Thoracoscopic plication for a huge thoracic meningocele in a patient with Neurofibromatosis

Chang

et al. 2015

J Cardiothorac Surg

BackgroundAn intrathoracic meningocele is a relatively rare disease, and it commonly accompanies neurofibromatosis type 1. Patients tend to have no symptom but if its size is too large and compresses a lung and neighboring organs, it needs shunt drainage or surgical resection.Case PresentationHerein, we present the case of a 52 year-old female patient with huge intrathoracic meningoceles associated with neurofibromatosis type 1, who has complained about chest discomfort and dyspnea at rest. As for a preliminary treatment, a neurosurgeon had performed a cystoperitoneal shunt, but the symptoms continued and the size of mass and the amount of pleural effusion did not change significantly. Therefore, the huge thoracic meningoceles were successfully treated through the thoracotomic approach in combination with lumbar puncture and cerebrospinal fluid drainage.ConclusionsIt is reported that double huge intrathoracic meningoceles associated with neurofibromatosis type 1 was successfully treated by a shunting procedure followed by thoracotomic resection with collaboration of a neurosurgeon.

Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Collaborative treatment of huge intrathoracic meningoceles associated with neurofibromatosis type 1: a case report

Chang

et al. 2015

J Cardiothorac Surg

Journal of Neurosurgery: Case Lessons

“…In the literature, this pathology has been documented only a few times in case reports and primarily in patients with NF1. 1 , 4 , 13 Here, we present a case of a nonsyndromic patient with an anterior cervicothoracic myelomeningocele and scoliosis, requiring surgical intervention due to progressive neurological decline. The patient’s progressive weakness was secondary to tethering of the herniated spinal cord within the meningocele sac.…”

Section: Discussionmentioning

confidence: 99%

“… 4 , 12 Chen et al. 4 reported a case of a 48-year-old woman with thoracic meningocele that was initially treated with a thoracoscopic cystoperitoneal shunt. The patient’s clinical history was complicated by shunt failure presenting with a large pleural effusion.…”

Section: Discussionmentioning

confidence: 99%

Treatment of an anterior cervicothoracic myelomeningocele together with spine deformity correction in a child: illustrative case

Jackson,

Laxpati,

Bauer

2024

BACKGROUND Anterior cervicothoracic myelomeningoceles are a rare pathology. In reported cases, treatment has included shunting, isolated resection and repair without deformity correction, or isolated deformity correction without meningocele repair. The authors describe a pediatric patient with an anterior cervicothoracic myelomeningocele presenting with progressive neurological decline, who underwent simultaneous treatment of the myelomeningocele to detether the spinal cord and achieve major correction of the scoliotic deformity. OBSERVATIONS A 15-year-old girl was born with C7-T1-T2 hemivertebrae and anterior cervical myelomeningocele at C7–T1. She developed progressive cervical thoracic scoliosis, left hemiparesis initially, and additional right hemiparesis eventually. She underwent surgical repair via C7, T1, and T2 corpectomies with intradural detethering of the spinal cord. The scoliosis was treated with C7–T2 Ponte osteotomies and C2–T5 posterior fixation, followed by anterior reconstruction with a titanium cage and anterior plate from C6 to T3. The myelomeningocele was adequately treated with good correction of the patient’s deformity. The patient had postoperative improvement in her strength and solid arthrodesis on postoperative imaging. LESSONS The authors describe the successful treatment of an anterior cervicothoracic myelomeningocele and associated scoliosis in a child. This is a unique report of a combined strategy to achieve both deformity correction and detethering of the spinal cord.

Journal of Neurosurgery: Spine

“…It is unlikely that primary repair alone would be successful in these patients because of the inherent abnormalities in the dura; however, thoracoscopic plication has been successful. 3 A posterolateral extradural approach has some advantages over an open thoracotomy. It does not require chest tube drainage, which can be advantageous as the dural repair may not be completely watertight.…”

Section: Discussionmentioning

confidence: 99%

Intrathoracic meningocele associated with neurofibromatosis Type 1 and a novel technique for surgical repair: case report

Das

Goyal

Hunt

2017

Neurofibromatosis Type 1 (NF1) is a neurocutaneous disorder that can have associated spinal abnormalities related to both bone and dural dysplasia. Thoracic meningoceles are one spine anomaly associated with NF1, although they are a fairly uncommon pathology. Surgical techniques to treat these meningoceles, usually undertaken only when the patient is symptomatic, are targeted at decreasing the size of the protrusion and improving lung capacity. Surgical interventions discussed in the literature include shunting the pseudomeningocele, primary repair with laminectomy, thoracoscopic plication, and reinforcement of the closure with cement, muscle, or fascia. Authors here report the case of a 43-year-old woman with NF1 with worsening pulmonary function tests and in whom shunting of the pseudomeningocele failed. Subsequently, a posterolateral thoracotomy was performed. The dura mater was reconstructed and primarily closed. On this closure a Gore-Tex soft-tissue patch was placed along with polypropylene mesh and Evicel fibrin sealant, followed by titanium mesh. At the end of the procedure, a chest tube was left in place and therapeutic pneumoperitoneum was performed to decrease the dead space as the lung did not fully expand with positive-pressure ventilation. The patient’s pulmonary function tests improved after the procedure.Thoracic meningoceles are uncommon and difficult pathologies to treat surgically. Although shunting is arguably the least invasive surgical option, it can fail in some patients. When it does fail, there are other options that require a multidisciplinary approach and careful attention to the dural closure and reinforcing layers.