Kishihara T, Nakagawa Y, Kaneko S, Saitoh H
No Shinkei Geka. 1976 Nov;4(11):1081-4.
A case reported here is one year-old girl, who was admitted to our neurosurgical service because of gradually increasing swelling in the left lumbar region, and maldevelopment and paresis of the left leg since birth. From the level of L-2 to S-1, there was a 8 X 7 xm subcutaneous swelling of lipomatous consistency with well-defined margins. Of particular characteristics was that the swelling didn't cross the midline and was entirely located in the left paravertebral region (Fig. 1). In the spine no gap could be felt between the spinous processes. There was no evidence of hydrocephalus, but she bad marked right sided scoliotic deformity of the lumbar region, and dislocation of hip joint and club-foot on the left side. Rectum-bladder-vaginal fistula with defect of anus and hypoplasia of kidney on the left side were also detected. Skiagram of the lumbosacral spine revealed marked right-sided scoliosis at the level of L-1 and hypoplasia of left pedicles, accompanied with marked dilation of transverse diameter of spinal canal between the level of L-1 to S-2. Defect of laminae of lumbosacral spine was not definately determined. Conray myelogram showed presence of cyst protruding laterally to the left paravertebral region probably through defect of lamina on the left side at the level of L-5 (Fig 2). At operation, it was confirmed that meningomyelocele protruded out laterally through the defect of half of lamina at the level of L-5. Massive lipoma was noted inside as well as outside the dura mater. Neural elements were replaced inside the spinal canal and the dura repaired. The postoperative period was uneventful. Diagram of defect of lamina at the level of L-5 and its relationships to the meningomyelocele sac is shown in Fig. 3. Meningocele or meningomyelocele which lays in the paravertebral lumbar region is very rare (Table 2), but the possibility of this disease should always be considered when we examine the patients with lipomatous or cystic swelling in the paravertebral lumbar region, especially when the patients present the neurological symptoms or signs.
本文报告的病例是一名1岁女童，因左腰区肿胀逐渐加重，自出生以来左腿发育不良及麻痹，入住我院神经外科。从L-2至S-1水平，有一个8×7cm大小、脂肪瘤样质地、边界清晰的皮下肿物。其特别之处在于肿物未越过中线，完全位于左椎旁区（图1）。脊柱棘突之间未触及间隙。没有脑积水的证据，但她有明显的右侧腰区脊柱侧弯畸形，左侧髋关节脱位和马蹄内翻足。还发现了直肠-膀胱-阴道瘘、肛门缺损和左侧肾发育不全。腰骶部脊柱X线片显示L-1水平有明显的右侧脊柱侧弯及左侧椎弓根发育不全，同时L-1至S-2水平椎管横径明显增宽。腰骶部椎板缺损未明确确定。碘苯酯脊髓造影显示，可能通过L-5水平左侧椎板缺损，有一囊肿向左侧椎旁区外侧突出（图2）。手术中证实，脊髓脊膜膨出通过L-5水平椎板一半的缺损向外侧突出。硬脑膜内外均可见大量脂肪瘤。椎管内神经组织被替代，硬脑膜得以修复。术后恢复顺利。图3显示了L-5水平椎板缺损及其与脊髓脊膜膨出囊的关系。位于腰段椎旁区的脊膜膨出或脊髓脊膜膨出非常罕见（表2），但当我们检查腰段椎旁区有脂肪瘤样或囊性肿物的患者时，尤其是伴有神经症状或体征的患者，应始终考虑到这种疾病的可能性。
