Intrathoracic meningocele

Surgical treatment of thoracic menigocele associated with neurofibromatosis and kyphoscoliosis

A 46-year-old man presented with a lateral thoracic meningocele associated with cutaneous neurofibromatosis type I and kyphoscoliosis of the thoracic spine upon medical examination. In the majority of such cases, these meningoceles remain asymptomatic, but surgery is indicated when giant or symptomatic cysts are present. The large thoracic meningocele was successfully extirpated through the transthoracic approach in combination with lumbar puncture and cerebrospinal drainage for decompression of the cyst.

Assessment of vertebral scalloping in neurofibromatosis type 1 with plain radiography and MRI

AIM

To evaluate vertebral scalloping in patients with neurofibromatosis type 1 (NF-1) and spinal deformity using plain radiographs and magnetic resonance imaging (MRI), and to determine the possible aetiological association with neurofibromas, dural ectasia and lateral meningocoeles.

MATERIAL AND METHODS

Nineteen patients with NF-1, who had full spine radiographs and whole-spine MRI, were retrospectively reviewed. Dystrophic features and their relationship to the curve were recorded from radiographs. A comparison was then made between the dystrophic features evident on radiographs and adjacent soft-tissue abnormalities identified on MRI.

RESULTS

Dystrophic changes were documented in 16 patients on plain radiographs and in all patients on MRI. Rib pencilling was the most common finding on radiographs. In 80% of the cases with scoliosis, scalloping was seen on the concavity of the curvature. In all patients with kyphoscoliosis, scalloping was contiguous to the apex of kyphosis. Twenty-four areas of scalloping were identified on MRI. Scalloping usually developed in the concavity of the scoliotic curve or at levels unrelated to the curve. Scalloping was evident in combination with dural ectasia or neurofibroma in 15 cases. The presence of dural ectasia was confirmed in 75% of the cases of posterior scalloping and in 25% of those of lateral scalloping. The presence of neurofibromas was recognized in 25% of the cases of anterior or lateral scalloping. Dural ectasia was identified in two patients without associated scalloping. Lateral meningocoeles were not related to the development of scalloping.

CONCLUSION

Whereas posterior scalloping was commonly associated with dural ectasia, anterior and lateral scalloping were commonly the result of primary mesodermal dysplasia.

Giant intrthoracic meningoceles associated with cutaneous neurofibromatosis type I: case report

BACKGROUND: Intrathoracic meningocele is a rare pathology, almost always associated with neurofibromatosis type I and with a few cases related in the literature. In the majority of cases cysts are small or asymptomatic, and the surgery is indicated when big or symptomatic cysts are present. We report a case of giant intrathoracic cysts surgically extirpated through out thoracotomy. CASE: A 59-year-old male with familiar Von Recklinghausen's disease which developed thoracic radicular pain after a fall. On examination he presented some difficulty in walking fast and dyspneia on small efforts. The chest plain x-ray showed the presence of 3 huge left side intrathoracic cysts (10 to 15cm). The patient was submitted to a surgical treatment and complete extirpation of the cysts was performed through a left side thoracotomy. During the surgery a fourth smaller cyst was detected and also extirpated. Evolution was uneventful and the patient remains well in these last 12 years. This finding of intrathoracic cysts related to neurofibromatosis type I is rare and is probably unique in the literature the presence of 4 huge cysts in one side of the thorax.

Large intrathoracic meningocele in a patient with neurofibromatosis: technical report

The authors describe a case of large intrathoracic meningocele (16 cm) associated with neurofibromatosis. Computed tomography with metrizamide myelography proved valuable in locating the lesion and in reformation after surgery. The authors make some comments about surgical excision of large meningocele.

Lateral thoracic meningocele

A case of intrathoracic meningocele is reported, and 95 cases from the literature are reviewed. Thoracic meningoceles are usually associated with neurofibromatosis; nevertheless their etiology remains controversial. The authors postulate the role of spinal trauma in some patients and the origin of the meningocele from an abnormal prolongation of a nerve sleeve in nontraumatic cases. Thoracic meningoceles often are asymptomatic or produce radicular intercostal pain. Spinal computed tomography is the most useful investigation, particularly in the exploration of large meningoceles. Surgery is required in symptomatic cases and usually results in remission of the pain.

Spinal cord herniation into a congenital extradural arachnoid cyst causing Brown-Séquard syndrome. Case report

This is a report of a patient who developed sharp intercostal pain and Brown-Séquard syndrome. Displacement of the spinal cord toward an extradural mass was noted at the T4-5 vertebral level on iophendylate myelography and metrizamide computerized tomography myelography. Multiple meningeal diverticular lesions of congenital origin were also found. Surgical correction of the spinal cord, which had herniated into a laterally located extradural arachnoid cyst and become incarcerated, resulted in a complete neurological recovery.

Decrease in size of intrathoracic meningocele following insertion of a ventriculo-venous shunt

A case of spontaneous disappearance of an intrathoracic meningocele following insertion of a ventriculo-venous shunt is reported. The shunt was performed for treatment of hydrocephalus secondary to Arnold-Chiari malformation. The intrathoracic meningocele reappeared when the shunt obstructed and decreased in size when the obstruction was relieved.

Spontaneous incarcerated herniation of the spinal cord into a vertebral body: a unique cause of paraplegia. Case report

✓ A case of progressive paraparesis is reported in which the normal spinal cord herniated through a defect in the ventral meninges and dura and became incarcerated in a cavity in the dorsal aspect of the body of T-7. Progress of the paraparesis was arrested by reduction of the hernia.