meningeocele disorders

1. By
ADNAN M ALBANNA

2.  Spinal Dysraphism refers to a variety of
congenital anomalies resulting fromfailed
fusion of dorsal spinalelements.

4. Types
Spina bifida occulta:
often incidental
cutaneous manifestations
Spina bifidaaperta:
Meningocele
Myelomeningocele
Myelocystocele
lipomeningocele

6. Meningocele
Meningocele
is a midline mass usuallyoccurring in thedorsal lumbar
area composedof
 CSF
 meninges
 and skin
 Neural elements areabsent
 neurologic deficit rarelypresent

7. • 1-2/1000
 1/3 have neurological deficits
 Surgical repair with water-tightdural
closure

12. Meningomyelocele
 Myelomeningocele
 is anotherdefect, almost always associated with
neurological deficit.
 The herniated mass arises midline usually inthe
thoracolumbar region.
 Itcontains
 CSF
 meninges
 and neural tissue.

13.  1-2/1000 live birth
 Failure of complete closure of caudal neuraltube
 85% occur in lumbarregion
 Associated conditions include
 Chiari malformation, club foot, hydrocephalus,
and various cerebral and cerebellarmalformations

14.  Myelomeningocele is subclassified into spina
bifida cysticaand apertadepending on whether
thecontentsof the mass communicatewith the
environment.

15. Myelocystocele
 refers toa terminal swelling of the neural axis probably
secondary to hydromyelia inutero.
 Theexpanding masscontainsdilated cord as well as
meninges
 CSF
 and fatty/fibrous tissue that herniates midlinethrough
a spina bifida defect. This results in a tethered
cord syndrome.

16.  Extrophyof the bladder is a commonassociated
defect.
 Sacrococcygeal teratoma should be considered inthe
differential diagnosis.

17.  Lipomeningocele refers to the fattycontentsof a
spina bifida lesion.
 These may be intradural, extradural, orboth.
 Present with back mass, bladder problems,paralysis
 Cutaneousstigmata
 Symptomsaredue to tethered cord and cord
compression from fattymass
 Treatment is surgicaldecompression

18.  Anterior Meningocele is an abnormal
communication between the spinalsubarachnoid
space and a pelvic (or rarely thoracic) mass via a
channel in the anterior vertebralcolumn

19. Radiological features
 Antenatal US
 Plain film findings
 structural vertebral anomalies such as hemivertebra,
butterfly vertebra, or incomplete fusion of posterior
elements; itdoes notallow imaging of the spinal cord.
 CT ,MR

20. Antenatal ultrasonogram shows a lumbar meningocele.

22. Antenatal ultrasonogram shows a lemon sign and a banana sign.

23. Transverse cranial sonogram of a 20-week-old fetus with spina bifida. Image obtained at
the level of the ventricles demonstrates the lemon like configuration of the fetal skull due
to biconcavity (arrows) of the frontal bones.

24. Defects of laminae of lower cervical spine

25. Plain radiograph of same pt showing spina bi fida occulta of s1

26. Films of the spine demonstrate spinabifida
involving L2 - S1.

27. Plain anteroposterior (AP) lumbar spinal radiograph in a 7-
year-old patient showsa defectwithin the laminaeof L4-5 and
S1. Note thediastematomyelia.

28. Axial CT scans through the lumbosacral junction shows absence of
the posterior spinal elements at L5-S1. Note sclerosis of the laminae
and the wide spinalcanal.

29.  When spinal malformations are suspected,
investigation of the spinal canal and itscontentsare
best performed byMRI

30. T2-weighted sagittal MRIs of the sacrum show an anterior sacral meningocele

31. Sagittal MRIsof the lumbarspine show diastematomyelia. Note the
congenital fusion of L1 and L2

32. Myelograms in a 5-year-old patient show the dorsal region of the spine and an anterior
thoracic meningocele. Note the gross dorsal kyphosis

33. Myelograms in a 4-year-old patient show the lumbosacral region; a long, tethered cord;
and diastematomyelia.

34. Unfused arch of C1 at CT

35. T1w image,showing ventriculomegaly

36. Banan Sign: Abnormal shape of cerebelum from compression in spina bifida and other
neural tube defects

37. Tethered Cord Syndrome

38. spine MR of T1-weighted (A) and T2-weighted images (B) showstethered
cornus medullaris to the level of sacrum and two isolated
lipomyelomeningoceles, a transitional type from L3 to L5 (arrows), and a
terminal type below S1 (arrowheads)

39. Surgical
Procedure :

47. Thank you