A baby girl born at term
to a 23-year-old
mother was noted to have a
large fluid-filled, skincovered
soft tissue mass
protruding from the
midthoracic region in the dorsal midline. Birth weight was 3.5
kg, and the baby had Apgar scores of 9 at 1 and 5 minutes.
Examination revealed the anterior fontanelle to be soft and
flat, and the patient’s head size was normal. No dysmorphic
features were noted. There was a small sacral dimple. The
infant had no obvious neurological deficits, moved all extremities
equally, and had normal reflexes.
A magnetic resonance imaging (MRI) scan of the brain and
spinal cord revealed a posterior thoracic meningocele with
displacement of the spinal cord into the base of the sac, which
otherwise seemed to be devoid of neural elements. An
MRI scan of the brain and craniocervical junction revealed an
associated Chiari malformation with herniation of the caudal
cerebellum down to the midportion of C1 . The ventricles
were of normal size and configuration.
A repair of the thoracic meningocele was performed on Day
2 of life with release of the circumferential area of spinal cord
tethering at the site of the dural defect. Direct communication
between the meningocele sac and the spinal subarachnoid
space was apparent. Watertight dural and myofascial closure
was then obtained. Because the child’s Chiari malformation
was asymptomatic, expectant management was pursued. A
follow-up MRI scan 3 months after the operation
revealed complete resolution of the previously noted Chiari
malformation, as well as ample CSF space at the foramen
magnum region. A follow-up MRI scan 4 months later revealed
no evidence of recurrence of the Chiari malformation.
The child continues to demonstrate normal neurological function
and is exhibiting appropriate developmental progress.(source)
This is amazing that they can fix the problem in the thoracic spine an the chiari malformation resolves itself. The body is so awesome.