A Case Report of a Posterior Thoracic Meningocele in a 38-week Newborn

Jamison D, Woolison Rutter L
Ohio University Heritage College of Osteopathic Medicine, Athens, Ohio, United states

Background Context: The Centers for Disease Control and Prevention (CDC) reports that ~1500 infants with spina bifida or neural tube defects (NTD) are born in the United States. Ninety-five percent of children with NTDs are born to couples with no family history of such defects. A meningocele is formed when the meninges herniate through a defect in the posterior vertebral arches or the anterior sacrum. The spinal cord is usually normal in position and function. A fluctuant midline mass might transilluminate across the vertebral column, usually found in the lower back. In asymptomatic children with normal neurologic findings and full-thickness skin covering over the defect, surgery may be delayed or not performed depending on the case. Meningoceles are rare in the thoracic spine.
Purpose: The purpose of this report is to bring awareness to a rare case of a thoracic meningocele in a newborn patient.
Study design: This is a clinical case report.
Setting: Southeastern Ohio Community Hospital
Methods: We report an asymptomatic 38-week newborn. On examination, the infant was found to have a step-off located around T2 with a bulge present when crying. The neurologic and physical exam was otherwise normal. Of note, the mother had Herpes Simplex Virus, on valcyclovir prophylaxis, and was also Group B Strep positive.
Results: After imaging, due to clinical suspicion, the patient was found to have a skin covered upper posterior thoracic meningocele from T1/2-T4/5 with T2-T4 dysraphism and a small intraspinal lipoma at T2 with normal spinal alignment on MRI. The patient was sent to a children’s hospital to await surgical and neurologic evaluation. CT scans and a head ultrasound were also ordered with significant findings consistent with the above description. The head ultrasound was normal. At 18 days old, he continued to be stable without changes to the size or character of cystic prominence within the superior midline. The patient was neurologically stable without motor deficits or changes in bowel or bladder function. In terms of the surgical evaluation, it was determined to be non-urgent but will likely need surgical intervention in the future. As long as the patient does not develop neurologic symptoms, the surgery can be held until 6-12 months. He was scheduled to return to Pediatric Neurosurgery for follow up in 3 months.
Conclusions: To the best of our knowledge, this is the only case of a posterior thoracic meningocele with dysraphism and an intraspinal lipoma in an otherwise asymptomatic 38-week newborn infant in the literature. Besides the defect, the patient continued to have a normal neurologic and motor exam. Other studies have shown patient cases with thoracic meningoceles associated with other conditions like Neurofibromatosis-1, Neurofibromatosis-2, or Arnold Chiari Malformation. This patient did not show signs or have findings consistent with an associated condition.
References: Kliegman, R. et al. (2016) Nelson’s Textbook of Pediatrics 20th Edition. Philadelphia, PA: Elsevier. P. Volume 2. P. 2805
Gomella, T.L. et al. (2013) Neonatology. New York:McGraw-Hill Education LLC. P. 776-785.