Upper Dorsal Meningocele: A Case Report and Review of the Literature

Background: Meningocele is a form of spinal dysraphism in which the meninges and cerebrospinal fluid herniate through a vertebral defect while the spinal cord usually remains within the spinal canal. Upper thoracic lesions are exceptionally uncommon and may present without neurological impairment. Case presentation: A 3-month-old male infant, born at term by vaginal delivery, was evaluated for a dorsal swelling. Examination showed a tense, well epithelialised, pedunculated mass measuring approximately 6 x 6 cm. Neurological examination was unremarkable. Magnetic resonance imaging demonstrated a cerebrospinal fluid-filled dorsal meningocele associated with a posterior arch fusion defect at T5. The lesion was excised through a circumferential skin incision. Intraoperatively, a lipoma surrounded a fibrovascular stalk; no nerve roots or spinal cord adhesion to the meningocele dura were identified. The immediate postoperative course was uneventful. Conclusion: Upper thoracic dorsal meningocele should be considered when a skin-covered dorsal mass is identified in an infant. Magnetic resonance imaging is essential for defining the bony defect and the relationship of the sac to neural structures. Careful operative exploration is required because a fibrovascular or neuroglial stalk may coexist even when the neurological examination is normal.