Is meningocele really an isolated lesion?

Object: We designed this study to elucidate the associated occult spinal le sions in patients with simple dorsal meningocele. Methods: The study popula tion was comprised of two groups. Group I comprised newly diagnosed patient s with dorsal spinal meningocele, and group II comprised patients who had h ad surgery for meningocele and presented with progressive neurological defi cits. Magnetic resonance imaging (MRI) scans of the whole spinal column wer e done. The associated spinal cord malformations were also treated at the s ame operation. There were 14 boys and 8 girls, with an age range from birth to 4 years (mean 3.9 months), in group I. Of 20 patients (90%) with associ ated spinal lesions, 6 had more than one lesion, excluding hydromyelia. Gro up II was made up of 6 patients who had been previously operated on for a m eningocele and who presented with tethered cord syndrome. These were 4 boys and 2 girls, who ranged in age from 4 to 10 years (mean 6 years). Results: The level of the conus terminalis was lower than L3 in all patients. The o ther findings on MRI, besides low conus, were as follows: tight filum, spli t cord malformation, epidermoid, dorsal lipoma and hydromyelia. Conclusions : Meningocele frequently camouflages a second, occult, spinal lesion. MRI o f the whole spinal column should be performed. An intradural exploration pe rformed with a microneurosurgical technique is needed to detect the fibrous bands that may lead to spinal cord tethering and to release the entrapped nerve roots. The other associated spinal anomalies should be operated on du ring the same operation.