Occipital meningocele

Case contributed by Dr Ghada Sheta

Presentation

30 weeks pregnant, prenatal ultrasound revealed a cystic lesion related to the fetal neck

Patient Data

Age: 40 years
Gender: Female
MRI
  • a large cystic lesion is seen at fetal occiput with a small defect about 1 cm related to lambdoid suture. It measures 6.7x5 cm in CC and AP diameters, showing thin septum, no brain tissue is seen within
  • the ventricular system showed mild lateral ventricle dilatation (17mm in the atrium). Normal 3rd and 4th ventricle
  • a small defect is seen in the sacral spine with small cyst likely small meningocele 1 cm (red arrow). Intact cervical spine
  • the subarachnoid space is compatible with the gestational age
  • the degree of gyration and sulcation is as expected for the stated gestational age
  • no structural abnormalities are noted in the cerebral hemispheres
  • the cavum septum pellucidum is normally formed
  • Corpus callosum is seen normal (compatible with the gestational age)
  • the craniocervical junction is unremarkable with no sign of Chiari or other malformation
MRI

Annotated image

Sagittal image demonstrates the sacral spinal defect (red arrow) with no mass protruding through the defect and intact overlying skin. 

Case Discussion

Findings are suggestive of occipital meningocele herniating through a small cranial defect with moderate ventriculomegaly and a suspected small sacral meningocele.

Prenatal MRI is valuable in cases of cystic lesions related to the head & neck as it delineates findings that can't be accurately assessed using ultrasound and helps to differentiate between cervical cysts (e.g cystic hygroma) and occipital meningocele

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Case information

rID: 78307
Published: 11th Jun 2020
Last edited: 11th Jun 2020
Inclusion in quiz mode: Included
Institution: Al Kasr Al-Ainy university hospitals