Terminal myelocystocele: a series of 30 cases and review of the literature

Objective: Terminal myelocystocele is a rare form of spinal dysraphism. We report on the clinical and radiological features, surgical procedures and outcome of myelocystocele.

Methods: Thirty patients, with an age range of 1 month to 15 years, which included 16 (53.3%) male children, had undergone surgery for terminal myelocystocele between 2000 and 2010. We had retrospectively analyzed their data. All patients had a swelling in the lumbosacral region which had a healthy skin cover. Twenty (66.7%) patients had presented with weakness, while 10 (33.7%) patients had no deficits at all. Bladder bowel involvement was evident in 12 (40%) cases. All patients had undergone excision of the meningocele sacs, the tethering bands were lysed, and filum was detethered. Ventriculoperitoneal shunt was done in 3 (10%) patients. Complications like pseudomeningocele were seen in 6 (20%) patients, cerebrospinal fluid leak in 4 (13.3%) patients, and meningitis and surgical site infection in 1 (3.3%) patient each. The mean follow-up period was 15.2 (1-60) months. The status of all patients with no preoperative deficits remained unchanged. Out of 20 patients with motor weakness, 12 (60%) had improvement; worsening was observed in 1 patient.

Conclusions: Though rare, the possibility of myelocystocele should be kept in mind when treating lumbosacral region masses as they have a better prognosis when compared with other masses in the region due to spinal dysraphism. We recommend early surgery in all diagnosed cases.