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Retained medullary cord extending to a sacral subcutaneous meningocele

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Abstract

Background

A retained medullary cord (RMC) is a rare closed spinal dysraphism with a robust elongated neural structure continuous from the conus and extending to the dural cul-de-sac. One case extending down to the base of a subcutaneous meningocele at the sacral level has been reported.

Clinical presentation

We report on three cases of closed spinal dysraphism, in which a spinal cord-like tethering structure extended out from the dural cul-de-sac and terminated at a skin-covered meningocele sac in the sacrococcygeal region, which was well delineated in curvilinear coronal reconstructed images of 3D-heavily T2-weighted images (3D-hT2WI). Intraoperative neurophysiology revealed the spinal cord-like tethering structure was nonfunctional, and histopathology showed that it consisted of central nervous system tissue, consistent with RMC. The tethering structure histologically contained a glioneuronal core with an ependymal-like lumen and smooth muscle, which may indicate developmental failure during secondary neurulation.

Conclusions

When the RMC extending to a meningocele is demonstrated with the detailed magnet resonance imaging including 3D-hT2WI, decision to cut the cord-like structure for untethering of the nervous tissue should be made under careful intraoperative neurophysiological monitoring.

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Acknowledgments

We thank Ann Turnley, PhD, from Edanz Group (www.edanzediting.com/ac) for editing a draft of this manuscript. This work was partly supported by Research Foundation of Fukuoka Children’s Hospital.

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Authors and Affiliations

  1. Department of Neurosurgery, Fukuoka Children’s Hospital, 5-1-1 Kashii-teriha, Higashi-ku, Fukuoka, 813-0017, Japan

    Nobuya Murakami & Takato Morioka

  2. Department of Neurosurgery, Kyushu Rosai Hospital, Kitakyushu, Japan

    Takato Morioka & Takafumi Shimogawa

  3. Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

    Takafumi Shimogawa, Kimiaki Hashiguchi, Nobutaka Mukae & Koji Iihara

  4. Department of Surgical Pathology, Kyushu Rosai Hospital, Kitakyushu, Japan

    Kazuyoshi Uchihashi

  5. Department of Neuropathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

    Satoshi O. Suzuki

Authors
  1. Nobuya Murakami
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  2. Takato Morioka
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  3. Takafumi Shimogawa
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  4. Kimiaki Hashiguchi
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  5. Nobutaka Mukae
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  6. Kazuyoshi Uchihashi
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  7. Satoshi O. Suzuki
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  8. Koji Iihara
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Corresponding author

Correspondence to Nobuya Murakami.

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The authors declare that they have no conflicts of interest.

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Informed consent was obtained from all individual participants included in the study.

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Murakami, N., Morioka, T., Shimogawa, T. et al. Retained medullary cord extending to a sacral subcutaneous meningocele. Childs Nerv Syst 34, 527–533 (2018). https://doi.org/10.1007/s00381-017-3644-2

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  • DOI: https://doi.org/10.1007/s00381-017-3644-2

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