Double Meningocele: An Uncommon Entity.

A 7-month-old male child presented to the outpatient department with a history of thoracic and lower lumbar swellings since birth. Clinical examination revealed a midline solitary thoracic and lumbar swelling which was transilluminant with no evidence of paraparesis, bladder, or bowel incontinence [Figure 1a and b]. Magnetic resonance imaging (MRI) of the spine and brain revealed a thoracic and lumbar meningocele with spinal dysraphism at vertebral levels, dorsal 5–dorsal 8 and lumbar 1–lumbar 2, and right dorsal 4 hemivertebra with butterfly dorsal 6 vertebrae with no evidence of hydrocephalus [Figure 2a and b].

Figure 1

(a and b) Preoperative image showing meningocele at thoracic and lumbar region, (c) intraoperative excised thecal sac, (d) immediate postoperative sutured wound

Figure 2

(a) T1-weighted magnetic resonance imaging sagittal section showing spinal dysraphism at dorsal 5–dorsal 8 and lumbar 1–lumbar 2 vertebral level. (b) T2-weighted magnetic resonance imaging axial section showing defect at lumbar region

The patient underwent excision and repair of both defects in a single sitting. Intraoperatively, there were a thoracic and lumbar meningocele with clear cerebrospinal fluid and 0.5 cm × 0.5 cm bony defect at both sites [Figure 1c and d]. The postoperative recovery was uneventful.

The presence of a meningocele at multiple levels along the spinal column is a rare event. There are only seven cases of double meningocele reported in the world literature,[1] with no cases reported from the Indian Subcontinent so far. Spina bifida results from a defective closure of the neural tube between 26 and 28 days of gestation. “The single-site” closure theory postulates that closure starts like a “zipper” from a single site and moves bidirectionally. Van Allen et al. in 1993 proposed the multisite closure theory stating that there were five sites of closure and neural tube defect (NTD) can result from defective closure at any of these sites, which better explains the embryogenesis of NTD.[2] The occurrence of multiple NTDs is possible with the multisite closure theory due to simultaneous defects at several sites.

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