Characteristics and surgery of cervical myelomeningocele

Cervical myelomeningocele (CMMC) is a rare entity in neurosurgical practice, which presents different clinical characteristics compared with other more common lumbosacral variant. Since not much about this lesion has been reported in the literature, this study, herein, demonstrates by cases the clinical characteristics, methods, and techniques of surgical treatment of CMMC in children.

A total of 10 children (six boys and four girls) with CMMC were recruited in this study. Their ages ranged from 9 days to 8 years with a median age of 3 months. All patients underwent neurological and radiological examinations. One was found to have had a mild unilateral arm weakness, and others were neurologically intact. Of these 10 patients, five had other associated neurological or orthopedic anomalies, including mild ventriculomegaly in two, cervical diastematomyelia in one, Chiari II malformation and hydrocephalus in one, and sacral spina bifida occulta in one. Surgical excision of the lesion with intradural exploration of the sac to release any potential adhesion bands was performed for all.

No complications, such as cerebrospinal fluid leakage and infection, had been found after operation. During the follow-up of 1-7 years (mean of 3.9 years), all cases did not suffer from aggravation of nervous symptoms. None of the patients deteriorated postoperatively, and the one with left arm weakness improved following surgery. In the two children with mild ventriculomegaly, cerebral ventricle returned to be normal after surgery.

The management strategies of CMMC are early surgical treatment with standard microneurosurgical techniques to prevent the development of neurological defects. It is safe and effective to adopt surgery excision of the lesions with intradural exploration of the sac to release any potential adhesion bands.