Related Experiment Videos
[Surgical indications in ventral sacral meningocele]
Insights
Sacral ventral meningoceles are rare spinal malformations. Surgical intervention is recommended for large, space-occupying meningoceles causing significant symptoms like urinary obstruction.
Area of Science:
- Neurology
- Pediatric Surgery
- Developmental Biology
Background:
- Sacral ventral meningoceles are rare spinal malformations.
- They likely stem from dysraphic disorders during early embryogenesis, related to spina bifida.
- These malformations involve a ventral defect extending towards the sacrum.
Observation:
- A case of a 4-year-old girl with an extensive sacral ventral meningocele causing urinary tract and rectal obstruction, and peroneal muscle paralysis.
- Three adult cases with smaller, asymptomatic sacral ventral meningoceles discovered during myelography for lumbar ischialgia.
- No correlation was found between neurologic symptoms and the smaller meningoceles in adults.
Findings:
- Surgical reduction of the large pelvic meningocele in the child led to significant postoperative improvement.
- Two adult patients with lumbar ischialgia improved after discectomy; one improved with conservative treatment.
- Surgical removal of sacral ventral meningoceles is indicated when they present as space-occupying pelvic tumors.
Implications:
- Surgical decompression from the cerebrospinal fluid (CSF) space can effectively relieve urinary and rectal obstruction caused by large meningoceles.
- Early diagnosis and surgical management are crucial for pediatric cases with significant mass effect.
- The study highlights the variable clinical presentation and management strategies for sacral ventral meningoceles in different age groups.
Abstract:
Comparison of some cases in adults to an extensive malformation in the small pelvis in a 4 years old girl. Sacral ventral meningoceles are rare spinal malformations which probably result from a dysrhaphic disorder in an early embryonal stage (spina bifida). The dysrhaphic malformation extends towards the os sacrum with a defect in ventral direction. In this paper, we present the cases of one child and three adults. The malformative tumor in the small pelvis of the child was so large that an obstruction of the urinary tract and of the rectum resulted. In addition to this there was a paralysis of the peroneal muscles caused by a congenital defect in the nervous system. The large space occupying tumor in the small pelvis was surgically reduced and separated from the subarachnoid space, after which considerable postoperative improvement was observed. In the cases of the three adults, suffering from lumbal ischialgy, similar but much smaller malformations had been discovered through myelography. Two of these patients improved after removal of degenerated discs, and one by conservative treatment. There was no relation between the neurologic symptoms and the small ventral meningoceles. A surgical removal of sacral ventral meningoceles is indicated, when these appear as space occupying tumors in the small pelvis. The tumor can then be reached from the CSF-space in order to relieve the obstruction of the urinary tract and the rectum.