Microsurgical Resection of an Inclusion Cyst in a Fetal Myeloschisis Patient: A Surgical Anatomy and Technical Note

Inclusion cysts (ICs) are a recognized sequela of myeloschisis closure, particularly in patients who undergo in utero repair. These lesions and their management present a unique challenge in the context of tethered cord surgery. Early detection and appropriate surgical management are essential for reversing or preventing further neurological decline.

We present the case of a 22-month-old girl who underwent fetal myeloschisis repair at 23 weeks' gestation. During routine screening, she was found to have progressive neurogenic bowel and bladder dysfunction, as well as stagnation in motor development. Imaging revealed a large lumbosacral IC, which was treated with maximal cyst resection.

Surgical Technique: The accompanying illustrations and operative video highlight the microsurgical techniques used to resect the IC and detether the spinal cord. The cyst was dissected from the dura, opened along the midline, and debulked. Maximal resection of the cyst was then achieved by carefully removing the posterior and lateral elements of the cyst wall from the underlying spinal cord and nerve roots.

This case highlights the importance of vigilant multidisciplinary surveillance, careful selection of surgical candidates, and the technical considerations involved in managing ICs in myelomeningocele patients.