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Article: Surgical repair of a large intrathoracic meningocele associated with neurofibromatosis type 1 after failed cystoperitoneal shunts: illustrative case
Title | Surgical repair of a large intrathoracic meningocele associated with neurofibromatosis type 1 after failed cystoperitoneal shunts: illustrative case |
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Authors | |
Keywords | neurofibromatosis type 1 intrathoracic meningocele intradural transthoracic VATS |
Issue Date | 2021 |
Publisher | American Association of Neurological Surgeons. The Journal's web site is located at http://www.thejns-net.org |
Citation | Journal of Neurosurgery, 2021, v. 2 n. 10, p. article no. CASE21404 How to Cite? |
Abstract | BACKGROUND
Surgical treatment of intrathoracic meningoceles, commonly associated with neurofibromatosis type 1 (NF1), aims to reduce sac size for symptomatic relief. The procedures can be divided into cerebrospinal fluid diversion and definitive repair. The authors describe the management of an intrathoracic meningocele in a 56-year-old female with preexisting NF1.
OBSERVATIONS
The patient presented with progressive dyspnea. Magnetic resonance imaging revealed a left hemithoracic meningocele arising from the thecal sac at C7–T2. Two attempts at diversion by cystoperitoneal shunts resulted in recurrence. For definitive repair, T2–3 costotransversectomy was performed, and intradural closure of the meningocele opening was performed utilizing spinal dura and autologous fascia lata graft. Trapezius muscle regional flap was turned for reinforcement. Persistent leak warranted reoperation 7 days later. A transthoracic approach was undertaken using video-assisted thoracoscopic resection of the sac at aortic arch level, with reinforcement by latissimus dorsi flap and synthetic materials. Mechanical pleurodesis was performed. Intradural repair of the meningocele opening was revised.
LESSONS
Inherent dural abnormality makes repair difficult for meningoceles associated with NF1. A combined intradural and thoracoscopic approach with regional muscle flap and synthetic material reinforcement is a unique method for definitive treatment. Some essential points of perioperative management are highlighted.
ABBREVIATIONS
CSF = cerebrospinal fluid; CT = computed tomography; MRI = magnetic resonance imaging; NF1 = neurofibromatosis type 1; VATS = video-assisted thoracoscopic surgery. |
Persistent Identifier | http://hdl.handle.net/10722/304272 |
ISSN | 2023 Impact Factor: 3.5 2023 SCImago Journal Rankings: 1.173 |
DC Field | Value | Language |
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dc.contributor.author | Sum, CHF | - |
dc.contributor.author | Li, LF | - |
dc.contributor.author | Taw, BBT | - |
dc.contributor.author | Lui, WM | - |
dc.contributor.author | Sit, KY | - |
dc.contributor.author | Chow, VLY | - |
dc.contributor.author | Wong, YW | - |
dc.date.accessioned | 2021-09-23T08:57:41Z | - |
dc.date.available | 2021-09-23T08:57:41Z | - |
dc.date.issued | 2021 | - |
dc.identifier.citation | Journal of Neurosurgery, 2021, v. 2 n. 10, p. article no. CASE21404 | - |
dc.identifier.issn | 0022-3085 | - |
dc.identifier.uri | http://hdl.handle.net/10722/304272 | - |
dc.description.abstract | BACKGROUND Surgical treatment of intrathoracic meningoceles, commonly associated with neurofibromatosis type 1 (NF1), aims to reduce sac size for symptomatic relief. The procedures can be divided into cerebrospinal fluid diversion and definitive repair. The authors describe the management of an intrathoracic meningocele in a 56-year-old female with preexisting NF1. OBSERVATIONS The patient presented with progressive dyspnea. Magnetic resonance imaging revealed a left hemithoracic meningocele arising from the thecal sac at C7–T2. Two attempts at diversion by cystoperitoneal shunts resulted in recurrence. For definitive repair, T2–3 costotransversectomy was performed, and intradural closure of the meningocele opening was performed utilizing spinal dura and autologous fascia lata graft. Trapezius muscle regional flap was turned for reinforcement. Persistent leak warranted reoperation 7 days later. A transthoracic approach was undertaken using video-assisted thoracoscopic resection of the sac at aortic arch level, with reinforcement by latissimus dorsi flap and synthetic materials. Mechanical pleurodesis was performed. Intradural repair of the meningocele opening was revised. LESSONS Inherent dural abnormality makes repair difficult for meningoceles associated with NF1. A combined intradural and thoracoscopic approach with regional muscle flap and synthetic material reinforcement is a unique method for definitive treatment. Some essential points of perioperative management are highlighted. ABBREVIATIONS CSF = cerebrospinal fluid; CT = computed tomography; MRI = magnetic resonance imaging; NF1 = neurofibromatosis type 1; VATS = video-assisted thoracoscopic surgery. | - |
dc.language | eng | - |
dc.publisher | American Association of Neurological Surgeons. The Journal's web site is located at http://www.thejns-net.org | - |
dc.relation.ispartof | Journal of Neurosurgery | - |
dc.rights | This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. | - |
dc.subject | neurofibromatosis type 1 | - |
dc.subject | intrathoracic meningocele | - |
dc.subject | intradural | - |
dc.subject | transthoracic | - |
dc.subject | VATS | - |
dc.title | Surgical repair of a large intrathoracic meningocele associated with neurofibromatosis type 1 after failed cystoperitoneal shunts: illustrative case | - |
dc.type | Article | - |
dc.identifier.email | Li, LF: lfrandom@hku.hk | - |
dc.identifier.email | Taw, BBT: tawb@hku.hk | - |
dc.identifier.email | Sit, KY: kysit@hku.hk | - |
dc.identifier.email | Chow, VLY: chowlyv@hku.hk | - |
dc.identifier.email | Wong, YW: yatwa@hkucc.hku.hk | - |
dc.description.nature | published_or_final_version | - |
dc.identifier.doi | 10.3171/CASE21404 | - |
dc.identifier.hkuros | 325720 | - |
dc.identifier.volume | 2 | - |
dc.identifier.issue | 10 | - |
dc.identifier.spage | article no. CASE21404 | - |
dc.identifier.epage | article no. CASE21404 | - |
dc.publisher.place | United States | - |