Dura herniation

Introduction Meningocele is a congenital dysplasia at the end of the spinal cord and spine that can cause meningocele.

Cause

The cause of dural bulging:

Due to congenital factors, the lamina is incompletely closed, and the meninges, spinal cord, and nerves bulge toward the lamina defect. The cause is still unknown. This disease occurs mostly in the midline of the dorsal aspect of the spine. The most common part of the lumbosacral segment is the cervical or thoracic segment. In some cases, the paravertebral canal protrudes from the side of the spinal canal through the enlarged intervertebral foramen, or the bulging sac extends into the posterior pharyngeal wall, the thoracic cavity, the abdominal cavity, and the pelvic cavity. Meningocele is generally single-shot, and multiple occurrences are rare. Meningocele sometimes coexists with congenital hydrocephalus.

an examination

Related inspection

Full physical examination CT examination

Examination and diagnosis of dural bulging:

Clinical manifestations of meningocele and spinal meningocele can be divided into three aspects:

1. 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 huge. The mass is round or elliptical, with a wide base and a few ribbons. The surface of the skin is normal, sometimes with a scar-like change, or a thin layer. When the baby is crying, the mass is swollen, and the compression mass is bulging. In the case of a ulceration, there is only one layer of arachnoid membrane on the surface defect, which is granulated or infected. In the case of ulceration, the surface of the mass has cerebrospinal fluid outflow, indicating that the bulging capsule communicates with the subarachnoid space. The light transmission test of the mass was found to have a high degree of light transmission in simple meningocele; for the spinal meninges, because there are spinal cords and nerve roots, some of the blocks have shadows; If the meningocele or the meningocele of the spinal cord is combined with lipoma, the surface is covered with adipose tissue, and the deep surface is the meningocele, so the degree of light transmission is low.

2. Symptoms of nerve damage: simple meningocele can have no neurological symptoms. Spinal meningocele and spinal cord developmental deformity, degeneration, 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 cervical and thoracic lesions. These neurological symptoms include deformed feet (such as varus, valgus, dorsal curvature and small feet), muscle atrophy, unequal length of the lower limbs with numbness, weakness and autonomic dysfunction. The tethered cord of the spinal cord and meningocele itself can be further aggravated with age and length of the tethered cord syndrome. Spinal cord exposure usually shows severe neurological symptoms and is also determined by the degree of spinal deformity.

3. Other symptoms: a small number of meningocele bulging to the lateral side of the spinal canal or the posterior pharyngeal wall, thoracic cavity, abdominal cavity and pelvic cavity extension, can show the symptoms of bulging sac compression of adjacent organs and organs. Some children with meningocele with other malformations such as hydrocephalus and scoliosis may have corresponding symptoms.

Differential diagnosis

Symptoms of dural bulging:

Open spine split type:

1. Spinal cord fissure: the spinal canal, spinal cord and meninges are split, the main part is thoracolumbar segment, often cerebrospinal fluid overflows, neurological dysfunction is serious, and the limbs below the diseased segment are often completely paralyzed.

2. Spinal meningocele: more common in the knee or lumbosacral segment, often cyst formation, spinal cord and nerve root into the sac or exposed, neurological dysfunction is light and heavy, depending on the degree of deformity.

3. The hemifacial meningocele bulges, and only the hemifacial spinal sac is bulging.

4. Hydrological spinal meningocele: The bulging contents contain an enlarged central tube and a dysplastic spinal cord dorsal nerve tissue, often with a more complete capsule.

5. The meninges bulge, the bulge mainly contains cerebrospinal fluid, and there are almost all fiber bundles on the wall of the sacral spinal cord, and the spinal nerves can directly adhere to the wall of the capsule.

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