IMAGES IN CLINICAL PRACTICE
|Year : 2020 | Volume
| Issue : 6 | Page : 411-412
Double meningocele: An uncommon entity
Gaurav Panchal1, V Shankar Raman2, Santosh K Dey2, Deepak Dwivedi3
1 Department of Surgery, AFMC, Pune, Maharashtra, India
2 Department of Paediatric Surgery, Command Hospital, Pune, Maharashtra, India
3 Department of Paediatric Anaesthesiology, Command Hospital, Pune, Maharashtra, India
|Date of Submission||20-Jun-2020|
|Date of Decision||02-Aug-2020|
|Date of Acceptance||04-Aug-2020|
|Date of Web Publication||27-Oct-2020|
Dr. V Shankar Raman
Department of Paediatric Surgery, Command Hospital, Pune - 411 040, Maharashtra
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Panchal G, Raman V S, Dey SK, Dwivedi D. Double meningocele: An uncommon entity. J Indian Assoc Pediatr Surg 2020;25:411-2
A 7-month-old male child presented to the outpatient department with a history of thoracic and lower lumbar swellings since birth. Clinical examination revealed a midline solitary thoracic and lumbar swelling which was transilluminant with no evidence of paraparesis, bladder, or bowel incontinence [Figure 1]a and [Figure 1]b. Magnetic resonance imaging (MRI) of the spine and brain revealed a thoracic and lumbar meningocele with spinal dysraphism at vertebral levels, dorsal 5–dorsal 8 and lumbar 1–lumbar 2, and right dorsal 4 hemivertebra with butterfly dorsal 6 vertebrae with no evidence of hydrocephalus [Figure 2]a and [Figure 2]b.
|Figure 1: (a and b) Preoperative image showing meningocele at thoracic and lumbar region, (c) intraoperative excised thecal sac, (d) immediate postoperative sutured wound|
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|Figure 2: (a) T1-weighted magnetic resonance imaging sagittal section showing spinal dysraphism at dorsal 5–dorsal 8 and lumbar 1–lumbar 2 vertebral level. (b) T2-weighted magnetic resonance imaging axial section showing defect at lumbar region|
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The patient underwent excision and repair of both defects in a single sitting. Intraoperatively, there were a thoracic and lumbar meningocele with clear cerebrospinal fluid and 0.5 cm × 0.5 cm bony defect at both sites [Figure 1]c and [Figure 1]d. The postoperative recovery was uneventful.
The presence of a meningocele at multiple levels along the spinal column is a rare event. There are only seven cases of double meningocele reported in the world literature, with no cases reported from the Indian Subcontinent so far. Spina bifida results from a defective closure of the neural tube between 26 and 28 days of gestation. “The single-site” closure theory postulates that closure starts like a “zipper” from a single site and moves bidirectionally. Van Allen et al. in 1993 proposed the multisite closure theory stating that there were five sites of closure and neural tube defect (NTD) can result from defective closure at any of these sites, which better explains the embryogenesis of NTD. The occurrence of multiple NTDs is possible with the multisite closure theory due to simultaneous defects at several sites.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
Ahmad FU, Dwarakanath S, Sharma BS, Mahapatra AK. Multiple neural tube defects: A clinical series of seven cases and their embryological basis. Pediatr Neurosurg 2008;44:280-7.
Van Allen MI, Kalousek DK, Chernoff GF, Juriloff D, Harris M, McGillivray BC, et al
. Evidence for multi-site closure of the neural tube in humans. Am J Med Genet 1993;47:723-43.
[Figure 1], [Figure 2]