The nature of congenital posterior cervical or cervicothoracic midline cutaneous mass lesions

Report of eight cases

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✓ Between 4% and 8% of cases of spina bifida cystica occur in a cervical or cervicothoracic location. Despite a large body of literature concerning spinal dysraphism, there has been little written specifically about patients afflicted with this disorder in a cervical location. Eight children who presented at birth with posterior cervical or cervicothoracic lumps, all of which represented a dysraphic state, are discussed. Two types of abnormalities were noted. Three patients had hydromyelia with an associated myelocystocele herniating posteriorly into a meningocele sac. In these three patients there was an associated Chiari II malformation and hydrocephalus. The other five children had a meningocele in which a band of tissue extended from the posterior aspect of the spinal cord through a defect in the bone and fascia to the posterior part of the meningocele sac itself. No patient had a lesion that could be described as a meningomyelocele. The investigation and surgical management of these conditions are discussed and the need for intradural exploration to untether the spinal cord in the cervical region is stressed.

Article Information

Address reprint requests to: Paul Steinbok, M.B., B.S., F.R.C.S.(C), Department of Pediatric Neurosurgery, British Columbia Children's Hospital, 4480 Oak Street, Vancouver, British Columbia V6H 3V4. Canada.

© AANS, except where prohibited by US copyright law.

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Figures

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    Case 1. Photograph of the patient showing a posterior midline cervical mass lesion.

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    Case 1. Upper Left: Myelogram showing a widened thoracic cord secondary to hydromyelia. Upper Right: Myelogram showing the widened conus and filum (arrow). Lower: Computerized tomography myelogram showing the myelocystocele (straight arrow, which does not communicate with the subarachnoid space) surrounded by a meningocele (curved arrow, which does communicate with the subarachnoid space).

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    Intraoperative photographs in Case 1. Left: The myelocystocele is seen attached by a narrow stalk (curved arrow) to the back of the cervical cord. The abnormally located cerebellar vermis is also visible (straight arrow) lying in the cervical canal. Right: After resection of the myelocystocele, a hole (curved arrow) is apparent at the back of the cervical cord, through which the hydromyelic central canal of the cord had communicated with the cavity of the myelocystocele.

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    Computerized tomography myelograms in Case 4. Left: A meningocele sac containing contrast is seen (arrow). Right: The spinal cord is shown tented posteriorly at the level of the spina bifida.

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    Case 4. Intraoperative photograph showing a band of tissue (arrow) attached to the back of the cervical spinal cord. The dura has been opened on one side of the band and is being retracted by sutures.

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    Diagrammatic representation of a cervical meningocele. A = a meningocele continuous with the subarachnoid space. B = a myelocystocele continuous with the central canal of the spinal cord.

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    Diagrammatic representation of a cervical meningocele. A = a meningocele continuous with the subarachnoid space. B = a band of tissue attached to the dorsal aspect of the spinal cord.

References

  • 1.

    Altman NR: MR imaging of spinal dysraphism. AJNR 8:5335381987Altman NR: MR imaging of spinal dysraphism. AJNR 8:533–538 1987

  • 2.

    Barson AJ: Spina bifida: the significance of the level and extent of the defect to the morphogenesis. Dev Med Child Neurol 12:129144. 1970Barson AJ: Spina bifida: the significance of the level and extent of the defect to the morphogenesis. Dev Med Child Neurol 12:129–144. 1970

    • Search Google Scholar
    • Export Citation
  • 3.

    Delashaw JBPark TSCail WMet al: Cervical meningocele and associated spinal anomalies. Childs Nerv Syst 3:1651691987Delashaw JB Park TS Cail WM et al: Cervical meningocele and associated spinal anomalies. Childs Nerv Syst 3:165–169 1987

    • Search Google Scholar
    • Export Citation
  • 4.

    Doran PAGuthkelch AN: Studies in spina bifida cystica. I. General survey and reassessment of the problem. J Neurol Neurosurg Psychiatry 24:3313451961Doran PA Guthkelch AN: Studies in spina bifida cystica. I. General survey and reassessment of the problem. J Neurol Neurosurg Psychiatry 24:331–345 1961

    • Search Google Scholar
    • Export Citation
  • 5.

    Eller TWBernstein LPRosenberg RSet al: Tethered cervical spinal cord. Case report. J Neurosurg 67:6006021987Eller TW Bernstein LP Rosenberg RS et al: Tethered cervical spinal cord. Case report. J Neurosurg 67:600–602 1987

    • Search Google Scholar
    • Export Citation
  • 6.

    Fisher RGUihlein AKeith HM: Spina bifida and cranium bifidum. Study of 530 cases. Mayo Clin Proc 27:33381952Fisher RG Uihlein A Keith HM: Spina bifida and cranium bifidum. Study of 530 cases. Mayo Clin Proc 27:33–38 1952

    • Search Google Scholar
    • Export Citation
  • 7.

    Freide RL: Developmental Neuropathology. New York: Springer-Verlag1975 pp 240253Freide RL: Developmental Neuropathology. New York: Springer-Verlag 1975 pp 240–253

    • Search Google Scholar
    • Export Citation
  • 8.

    Matson DD: Neurosurgery of infancy and childhooded 2. Springfield, Ill: Charles C Thomas1969 pp 160Matson DD: Neurosurgery of infancy and childhood ed 2. Springfield Ill: Charles C Thomas 1969 pp 1–60

    • Search Google Scholar
    • Export Citation
  • 9.

    Suneson AKalimo H: Myelocystocele with cerebellar heterotopia. Case report. J Neurosurg 51:392396. 1979Suneson A Kalimo H: Myelocystocele with cerebellar heterotopia. Case report. J Neurosurg 51:392–396. 1979

    • Search Google Scholar
    • Export Citation

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