Kaya KILIÇ, Salim KATAR

Lumbosacral Meningocele in Adulthood

Spinal disrafizm nöral arkın kapalı veya açık nöral tüp defekti şeklinde görülen inkomplet füzyonudur. Meningoseller açık nöral tüp defektleri olup meninkslerin içi beyin omurilik sıvısı (BOS) dolu ve nöral doku içermeyen kistik dilatasyonları olarak görülürler. Doğum sırasında tespit edilen benign lezyonlardır. Uzun yaşam süresi ile bağdaşmayacağından, meningosele yönelik cerrahi girişim hemen yenidoğan periyodunda yapılmalıdır. Meningoseller erişkin spinal disrafik lezyonlar arasında nadiren rapor edilmiştir. Duraya ve diğer yumuşak dokulara fibröz bantlarla yapışarak spinal kordu gererler. Servikal konjenital orta hat meningosellerinin aksine kaudal yerleşimli lezyonlar genellikle BOS sızıntısına neden olurlar. Lezyon yerinden BOS sızıntısıyla başvuran 41 yaşındaki kadın meningosel olgusunu rapor ediyoruz. Klinik gidişat, cerrahi yaklaşım ve ameliyat sonrası takip sürecindeki müdahaleler tartışılmıştır.

Erişkinde Lumbosakral Meningosel

Spinal dysraphism is the incomplete fusion of the neural arch, which can be seen as an occult or open neural tube defect. Meningoceles are a form of open neural tube defect and characterized by cystic dilatation of the meninges containing cerebrospinal fluid (CSF), without the involvement of neural tissue. These lesions are often benign and typically diagnosed at birth. Neurosurgical intervention is necessary in the newborn period, since survival in advancing ages is often impossible. Therefore, meningoceles are rarely reported among spinal dysraphic lesions in adulthood. They are tethering lesions of the spinal cord, adhering to the dura and other soft tissues with fibrous elements. In addition, the caudal lesions tend to leak CSF, unlike cervical congenital midline meningoceles. Here, we present a 41 year-old female patient with a meningocele that has developed CSF leakage. The clinical course, surgical management, and follow-up period of this rarely seen adulthood meningocele are also discussed.

PDF

___

Akay KM, Ersahin Y, Cakır Y: Tethered cord syndrome in adults. Acta Neurochir(Wien). 2000;142:1111-5.
Akay KM, Gonul E, Ocal E, Timurkaynak E: The initial treatment of meningocele lesions in adulthood: experiences with seven patients. Neurosurg Rev. 2003;26:162-7.
Brinker M, Rosenfeld S, Feiwell E, Granger S, Mitchell D, Rice J: Myelomeningocele at the sacral level. Journal of Bone and Joint Surgery. 1994;76- A:1293-1300.
Dahlgren R, Baron E, Vaccaro A: Pathophysiology, diagnosis, and treatment of spinal meningoceles and arachnoid cysts. Department of Orthopaedic Surgery. Faculty Papers, 2007, p. 4. Available from: http://jdc.jefferson.edu/
Duz B, Arslan E, Gonul E: Cervical congenital midline meningoceles in adults. Neurosurgery. 2008;63:938- 44.
Duz B, Gocmen S, Secer Hİ, Basal S, Gonul E: Tethered cord syndrome in adulthood. J Spinal Cord Med. 2008;31:272-8.
Gok B, Ayberk G, Tosun H, Seckin Z: Clinical course and evaluation of meningocele lesion in adulthood: a case report. Neuroanatomy. 2005;4:52-4.
Konya D, Dagcınar A, Akakın A, Gercek A, Ozgen S, Pamir MN: Cervical meningocele causing symptoms in adulthood: case report and review of the literature. Journal of Spinal Disorders and Techniques. 2006;19:531-3.
Laffey P, Kricun ME: Sonographic recognition of postoperative meningocele. AJR. 1984;143:177-8.
Lee GY, Paradiso G, Tator CH, Gentili F, Massicotte EM, Fehlings MG: Surgical management of tethered cord syndrome in adults: indications, techniques, and long-term outcomes in 60 patients. J Neurosurg Spine. 2006;4:123-31.
Pang D, Wilberger JE: Tethered cord syndrome in adults. J Neurosurg. 1982;57:32-47.
Piatt JH: Treatment of myelomeningocele: a review of outcomes and continuing neurosurgical considerations among adults. J Neurosurg Pediatrics. 2010;6:515-525.
Plaum PE, Riemer G, Froslie K: Risk factors for pressure sores in adult patients with myelomeningocele-a questionnaire-based study. Cerebrospinal Fluid Research. 2006;3:14.
Pool JL: Spinal cord and local signs secondary to occult sacral meningoceles in adults. Bull N Y Acad Med. 1952;28:655-63.
Shih P, Halpin R, Ganju A, Liu JC, Koski TR: Management of recurrent adult tethered cord syndrome. Neurosurg Focus. 2010;29:E5.
Stetler WR, Park P, Sullivan S: Pathophysiology of adult tethered cord syndrome: review of the literature. Neurosurg Focus. 2010;29:E2.
Walcott BP, Kahle KT, Wain JC, Borges LF : Giant thoracic meningocele associated with neurofibromatosis 1. Neurology. 2011;31;76:1943.
Woodhouse CRJ: Myelomeningocele in young adults. BJU. 2005;95:223-30.
Woodhouse CRJ: Myelomeningocele: neglected aspects. Pediatr Nephrol. 2008;23:1223-31.