Meningocele and Meningocele
Introduction
Introduction of meningocele and spinal cord bulging Spinal meningocele is a common type of partial spina bifida. It refers to the swelling of the spinal canal and/or spinal nerve tissue into the spinal canal based on the spina bifida. If the spinal nerve tissue and the meninges bulge at the same time, and the bulging sac has intact skin or pseudo-epithelial coverage, it is called meningocele bulging. basic knowledge The proportion of illness: 0.0002% Susceptible people: infants and young children Mode of infection: non-infectious Complications: cerebrospinal fluid leakage dehydration
Cause
Meningocele and the cause of meningocele
Meningocele (35%):
A capsule is bulged in the soft tissue at the unconfined lamina of the midline of the back. The size of the capsule is different, the width of the base is different, the surface of the skin is normal, and the deep film of the subcutaneous layer is the bulging dura. Forming the lining of the bulging capsule and forming a cyst-like mass together with the skin. The capsule is filled with colorless, transparent cerebrospinal fluid, no nerve tissue, or only a thin fiber band is attached to the surface of the spinal cord, and the neck is usually small. The spinal cord in the spinal canal is in a normal form, and the skin of the bulging sac of a few patients has a scar-like appearance.
Spinal cord, meningocele (30%):
The dural sac bulges from the laminar rupture, the size is different, the base is wider, the lining of the capsule is the dura mater, the cystic neck is generally wider, and the contents of the capsule are two cases:
(1) A component with a small number of nerve roots in the sac and attached to the sac wall, that is, a swelled sac containing nerve roots and cerebrospinal fluid.
(2) The other is the lumbosacral spinal cord, the meninges bulge, the spinal cord and nerve roots are in and out of the sac, and the spinal cord and nerve tissue protrude into the sac and then curl, returning to the hard ridge of the spinal canal. Inside the capsule.
The bulging sac is filled with cerebrospinal fluid, and sometimes the fibrous band is divided into small chambers or small sacs. The spinal cord and nerve tissue protruding into the sac may have loose adhesion between the sac and the sac wall, but some are with the sac wall. It is solid adhesion, even integrated and difficult to separate, so the degree of nerve damage is very different. In some cases, the skin on the surface of the capsule is thin or scar-like, and in some cases, it is a squamous cell carcinoma.
Part of the meningocele and spinal cord, meningocele and lipoma are combined, called "lipoma-type meningocele" combined with "lipoma-type spinal cord and / or meningocele", such lesions sometimes include The block is large, the base is much wider, and the capsule is thick.
Spinal cord exposure or spinal cord bulging (20%):
This type is the most serious, clinically rare, laminae is wide, the spinal canal and dura mater are widely open, the spinal cord and nerve tissue are directly exposed, and its appearance is only a layer of arachnoid, generally does not form a cystic mass, It can be seen that the spinal cord and nerve root tissue and pulsation in it, and the degeneration of nerve tissue, there is a layer of dura covering.
Prevention
Meningocele and spinal cord bulging prevention
There is no effective preventive measure for this disease. Early detection and early diagnosis are the key to the prevention and treatment of this disease.
Complication
Meningocele and complications of meningocele Complications, cerebrospinal fluid leakage, dehydration
The main complications after meningocele surgery are cerebrospinal fluid leakage and the resulting meningitis and postoperative secondary tethering. In order to prevent cerebrospinal fluid leakage, in addition to the dural suture, the waist should be tight. The dorsal fascia strengthens the defect of the lower back, which can significantly reduce the incidence of cerebrospinal fluid leakage. Postoperative application of antibiotics that can pass the blood-cerebrospinal fluid barrier to reduce the occurrence of meningitis, intracranial In cases of increased pressure, dehydration drugs such as mannitol/sorbitol are used. Because of the blood stimulation in the arachnoid cavity after surgery, the body temperature rises. To prevent hyperthermia, dexamethasone and other drugs may be appropriately applied to relieve symptoms. Postoperative patients should be kept in the lateral or prone position. Patients with cerebrospinal fluid leakage should maintain a low head position, prevent a large number of cerebrospinal fluid outflows from inducing cerebral palsy, and prevention of surgical infection leading to meningeal suppuration is very important. Patients with cerebrospinal fluid leakage should not use local drugs, especially those with neurotoxicity, to prevent accidents.
Symptom
Meningocele and spinal cord bulging symptoms Common symptoms Powerless muscle atrophy Hydrocephalus Scoliosis
Clinical manifestations of meningocele and spinal meningocele can be divided into three aspects:
Partial mass
When the baby is born, a cystic mass can be seen in the neck, chest or lumbosacral region of the midline of the back. The volume varies from jujube to large, and the mass is round or elliptical. Most of the base is wide and a few are banded. The surface of the skin is normal, sometimes it is scar-like change, or it is a thin layer. When the baby is crying, the mass is swollen, and the compression mass is bulging before the cardia. If there is a ulceration, there is only one layer of arachnoid in the surface defect. The granulation or infection, the ulcer has broken, the surface of the mass has cerebrospinal fluid outflow, indicating that the bulging capsule communicates with the subarachnoid space, and the light transmission test of the mass is found in the simple meningocele. The degree of light transmission is high; for the meningocele of the spinal cord, because it contains the spinal cord and nerve roots, some of the blocks are shaded; if the meningocele is bulging or the meninges of the spinal cord are combined with lipoma, due to their appearance Covered by adipose tissue, the deep surface is the meningocele, so the degree of light transmission is low.
2. Symptoms of nerve damage
Simple meningocele can be free of neurological symptoms, spinal meningocele and spinal cord developmental malformation, degeneration, the formation of syringomyelia, the symptoms are more serious, often have varying degrees of lower extremity paralysis and incontinence The symptoms of severe neurological damage caused by lumbosacral lesions are far more than those of the neck and chest lesions. These neurological symptoms include deformed feet (such as varus, valgus, dorsal curvature and small feet), muscle atrophy, and lower limbs. Isotope with numbness, weakness and autonomic dysfunction, etc., spinal cord, meningocele bulging itself constitutes the tethered cord system, with the increase of age and length, the tethered cord syndrome is further aggravated, the spinal cord exposure is usually performed Severe neurological symptoms are also determined by the degree of spinal deformity.
3. Other symptoms
A small number of meningocele to the lateral side of the spinal canal or the posterior pharyngeal wall, thoracic cavity, abdominal cavity and pelvic extension, can show the symptoms of bulging sac compression of adjacent organs and organs, some children with meningocele with hydrocephalus and scoliosis Other symptoms, such as the corresponding symptoms.
Examine
Examination of meningocele and spinal cord bulging
1. Spinal X-ray film
It can show the bony structural changes of the spina bifida. The bulging sac extends to the thoracic cavity. The abdominal cavity and the intervertebral foramen are more common. When the pelvic cavity is prominent, the common fistula is significantly enlarged.
2.CT, MRI scan
It shows pathological conditions such as spina bifida and spinal cord, nerve malformation, and local adhesion.
Diagnosis
Diagnosis of meningocele and spinal cord bulging
According to the characteristics of clinical symptoms, diagnosis can generally be made. The light transmission test can be used as a reference for diagnosis. The most critical diagnosis point is that the baby is found to have a midline of the back and a swelling mass after birth, and it expands with age. And the accompanying symptoms of corresponding neurological impairment.
Differential diagnosis
1. teratoma of the appendix
The teratoma of the appendix is of low position, different in size, irregular in shape and uneven in hardness. It is a cystic solid mass. The position is mostly biased to one side. The mass usually has substantial tissues, such as bones and teeth. Cartilage, etc., the boundary of the tumor is clear, the cystic teratoma is positive for the light transmission test, because it is not connected with the spinal canal, so there is no impact when the tumor is compressed, and the sacral mass can be touched during rectal examination. When the ball is measured >20 ng%, there is a possibility of malignant transformation. The B-ultrasound examination is cystic, and the X-ray film shows no lumbosacral vertebral defect, and the teeth and bones in the tumor are visible.
2. Lipoma
Lipoma is soft, although the surface of the skin is high, but normal, the boundary is clear, often lobulated, the light transmission test is negative, and the spinal canal is not connected, the puncture can not extract the cerebrospinal fluid, but the spina bifida often combined with the subcutaneous lipoma of the site More attention should be paid to the identification of the fatty spinal meningocele.
3. Dermoid cyst
The cyst is composed of connective tissue and contains sebaceous glands, sweat glands, hair, etc. There are still epithelial and sebum in the sac. The covered skin is normal, the cyst is small, and it is closely connected with the skin. It can move, it is a sense of substance, and the light transmission test is negative. , does not communicate with the spinal canal, the impulse is not impulsive when pressed.
