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[A report of four cases of intrathoracic meningocele]
M Shibuya1, M Mikoshiba, J Ikeda
1Department of Neurosurgery, Tokyo Medical College.
Insights
Intrathoracic meningoceles, often linked to von Recklinghausen's disease, are rare posterior mediastinal masses. Surgical intervention for these asymptomatic lesions carries risks, including mortality, while conservative management may be effective.
Area of Science:
- Neurosurgery
- Radiology
- Thoracic Surgery
Background:
- Intrathoracic meningocele is an uncommon condition.
- It is frequently associated with von Recklinghausen's disease (neurofibromatosis type 1).
Observation:
- Four cases (3 males, 1 female, aged 40-50) of asymptomatic intrathoracic meningocele were treated.
- Three cases had concurrent von Recklinghausen's disease.
- Imaging revealed posterior mediastinal masses and enlarged vertebral canals (T3-T11).
Findings:
- Myelography showed dorsolateral masses; CT myelography revealed vertebral bone deformity and contrast passage into paravertebral masses.
- MRI demonstrated paravertebral masses communicating with the spinal canal.
- Surgical ligation/wrapping in two cases resulted in one death (paraparesis, meningitis) and one uneventful recovery.
Implications:
- Conservative management of asymptomatic intrathoracic meningoceles may be a viable option.
- Surgical treatment of these lesions carries significant risks.
- Early diagnosis and careful consideration of treatment strategies are crucial for patient outcomes.
Abstract:
Intrathoracic meningocele is regarded as an uncommon pathological entity frequently associated with von Recklinghausen's disease. In this paper, four cases of intrathoracic meningocele, treated between 1966 and 1986, are presented. There were three males and one female, all between the ages of 40 and 50. These were referred to our clinic for further evaluation of an asymptomatic lesion which had been seen on a routine chest roentgenogram. There was definite evidence of von Recklinghausen's disease in three cases: two males and one female. All four cases had no pain, dyspnea or neurological disorder. Chest and vertebral tomograms revealed masses in the posterior mediastinum and enlarged vertebral canals at the location of the lesion which varied from T-3 to T-11; three on the left side and one on the right side. None of them revealed scoliosis or kyphosis of the spine. In three cases, myelography was performed and showed an egg-shaped mass dorsolaterally. In two cases, metrizamide computed tomographic myelography was carried out and demonstrated deformity of the vertebral bone and passage of the contrast material through the enlarged vertebral canal into the paravertebral mass. Furthermore, magnetic resonance imaging was performed in two cases, and showed a homogeneous low signal intensity paravertebral mass communicating with the spinal canal on T1-weighted image. In two cases, the meningoceles were ligated or wrapped surgically. Postoperatively one presented a paraparesis and severe meningitis, and died; the other had an uneventful postoperative course. Two patients were followed conservatively without developing any symptoms or signs.(ABSTRACT TRUNCATED AT 250 WORDS)