Double Lumbar Localization of Myelomeningocele: Case Report

Abstract

Introduction: myelomeningocele (MMC) is a malformation resulting from the neural tube’s failure to close during embryonic development, the majority of the cases of neural tube defects (NTDs) were prevalent as single location lesions along the spine, however multiple neural tube defects (MNTDs) are a very rare condition. Only a few cases of MNTDs were found in the literature. Case Report: we report the case of a 2-month-old male infant prenatally diagnosed with MMC, presented with two unconnected lumbar and lumbosacral epidermal, soft, dome-shaped swellings located on both sides of the midline (paravertebral) covered by intact skin. MRI revealed double myelomeningocele at the level of L4-L5, with spinal nerve roots. The patient underwent surgical repair of the defects by replacing the spinal cord and its nerve roots inside the thecal sac and recreating a covering layer around the neural structures to resemble thecal sac. The outcome was favorable, and postoperative head CT scan did not show any complication. Discussion/Conclusion: Our case report is considered the first from Algeria to report the condition and the first to report the occurrence of double lesions in the same spine region. MMC can be associated with neurological deficits or other congenital anomalies, thus it is necessary to thoroughly examine such patients. However there was no antenatal folic acid deficiency in our case, We recommend antenatal care with adequate folic acid supplementation given that its deficiency during pregnancy is considered a ubiquitous risk factor for the condition. The optimal timing for surgery of MMC cases is 8±5 days. Prenatal intrauterine repair of the condition provides favorable outcomes but carries high fetal and maternal risks. Surgical repair should include the sac removal, the reconstruction of the placode and the closure of the overlying meninges. With early diagnosis and proper repair of such cases, MMC has good prognosis and favorable outcomes.

Double Myelomeningocele Repair by Fetal Surgery with a Single Micro-Hysterotomy

“…Double neural tube defects on the spine are rare, accounting for less than 1% of all defects [8], and are considered a severe condition associated with hydrocephalus often requiring postnatal ventriculoperitoneal shunting, severe motor and neurological impairment, and even infant death [9][10][11][12][13][14][15]. There are only a few cases of double neural tube defects reported in the literature, with a very small proportion of them having been diagnosed prenatally [15,16], and all of them receiving postnatal surgical repair [17][18][19]. Thus, there is a lack of previous evidence on fetal surgery for this specific population.…”