Cervical cystic dysraphism is different from lumbosacral dysraphism, wherein the sac content is a misplaced neural placode tethering the spine instead of the neuroglial stalk [[3]Kasliwal M.K. Dwarakanath S. Mahapatra A.K. Cervical meningomyelocele—an institutional experience.Childs Nerv Syst. 2007; 23: 1291-1293Crossref Scopus (13) Google Scholar]. Cervical meningocele generally presents without neurological impairment. However, it may be accompanied by hydrocephalus, type II Chiari malformation, syrinx, or vertebral anomalies [[2]Habibi Z. Nejat F. Tajik P. Kazmi S.S. Kajbafzadeh A.M. Cervical myelomeningocele.Neurosurgery. 2006; 58: 1168-1175Crossref PubMed Scopus (0) Google Scholar,[3]Kasliwal M.K. Dwarakanath S. Mahapatra A.K. Cervical meningomyelocele—an institutional experience.Childs Nerv Syst. 2007; 23: 1291-1293Crossref Scopus (13) Google Scholar]. Treatment involves intradural excision and untethering of the spinal cord to avoid delayed appearance of a neurological deficit. Cervical meningocele has a favorable outcome [[2]Habibi Z. Nejat F. Tajik P. Kazmi S.S. Kajbafzadeh A.M. Cervical myelomeningocele.Neurosurgery. 2006; 58: 1168-1175Crossref PubMed Scopus (0) Google Scholar,[3]Kasliwal M.K. Dwarakanath S. Mahapatra A.K. Cervical meningomyelocele—an institutional experience.Childs Nerv Syst. 2007; 23: 1291-1293Crossref Scopus (13) Google Scholar]. The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Only cited authors contributed to the work. Our institute approves this study and publication. The following are the Supplementary data to this article: