Tandon Vivek, Garg Kanwaljeet, Mahapatra Ashok Kumar
Department of Neurosurgery, Cardioneurosciences Centre, All India Institute of Medical Sciences, New Delhi, India.
Pediatr Neurosurg. 2012;48(4):229-35. doi: 10.1159/000349915. Epub 2013 Mar 23.
Terminal myelocystocele is a rare form of spinal dysraphism. We report on the clinical and radiological features, surgical procedures and outcome of myelocystocele.
Thirty patients, with an age range of 1 month to 15 years, which included 16 (53.3%) male children, had undergone surgery for terminal myelocystocele between 2000 and 2010. We had retrospectively analyzed their data. All patients had a swelling in the lumbosacral region which had a healthy skin cover. Twenty (66.7%) patients had presented with weakness, while 10 (33.7%) patients had no deficits at all. Bladder bowel involvement was evident in 12 (40%) cases. All patients had undergone excision of the meningocele sacs, the tethering bands were lysed, and filum was detethered. Ventriculoperitoneal shunt was done in 3 (10%) patients. Complications like pseudomeningocele were seen in 6 (20%) patients, cerebrospinal fluid leak in 4 (13.3%) patients, and meningitis and surgical site infection in 1 (3.3%) patient each. The mean follow-up period was 15.2 (1-60) months. The status of all patients with no preoperative deficits remained unchanged. Out of 20 patients with motor weakness, 12 (60%) had improvement; worsening was observed in 1 patient.
Though rare, the possibility of myelocystocele should be kept in mind when treating lumbosacral region masses as they have a better prognosis when compared with other masses in the region due to spinal dysraphism. We recommend early surgery in all diagnosed cases.
终末型脊髓脊膜膨出是一种罕见的脊柱裂畸形。我们报告脊髓脊膜膨出的临床和放射学特征、手术方法及结果。
2000年至2010年间，30例年龄在1个月至15岁之间的患者接受了终末型脊髓脊膜膨出手术，其中包括16例（53.3%）男童。我们对他们的数据进行了回顾性分析。所有患者腰骶部均有肿胀，表面皮肤正常。20例（66.7%）患者出现肌无力，10例（33.7%）患者无任何功能缺损。12例（40%）患者有膀胱直肠受累表现。所有患者均接受了脊膜膨出囊切除、松解栓系带及切断终丝。3例（10%）患者进行了脑室腹腔分流术。6例（20%）患者出现假性脊膜膨出等并发症，4例（13.3%）患者出现脑脊液漏，1例（3.3%）患者出现脑膜炎和手术部位感染。平均随访时间为15.2（1 - 60）个月。所有术前无功能缺损的患者病情无变化。20例肌无力患者中，12例（60%）病情改善，1例病情恶化。
尽管终末型脊髓脊膜膨出罕见，但在治疗腰骶部肿块时应考虑到这种可能性，因为与该区域因脊柱裂畸形导致的其他肿块相比，其预后较好。我们建议对所有确诊病例尽早进行手术。
