Cases reported "Meningocele"

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1/12. Rudimentary meningocele: remnant of a neural tube defect?

    BACKGROUND: Rudimentary meningocele, a malformation in which meningothelial elements are present in the skin and subcutaneous tissue, has been described in the past under a variety of different terms and has also been referred to as cutaneous meningioma. There has been debate as to whether rudimentary meningocele is an atretic form of meningocele or results from growth of meningeal cells displaced along cutaneous nerves OBJECTIVE: We reviewed the clinical, histological, and immunohistochemical characteristics of rudimentary meningocele in an attempt to assess the most likely pathologic mechanism for it. DESIGN: Retrospective study. SETTING: University hospitals. patients: Thirteen children with rudimentary meningocele. MAIN OUTCOME MEASURES: medical records were reviewed and histopathologic examination as well as immunohistochemistry studies were performed for each case. A panel of immunoperoxidase reagents (EMA, CD31, CD34, CD57, S-100, and CAM 5.2) was used to assess lineage and to confirm the meningothelial nature of these lesions. RESULTS: Recent evidence indicating a multisite closure of the neural tube in humans suggests that classic meningocele and rudimentary meningocele are on a continuous spectrum. CONCLUSION: Rudimentary meningocele seems to be a remnant of a neural tube defect in which abnormal attachment of the developing neural tube to skin (comparable to that in classic meningocele) could explain the presence of ectopic meningeal tissue. In the majority of cases, no underlying bony defect or communication to the meninges could be detected. However, in light of the probable pathogenesis, imaging studies to exclude any communication to the central nervous system should precede any invasive evaluation or intervention.
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2/12. The utility of magnetic resonance imaging in the diagnosis of intranasal meningoencephaloceles.

    We present three patients in whom the diagnosis of intranasal meningoencephalocele was made by magnetic resonance imaging. The initial clinical evaluation and computed tomographic examinations of these patients failed to distinguish between chronic inflammation and intranasal meningoencephalocele. Although both computed tomography and magnetic resonance imaging are used to distinguish between normal, inflammatory, and neoplastic tissue in the nasal cavity and paranasal sinuses, limitations do exist and these are the focus of our communication. A clear understanding of the efficacy of these radiographic modalities will enhance surgical planning and can preclude severe complications.
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3/12. Endoscopic cure of a giant sacral meningocele associated with Marfan's syndrome: case report.

    An unusual anterior sacral meningocele associated with Marfan's syndrome, with demonstrated dural anomalies related to Marfan's syndrome is reported. endoscopy enabled complete exploration of the meningocele, its morphological description, and ultimate cure. The meningocele resembled an hourglass made up of intrasacral and anterior sacral components. The communication of this bilobed malformation with the dural sac was so small that only the intrathecal injection of a colored solution allowed its localization. The closure of this communication was accomplished under endoscopic view by a single stitch. The postoperative course of the patient was characterized by immediate disappearance of the preoperative clinical signs. Computed tomographic scans demonstrated progressive complete collapse of the anterior sacral meningocele and partial resolution of the intrasacral component. Dural anomalies of Marfan's syndrome are described, and their relationship to the formation of the meningocele is discussed.
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4/12. Presacral meningocele associated with hereditary sacral agenesis and treated surgically: evaluation in three members of the same family.

    OBJECTIVE AND IMPORTANCE: Presacral meningocele in hereditary sacral agenesis is a complex and unusual spinal dysgenetic syndrome. Recognition of the syndromic triad, its natural history, and familial presentation has important practical applications for the management of this disease as well as its complications. CLINICAL PRESENTATION: This report concerns three patients in one family with Currarino syndrome. We detail its clinical presentation, operative management, and outcome and suggest management procedures based on reports in the literature and the results of our surgical techniques, which focus on cases with an "incomplete" triad. INTERVENTION: Three members of the same family, one adult and two children, underwent surgery through the posterior sacral approach tying off the communication between dural sac and anterior meningocele. The adult underwent a second surgical procedure in which a custom-designed surgical technique was used to resolve postoperative cerebrospinal fluid leakage. One of the children underwent an additional posterior sagittal anorectoplasty to remove a presacral teratoma. CONCLUSION: We report a rare occurrence of three familial cases of sacral agenesis accompanied by a presacral mass with various degrees of phenotypic expression and with male dominant transmission. Because of its rarity, the best surgical technique and timing remain an open question especially in cases with incomplete triad syndrome.
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5/12. Parietal cephaloceles: radiographic and magnetic resonance imaging evaluation.

    Three patients with parietal cephaloceles underwent evaluation and treatment at Duke University Medical Center between 1984 and 1987. All presented within the first 2 years of life with painful swelling near the vertex of the head. All patients had skull films and computed tomography, and two underwent magnetic resonance imaging (MRI). All 3 children had associated hindbrain deformities; two with Dandy-Walker malformation, the third with a Chiari II malformation. Each child eventually developed hydrocephalus. MRI is the procedure of choice to evaluate these patients, providing direct sagittal imaging of the posterior fossa and craniocervical junction, and displaying communication of the cephalocele with intracranial structures as well as associated venous vascular anomalies.
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6/12. Congenital spinal extradural cyst (lateral meningocele) simulating acute transverse myelitis. Report of a case.

    Congenital spinal extradural cysts are rare and may be the cause of acute paraplegia. In their clinical features they closely resemble acute transverse myelitis. Immediate decompression of the spinal cord and removal of the cyst may lead to restoration of normal function. myelography differentiates these two conditions by showing a cyst in communication with the spinal canal. This investigation must be mandatory.
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7/12. Anterior sacral meningocele discovered by whole body computerized tomography: case report.

    A case of anterior sacral meningocele which was clearly visualized on whole body computerized tomography is presented. Posterior surgical approach with ligation of the narrow communication between the sacral dural sac and the meningocele alleviated the subjective complaints of a feeling of abdominal distention and of dysuria. For the purpose of postoperative follow-up study, examination by whole body computerized tomography proved to be the best method of evaluating the size of the meningocele and also the state of neighbouring structures.
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8/12. Dandy-Walker cyst associated with occipital meningocele.

    Two cases of Dandy-Walker cyst associated with occipital meningocele are presented. Only 9 cases with such association have been described in the literature. In our patients computed tomography clearly demonstrated direct communication of a posterior fossa cyst with an occipital meningocele at one end and with the fourth ventricle at the other. Occipital meningocele might simply be an expression of increased intracystic pressure in Dandy-Walker cyst in embryonic life, or such association might suggest its morphogenetic situation during embryogenesis.
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9/12. Anterior sacral meningocele and marfan syndrome: a review.

    Anterior sacral meningocele is a not rare entity. Treatment is usually surgical and consists in a transacral posterior approach with patching of the communication between the malformation and the dural sac. But surgery can be difficult and require multiple procedures. We report the first case of a giant anterior sacral meeningocele rapidly cured by a simple endoscopic procedure. We believe that more attention should be used in the diagnosis of such cases as they can be so easily cured. We have reviewed the literature about anterior sacral meningocele and particularly its treatment and its association either with marfan syndrome or a familial occurrence.
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10/12. Orbital meningoencephalocele in a healthy adult.

    A 28-year-old white female had a two month history of a slightly painful right eye without proptosis. A radiolucent area was noted in the roof of the right orbit. Orbital exploration demonstrated brown friable tissue without any communication to the cranium. Microscopic examination revealed brain tissue, glial cells and fibrous tissue compatible with dura.
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