2005-07-25-17 Meningocele and diastematomyelia © Cuillier www.thefetus.net/

Service de Gynécologie, CHD Félix Guyon, 97400 Saint-Denis, La Réunion. France. Tél : 0262 90 55 40. Fax : 0262 90 77 30. Email : fabrice.cuillier@wanadoo.fr Service de Gynécologie, CHI, 97400 Saint-Benois, La Réunion. France. Service d’obstétrique, CHD, 97400 Saint-Pierre, La Réunion. France. Tél : 0262 90 55 40. Fax : 0262 90 77 30. Email : fabrice.cuillier@wanadoo.fr

This is a 18-year-old woman G1, was referred for a second trimester prenatal scan. Serial ultrasound scans are shown below. The ultrasound features are suggestive of meningocele at the thoracic level. The amniotic fluid index was normal and the placenta was posteriorly placed. At 32 weeks of gestation, an amniocentesis was realised (46 XX).

Prenatal MRI scans showed: 

• A cavity in the middle of the spinal cord (? syringomyelia) in the cervical region .
• In the midthoracic dorsal region, a cystic lesion filled with cerebrospinal fluid and containing no neural elements.
• In the lumbar region there was a suspicion of diastematomyelia.

The diagnosis of meningocele and syringomyelia was considered during the pregnancy. The parents decide to continue the pregnancy. 

A female child was delivered at term (3000 g). On physical examination, there was a 15 mm X 10 mm dorsal midline midthoracic mass which felt semi-solid, but did not transilluminate. On neurological examination, there were no deficits. 

The diagnosis of meningocele was confirmed after delivery by MRI-scanning. A syrinx was visible above of the lesion (C6) which appeared not to communicate with the sac. T1-weighted and T2-weighted sagittal MR scans also showed normal spinal canal in the thoraco-lumbar region and revealed an osseous septum at the L3 level. A diastematomyelia was suspected on L3. A T2-weighted axial MR view demonstrated a split cord at the T10 level. The two hemicords were in the same dural sac and were separated by osseous median septum. The osseous septum completely traversed the spinal canal.

Postnatal photograph of the baby: