A. Chirianc, Giorgiana Ion, Z. Faiyad, I. Poeata


 

DOI: 10.33962/ roneuro-2019-081 

A lateral meningocele in a 48 years lady 
revealed by a CSF fistula. 

Exceptional case 

Ibrahim Assoumane,Nadhim 
Benmedakhene, Adakal Ousseini, 
Bachir Sabrina, Nadia Lagha, Sidi 
Said Abderahmanne, Abdelhalim 

Morsli 



Romanian Neurosurgery (2020) XXXIV (1): pp. 85-88 
10.33962/roneuro-2019-081 
www.journals.lapub.co.uk/index.php/roneurosurgery 

 
 

 

A lateral meningocele in a 48 years lady 
revealed by a CSF fistula. 
Exceptional case  
 

 
Ibrahim Assoumane1,2, Nadhim Benmedakhene1, 

Adakal Ousseini3, Bachir Sabrina1, Nadia Lagha1, 

Sidi Said Abderahmanne1, Abdelhalim Morsli1 

 
1 Department of Neurosurgery CHU Bab El Oued, Algiers, ALGERIA 
2 Department of Neurosurgery Maradi Reference Hospital, NIGER  
3 Department of general surgery, Faculty of Health Sciences, 

University of Maradi, NIGER 

 
 

ABSTRACT 
Background: Lateral meningocele is defined by the presence of protrusions of the 

arachnoid and the dura matter extending laterally through inter- or intravertebral 

foramina. It is an extremely rare condition; to the best of our knowledge, only a few 

cases are reported in the literature and most of them in childhood. 

Case presentation: Authors reported a case of a 48 years old lady who consulted for 

a lombo-sacral mass right-sided with a CSF fistula. The Spinal MRI objectified a 

meningocele lateralized in the right side associated with multiples malformations. 

The patient underwent surgery and the meningocele was closed after excision of the 

associated subcutaneous lipoma. The long-term outcome was favourable and the 

follow up was assured by clinical examination monthly in the first year. 

Conclusion: Lateral meningocele is very rarely reported, it is usually associated with 

multiples malformations. Surgical treatment is a good option for treatment for 

avoiding complications. The prognostic depends on the preoperative status and the 

associated malformations. 

 

 

INTRODUCTION 

Lateral meningocele is defined by the presence of protrusions of the 

arachnoid and the dura matter extending laterally through inter- or 

intravertebral foramina. 

These often occur in the setting of Marfan syndrome, 

neurofibromatosis type 1or lateral meningocele syndrome but may also 

be seen as isolated anomalies. 

It is extremely rare condition, and only few cases are reported in the 

literature and most of them in childhood. The most reported cases are 

in thoracic and cervical regions. The localization at the sacral spine is 

very infrequent [1] 

Here we report the management of a fistulized lumbo sacral lateral 

meningocele in a 48 years old lady in the department of neurosurgery 

of Bab El Oued teaching hospital of Algiers Algeria.  

Keywords 
lateral, 

meningocele, 
spinal sacral  

 
 

 
 

Corresponding author: 
Ibrahim Assoumane 

 
Department of Neurosurgery CHU 

Bab El Oued, Algiers, Algeria 
 

assoubrahim18@gmail.com 
 
 

 
 

Copyright and usage. This is an Open Access 
article, distributed under the terms of the Creative 
Commons Attribution Non–Commercial No 
Derivatives License (https://creativecommons 
.org/licenses/by-nc-nd/4.0/) which permits non-
commercial re-use, distribution, and reproduction 
in any medium, provided the original work is 
unaltered and is properly cited. 
The written permission of the Romanian Society of 
Neurosurgery must be obtained for commercial 
re-use or in order to create a derivative work. 
 

 
ISSN online 2344-4959 
© Romanian Society of 

Neurosurgery 
 

 
 

First published 
March 2020 by 

London Academic Publishing 
www.lapub.co.uk 

 

http://www.lapub.co.uk/


 86 
Ibrahim Assoumane, Nadhim Benmedakhene, Adakal Ousseini et al. 

CASE PRESENTATION 

Madame B N aged of 48 years with past medical 

history of surgical intervention for a right foot 

deformation consulted in the emergency unit of our 

department for Cerebro Spinal Fluid (CSF) leaking in 

the lumbosacral region through a small mass. The 

patient reported that she was born with a small mass 

in the lumbo sacral region but any investigation was 

performed and she never consulted for. One year 

before, she was victim of a traffic accident and since 

date the volume of the mass grows progressively 

with the extension toward the right side.  

At the admission the clinical exam found 

conscious patient in good general health, 

temperature 37 degre celcius, complaining of back 

pain and a paraparesia coted 4/5, a right clubfoot 

with stigmas of previous surgical interventions. 

There was no sensory or sphincter disturbance and 

no <<café au lait˃˃ lesions. In the lumbo sacral 

region right sided there was a mass of 15 cm of size, 

well epidermised with large implantation base 

(Figure 1). Through the masse there was a fistula of 

Cerebro Spinal Fluid (CSF).  

The biological investigations are normal; Spinal 

MRI (Figure 2) objectified a spinal cord extension up 

to S1 and a subcutaneous liquid mass extending to 

the right sacral region as a meningocele. This 

investigation revealed other malformations; a 

tethered spinal cord at S1 level, a subcutaneous 

lipoma, a malformative L2-L3 fusion. 

We operated the patient under general 

anesthesia, on prone position. We performed an 

“ogive fashion” skin incision, after the excision of the 

subcutaneous lipoma, we dissected the meningocele 

and found a fibrous stalk attached in the wall of the 

meningocele, this fibrous element was detached 

before the closure of the meningocele using silk 3/0. 

(Figure 3) 

The post-operative outcome was marqued by the 

relief of back pain and improvement of paraparesia. 

The patient exited from the hospital seven days after 

surgery with appointment in three days for total 

removal of sutures. After 3 days the patient came 

back for the appointment but we discover a liquid 

collection, we use a needle gauge to carry out a 

puncture of 125 cc of serum bloody. The 

bacteriological study revealed a staphylococcus a 

coagulase negative. We put her under Acetazolamide 

250mg twice daily, oxacillin 1g bid daily. 

The evolution was uneventful and the patient was 

discharged from the hospital after 7 days of 

treatment with appointment in one month. She was 

followed up monthly and after 2 years there is no 

complaint. She recovered the motor disturbance 

with the help of physiotherapy.  

 

 
 

Figure 1. Pre-operative image of the Mass in the lumbo sacral 

region right sided. 
 

 
 

Figure 2. Spine MRI showed a spinal cord extension up to S1 

and a subcutaneous liquid mass extending to the right sacral 

region as a meningocele. 

 

Figure 3. Per operative image showing the walls of the 

meningocele. 



 87 
A lateral meningocele in a 48 years lady revealed by a CSF fistula 

DISCUSSION  

Meningomyelocele are the most common forms of 

neural tube defects. Lateral presentations are 

extremely rare [2, 5], the incidence of lateral 

meningoceles was reported to be 0.3% [4] 

These lateral presentations often occur in the 

setting of Marfan syndrome or neurofibromatosis 

type 1but our patient did not present any café au lait 

lesions. 

Lateral meningocele is also seen in Lateral 

meningocele syndrome. 

This syndrome is a rare disorder, originally 

described by Lehman et al. in 1977 [3]; Patients with 

lateral meningocele syndrome present widened 

spinal canal with scalloping of the posterior surfaces 

of the vertebral bodies and multiple lateral 

meningoceles, frequently associated with distinctive 

craniofacial features such as downslanting palpebral 

fissures, ptosis, mandibular hypoplasia, a high 

palate, and skeletal abnormalities such as hypoplasia 

of the posterior arch of the atlas, short stature, 

scoliosis, and kyphosis [3], our patient did not 

present any distinctive craniofacial features.  

To the best of our knowledge lateral meningocele 

in adult not associated with Marfan syndrome or 

neurofibromatosis type 1or Lateral meningocele 

syndrome has not been published earlier. 

Many meningomyelocele often are associated with 

tethered cord [2]. 

Some authors reported that Lateral 

meningoceles are usually associated with vertebral 

defects such as hemivertebrae, scoliosis, absence of 

neural arches on the affected side, and widening of 

the spinal canal and intervertebral foramina. 

Scalloping of the pedicles, laminae and vertebral 

bodies that are adjacent to the meningocele result in 

an enlarged spinal canal. Butterfly vertebra and 

segmental anomalies of the vertebral bodies may be 

found in as many as 43% of affected patients. Sacral 

anomalies, such as confluent sacral foramina and 

partial sacral agenesis, occur in up to 50% of 

reported cases [6,7]. 

Our patient presented many associated 

malformations, a tethered spinal cord at S1 level, a 

subcutaneous lipoma, and a malformative L2-L3 

fusion. 

A patient with lateral meningoceles may remain 

asymptomatic or may suffer from paraparesis or 

back pain [8]. Chronic symptoms in lateral 

meningoceles usually arise when meningeal 

protrusions compress against or deform the 

adjacent structures such as vertebral bodies, nerves, 

and viscera. 

The index patient presented a mass since birth 

but the clinical sign were back pain and paraparesia. 

The consultation was motivated by the CSF fistula 

upon the right sacral mass. Patient leaving in some 

regions did not come to consultation early because 

of ignorance or poverty. 

Surgical closure is the treatment of choice, 

because the lateral meningocele does not have 

spontaneous regression and generally progresses its 

enlargement with a corresponding increase in the 

risk of complications like bladder or bowel 

dysfunction or neurological deficits. Surgical excision 

may be indicated in cases where giant and 

symptomatic cysts are present and they are causing 

bladder or bowel dysfunction or neurological deficits 

[9]. 

 

CONCLUSION 

Lateral meningocele is a very rarely reported entity 

and only few published cases are reported in the 

literature. Surgical treatment is a good option of 

treatment avoiding complications. The prognostic 

depends on pre-operative status and the associated 

malformations. 

 

CONFLICT OF INTERESTS 

None 

 

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