Case Report of an Anterior Thoracic Myelomeningocele: A Multidisciplinary Approach to Surgical Management.

Abstract

Cervicothoracic myelomeningocele (MMC) is a rare entity with only 2 reported cases in the literature of anterior thoracic MMC. We report a third case in a 3-year-old boy. MMC was diagnosed during antenatal screening and later warranted surgical intervention. Despite being asymptomatic, radiologic surveillance demonstrated worsening syringomyelia, tonsillar descent, and cord signal change concerning for myelomalacia. Preoperative management involved respiratory assessment for pulmonary compromise, general pediatric consultation, gait analysis by physiotherapy, and serial imaging by radiology. Surgical management involved an anterior thoracotomy approach by cardiothoracic surgeons, repair of the MMC by neurosurgeons, and bone graft to ameliorate the bony defect in the vertebral body by orthopaedic surgeons. Postoperative care involved 4 days in the intensive care unit and 14 days on the pediatric neurosurgical ward. At 3-year follow-up, there was radiologic improvement of syringomyelia, tonsillar descent, and kyphoscoliosis with no neurological or pulmonary complications. This case highlights the unique multidisciplinary surgical management of the rare entity of anterior thoracic MMC without scoliosis correction for radiologic progression.