Zur Operationsindikation bei Ventralen Sakralen Meningozelen

Abstract

Comparison of some cases in adults to an extensive malformation in the small pelvis in a 4 years old girl.

Sacral ventral meningoceles are rare spinal malformations which probably result from a dysrhaphic disorder in an early embryonal stage (spina bifida). The dysrhaphic malformation extends towards the os sacrum with a defect in ventral direction.

In this paper, we present the cases of one child and three adults. The malformative tumor in the small pelvis of the child was so large that an obstruction of the urinary tract and of the rectum resulted. In addition to this there was a paralysis of the peroneal muscles caused by a congenital defect in the nervous system. The large space occupying tumor in the small pelvis was surgically reduced and separated from the subarachnoid space, after which considerable postoperative improvement was observed.

In the cases of the three adults, suffering from lumbal ischialgy, similar but much smaller malformations had been discovered through myelography. Two of these patients improved after removal of degenerated discs, and one by conservative treatment. There was no relation between the neurologic symptoms and the small ventral meningoceles.

A surgical removal of sacral ventral meningoceles is indicated, when these appear as space occupying tumors in the small pelvis. The tumor can then be reached from the CSF-space in order to relieve the obstruction of the urinary tract and the rectum.

Zusammenfassung

Es werden vier Fälle mit sakralen ventralen Meningozelen dargestellt: Bei einem Kinde ergab sich eine sichere Operationsindikation: Es lag eine große raumfordernde liquorgefüllte Mißbildung im kleinen Becken vor. Sie wurde verkleinert und vom Liquorraum getrennt, wonach sich die klinischen Symptome erheblich besserten. In den drei übrigen Fällen hat es sich um zufällig entdeckte ähnliche, aber erheblich kleinere (nicht im Becken raumfordernde) Mißbildungen gehandelt. Diese drei Patienten wurden wegen einer Bandscheibenerkrankung in zwei Fällen operativ und in einem Fall konservativ behandelt, wonach weitgehende Besserung eintrat. Zur Operationsindikation bei solchen Mißbildungen wird Stellung genommen.

Keyword

Sacral ventral meningocele - spinal malformation - spina bifida