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Cureus Mar 2023Sacrococcygeal masses encompass a diverse range of pathologies. Prenatal ultrasound facilitates early detection of congenital sacrococcygeal masses. We present the case...
Sacrococcygeal masses encompass a diverse range of pathologies. Prenatal ultrasound facilitates early detection of congenital sacrococcygeal masses. We present the case of a newborn of a 22-year-old woman who was identified to have a sacrococcygeal mass by prenatal ultrasound that was initially diagnosed as sacrococcygeal teratoma. On examination after delivery, a large midline mass in the sacrococcygeal region was observed, which was globular in shape and had smooth, thin skin with bluish discoloration. Magnetic resonance imaging revealed a cystic lesion that protruded through a caudal sacral defect, consistent with a sacrococcygeal meningocele. The patient underwent surgical repair of the meningocele without any intraoperative complications and had preserved motor function in the lower extremities after the procedure. This case underscores the challenge of distinguishing sacrococcygeal teratoma from meningocele based on clinical presentation and prenatal ultrasound findings. An accurate preoperative diagnosis is essential for effective surgical planning.
PubMed: 37090346
DOI: 10.7759/cureus.36485 -
Cureus Feb 2023The sphenoethmoidal meningocele is a herniation of the meninges through a communication of the skull base with an aeric cavity. It means the presence of an...
The sphenoethmoidal meningocele is a herniation of the meninges through a communication of the skull base with an aeric cavity. It means the presence of an osteomeningeal breach, which is manifested by cerebrospinal rhinorrhea and nasal obstruction. iIs diagnosis is based on a very specific radiological assessment and biology allows the dosage of certain substances to confirm the nature of the cerebrospinal fluid, such as beta-2-transferrin, Once the breach has been found, the endoscopic route exclusively allows the pathology to be treated and the defect to be reconstructed using different materials before the occurrence of serious complications such as meningitis.
PubMed: 36938298
DOI: 10.7759/cureus.35022 -
Frontiers in Neurology 2023Cerebrospinal fluid (CSF) leakage is considered the cause of spontaneous intracranial hypotension (SIH), an important etiology for new daily persistent headaches and a...
Cerebrospinal fluid (CSF) leakage is considered the cause of spontaneous intracranial hypotension (SIH), an important etiology for new daily persistent headaches and a potentially life-threatening condition. Minor traumatic events rarely lead to CSF leakage, contrasting with iatrogenic interventions such as a lumbar puncture or spinal surgery, which are commonly complicated by dural tears. Most meningeal lesions are found in the cervicothoracic region, followed by the thoracic region, and rarely in the lumbar region, and extremely rarely in the sacral region. We describe two patients admitted to our hospital for severe headaches aggravated in the orthostatic position, with a recent history of minor trauma and sustained physical effort, respectively. In the first case, a bone fragment pierced an incidental congenital meningocele creating a dural fistula. An extensive extradural CSF collection, spanning the cervicothoracic region (C4-T10), was described in the second case. In both patients, the clinical evolution was favorable under conservative treatment.
PubMed: 36908611
DOI: 10.3389/fneur.2023.1132793 -
Child's Nervous System : ChNS :... Jul 2023Encephaloceles are considered to result from defects in the developing skull through which meninges, and potentially brain tissue, herniate. The pathological mechanism...
OBJECTIVE
Encephaloceles are considered to result from defects in the developing skull through which meninges, and potentially brain tissue, herniate. The pathological mechanism underlying this process is incompletely understood. We aimed to describe the location of encephaloceles through the generation of a group atlas to determine whether they occur at random sites or clusters within distinct anatomical regions.
METHODS
Patients diagnosed with cranial encephaloceles or meningoceles were identified from a prospectively maintained database between 1984 and 2021. Images were transformed to atlas space using non-linear registration. The bone defect, encephalocele and herniated brain contents were manually segmented allowing for a 3-dimensional heat map of encephalocele locations to be generated. The centroids of the bone defects were clustered utilising a K-mean clustering machine learning algorithm in which the elbow method was used to identify the optimal number of clusters.
RESULTS
Of the 124 patients identified, 55 had volumetric imaging in the form of MRI (48/55) or CT (7/55) that could be used for atlas generation. Median encephalocele volume was 14,704 (IQR 3655-86,746) mm and the median surface area of the skull defect was 679 (IQR 374-765) mm. Brain herniation into the encephalocele was found in 45% (25/55) with a median volume of 7433 (IQR 3123-14,237) mm. Application of the elbow method revealed 3 discrete clusters: (1) anterior skull base (22%; 12/55), (2) parieto-occipital junction (45%; 25/55) and (3) peri-torcular (33%; 18/55). Cluster analysis revealed no correlation between the location of the encephalocele with gender (χ (2, n = 91) = 3.86, p = 0.15). Compared to expected population frequencies, encephaloceles were relatively more common in Black, Asian and Other compared to White ethnicities. A falcine sinus was identified in 51% (28/55) of cases. Falcine sinuses were more common (χ (2, n = 55) = 6.09, p = 0.05) whilst brain herniation was less common (χ (2, n = 55) = .16.24, p < 0.0003) in the parieto-occipital location.
CONCLUSION
This analysis revealed three predominant clusters for the location of encephaloceles, with the parieto-occipital junction being the most common. The stereotypic location of encephaloceles into anatomically distinct clusters and the coexistence of distinct venous malformations at certain sites suggests that their location is not random and raises the possibility of distinct pathogenic mechanisms unique to each of these regions.
Topics: Humans; Encephalocele; Skull; Meningocele; Brain; Cluster Analysis
PubMed: 36897404
DOI: 10.1007/s00381-023-05883-7 -
World Neurosurgery: X Apr 2023To study the impact of a visiting consultant neurosurgeon on the management and outcome of neurosurgical patients in a hospital with no resident neurosurgeon.
OBJECTIVE
To study the impact of a visiting consultant neurosurgeon on the management and outcome of neurosurgical patients in a hospital with no resident neurosurgeon.
METHODS
This is a 5-year retrospective study of neurosurgical conditions and their management outcomes by a visiting consultant neurosurgeon in a Nigerian Tertiary institution from January 2016 to December 2020.
RESULTS
Thousand two hundred and four (1,204) patients were reviewed. Patients' ages were between 1 h and to 86-year-olds, with a mean of 23 years and a mode of 32 ± 4 years. Children were 423 (35.1%), with 781(64.9%) adults. Males were 862 (71.6%), and Females were 342 (28.4%), with a Male to Female ratio of 5:2. Congenital problems were 170 (14.1% of 1204): meningocoeles (38, 22.4%), myelomeningocoeles (61, 35.9%), encephalocoeles (24, 14.1%), anencephaly (6, 3.5%), and hydrocephalus (41, 24.1%). Acquired conditions were 1034 (85.9% of 1204): Head injuries (486, 47%), spinal cord injuries (51, 5%), Pyogenic brain Abscess (3, 0.3%), Pott's disease (2, 0.2%), Hydrocephalus (63, 6.1%), brain tumour (5, 0.5%), degenerative spine (421, 40.7%), vascular (3, 0.3%). Surgery was indicated in 348(28.9%) patients. Two hundred and twenty-six (18.8% of 1204) had surgeries, while 978 (81.2% of 1204) had no surgeries. Referred to other facilities were 122 (10.1%). Overall, surgical intervention was 64.9% (226 of 348), with mortality of 13.5% (18 patients) among those who had surgical interventions.
CONCLUSIONS
In countries with very few medical specialists, particularly neurosurgeons, such a regular visit can impact the care of neurosurgical patients in their environment.
PubMed: 36851941
DOI: 10.1016/j.wnsx.2023.100161 -
Cureus Jan 2023Fetus in fetu (FIF) is a rare congenital anomaly of asymmetric monozygotic twins, where the parasitic twin develops abnormally inside the body of the host twin. In most...
Fetus in fetu (FIF) is a rare congenital anomaly of asymmetric monozygotic twins, where the parasitic twin develops abnormally inside the body of the host twin. In most cases, it is incorporated into the sibling's abdomen, which frequently presents as a retroperitoneal mass. Currently, at least 200 cases have been reported worldwide, being this the first case in Nicaragua. We describe a case of a male newborn, born via cesarean section, with a history of multiple congenital malformations observed via ultrasound examination. At birth, a mass is observed on its dorsum that impresses a skull, but without the presence of bones, with three limbs, two upper and one lower, with an outline located transversely on the pelvic girdle and the presence of two male genitalia with agenesis of the testicles and an accessory kidney. A preoperative diagnosis of FIF and spinal dysraphism was made by computed tomography (CT) and magnetic resonance imaging (MRI). They shared a spinal cord and had the presence of an open spinal defect type meningocele with aberrant roots. After the diagnosis and discussion, the multidisciplinary team proceeded to surgery to perform the separation of the twin (FIF). The subsequent anatomopathological examination revealed that the fetus was anencephalic and had reliable FIF characteristics. The resection was performed followed by the closure of the 430 mL meningocele and complete separation of the spine and the parasitic twin. We present the first case of fetus in fetu in Nicaragua.
PubMed: 36819441
DOI: 10.7759/cureus.33835 -
Journal of Neurosciences in Rural... 2022Optic nerve (ON) sheath meningocele is an enlargement of the ON sheath, consisting in a cerebrospinal fluid collection along the perineural space of the optic nerve. It...
Optic nerve (ON) sheath meningocele is an enlargement of the ON sheath, consisting in a cerebrospinal fluid collection along the perineural space of the optic nerve. It should be considered primary when it is not associated with orbital-cerebral neoplasm or with cranio-orbital junction malformations. Here, we report a case of bilateral primary idiopathic ON meningocele with gradual vision loss, treated with acetazolamide, which showed a maintained visual recovery and partial improvement during a 6-month follow-up period. The literature review retrieved eight cases of primary idiopathic ON sheath meningocele: ON sheath fenestration is considered in patients with progressive and severe vision loss, otherwise, acetazolamide treatment is indicated with good results on symptoms control, as confirmed in our case report.
PubMed: 36743743
DOI: 10.25259/JNRP_5_2022 -
International Journal of Surgery Case... Feb 2023Benign cystic teratoma considered an extragonadal germ cell tumor that can present at any age and mostly located in the anterior mediastinum, only 3 %-8 % are in the...
INTRODUCTION AND IMPORTANCE
Benign cystic teratoma considered an extragonadal germ cell tumor that can present at any age and mostly located in the anterior mediastinum, only 3 %-8 % are in the posterior mediastinum. Meningomyelocele is an abnormal herniation of the meninges that located in most cases posteriorly in lumbosacral spine. Cervicothoracic meningomyelocele are rare entities resemble only 1 %-5 % of all neural tube defects. The presence of both anterior meningomyelocele (MMC) an benign teratoma is very rare and this association in the thoracic column has never been mentioned before in the medical literature.
CASE PRESENTATION
We present the case of a one-year-old child, who was admitted to our hospital with a complaint recurrent vomiting episode, and respiratory distress, with no improvement in symptoms after conservative treatment. Computed tomography showed an anterior heterogeneous meningomyelocele that extend posteriorly to the upper lobe of right lung tissue. MRI confirmed the presence of the meningomyelocele in addition to a heterogenous cystic structure within. Thoracotomy was indicated and the meningomyelocele was carefully resected and sent to histopathology analysis which showed the presence of a benign teratoma accompanying the meningomyelocele.
CLINICAL DISCUSSION
Meningomyeloceles and teratoma are rarely associated, especially in the thoracic spine. Mediastinal tumors should be taken into consideration when a mass is found. A thorough imaging investigations is crucial in establishing the diagnosis along with histopathology after complete resection.
CONCLUSION
In the presence of posterior mediastinal meningomyelocele with heterogeneity, a histopathological examination of the specimen should be performed to exclude the mediastinal tumors.
PubMed: 36737867
DOI: 10.1016/j.ijscr.2023.107914 -
Journal of Neurosurgery. Case Lessons Sep 2022Multiple-site open neural tube defects (MNTDs) and multiple-site split cord malformations (MSCMs) are extremely rare congenital anomalies that are defined by the...
Multiple-site neural tube defects complicated by multiple-site split cord malformations and thickened filum terminale: experience at a pediatric neurosurgical teaching hospital in Ethiopia. Illustrative case.
BACKGROUND
Multiple-site open neural tube defects (MNTDs) and multiple-site split cord malformations (MSCMs) are extremely rare congenital anomalies that are defined by the simultaneous noncontiguous occurrence of more than one neural tube defect (NTD) and split cord malformation (SCM), respectively, in a single case with normal neural tissue in between. This work shows the cooccurrence of MNTDs and MSCMs, which has never been reported in the literature.
OBSERVATIONS
A single-stage repair for a 13-day-old female neonate with a preoperative diagnosis of MNTDs (thoracic meningocele and thoracolumbar myelomeningocele) plus an additional intraoperative diagnosis of MSCMs (type 3c) of thoracic and thoracolumbar spine, and thickened filum terminale was done with a favorable smooth postoperative course.
LESSONS
The use of intraoperative meticulous surgical technique along with preoperative skin stigmata helped for anticipation, detection, and treatment of associated complex spinal MNTDs, especially in resource-limited settings, where preoperative magnetic resonance imaging is not routinely used. Whether to repair the MNTDs as a single- versus multiple-stage procedure is mainly a function of the patient's tolerance to the duration of anesthesia and the anticipated blood loss for the patient's age. The overall developmental biology and long-term clinical outcome of MNTDs compared to single NTD/SCM is poorly understood and needs further study.
PubMed: 36593675
DOI: 10.3171/CASE22220