Meningoceles and neurological involvement.

The term meningocele is used in this communication to include all lesions presenting as swellings associated with spina bifida, when neural tissue is not exposed on the surface. 144 meningoceles were operated on during an 18-year period. The stalk of the meningocele was connected with the neural tissue in 113 of them. Two distinct types of lesions have been noted in these patients and have been designated "meningocele with tethered cord" (52) and "meningocele with tethered roots" (56). In both conditions about half the number of cases presented clinically before the age of 3 months, when paraplegia was evident in only 5 of the 26 infants with tethered cord and 3 of the 25 with tethered roots. In contrast, all or the majority of babies reporting after the age of one year, had paraplegia. Hence, a case is made out for an early operation in all these patients. At surgery the main lesion was a fatty mass in 29 babies with tethered cord, and a cystic mass in 30 with tethered roots. While hydrocephalus was virtually absent in these babies, there were 5 others who manifested obstructive hydrocephalus with meningocele. "Meningomyelocele", the commonest lesion associated with spina bifida, presents with an exposed spinal cord at birth, is associated with communicating hydrocephalus, and can be clearly distinguished from the meningocele.