Andy Wells11 months ago

Congenital Spinal Meningocele

A newborn boy was admitted to the neonatal intensive care unit for management of an open lumbosacral neural-tube defect, which had first been identified on an antenatal ultrasound image at 20 weeks’ gestation. No known risk factors — such as folate deficiency, gestational diabetes, use of high-risk medications, or genetic anomalies — had been found on evaluation of the mother and fetus. During antenatal consultation, the parents opted not to pursue referral to an in utero surgical repair center. A planned cesarean section had been performed at 39 weeks’ gestation. The Apgar score was 9 at both 1 minute and 5 minutes. A physical examination was notable for the presence of a red, fluid-filled sac, measuring 7.7 cm by 7.1 cm by 5.3 cm, that protruded through a lumbosacral defect (Panel A). Subsequent magnetic resonance imaging of the spine confirmed the finding (Panel B). Six days after the baby’s birth, he underwent excision of the sac and reconstruction of the defect; no neural elements were found within the sac. The diagnosis of a meningocele was confirmed. A meningocele is a type of open neural-tube defect in which meninges and cerebrospinal fluid (but not neural tissue) herniate through an opening in the spinal column. On postoperative day 4, the baby was discharged home. At a 6-month follow-up visit, his development was normal. source: nejm.org