Giant Thoracic Meningocele Causing Acute Respiratory Compromise

Alp Yurter, Paul E. Kaloostian

Johns Hopkins University Medical Center, Baltimore, USA.

DOI: 10.4236/ojmn.2013.34017                

Abstract

Objective: The authors report a rare case of giant thoracic meningocele causing acute respiratory compromise, treated with a ventriculoperitoneal shunt. Case Report: We report the case of a 36-year-old with severe scoliosis status post repair over a decade ago, neurofibromatosis type I, and a known large meningocele in the left thoracic cavity, presenting with new acute respiratory compromise. She was taken to the operating room for a lumboperitoneal shunt, but the operation was aborted due to her severe spinal deformity. Two days later, she successfully underwent a procedure for ventriculoperitoneal shunt placement. Upon discharge a week later, the patient was hemodynamically stable, able to move all extremities with good strength, and demonstrated improved oxygenation. In the following 7 months, the patient demonstrated continued minimal requirement on nasal cannula, and MRI showed a stable left thoracic giant meningocele. Conclusion: Ventriculoperitoneal shunting is a method of treating and stabilizing acutely symptomatic giant meningoceles.

Keywords

Giant Thoracic Meningocele; Intrathoracic; Cerebrospinal Fluid (CSF); Ventriculoperitoneal (VP) Shunt; Respiratory Compromise; Neurofibromatosis Type I (NF-I)

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	G. C. de Andrade, O. P. Braga, M. K. Hisatugo, M. A. de Paiva Neto, E. Succi and F. M. Braga, “Giant Intrathoracic Meningoceles Associated with Cutaneous Neurofibromatosis Type I: Case Report,” Arq Neuropsiquiatr, Vol. 61, No. 3A, 2003, pp. 677-681. http://dx.doi.org/10.1590/S0004-282X2003000400029
[2]	K. Tanaka, K. Shimizu, S. Kakegawa, K. Oshima and I. Takeyoshi, “Cystoperitoneal Shunt for a Giant Intrathoracic Meningocele under Local Anesthesia,” Annals of Thoracic Surgery, Vol. 91, No. 1, 2011, pp. 317-319. http://dx.doi.org/10.1016/j.athoracsur.2010.01.071
[3]	A. Y. Oner, M. Uzun, N. Tokgoz and E. T. Tali, “Isolated True Anterior Thoracic Meningocele,” American Journal of Neuroradiology, Vol. 25, No. 10, 2004, pp. 1828-1830.
[4]	S. Ebara, Y. Yuzawa, T. Kinoshita, J. Takahashi, I. Nakamura, H. Hirabayashi, J. Kitahara, M. Yamada and K. Takaoka, “A Neurofibromatosis Type 1 Patient with Severe Kyphoscoliosis and Intrathoracic Meningocele,” Journal of Clinical Neuroscience, Vol. 10, No. 2, 2003, pp. 268-272. http://dx.doi.org/10.1016/S0967-5868(03)00003-1
[5]	Y. J. Kim, H. M. Cho, C. S. Yoon, C. K. Lee, T. Y. Lee and J. P. Seok, “Surgical Treatment of Thoracic Menigocele Associated with Neurofibromatosis and Kyphoscoliosis,” Korean Society for Thoracic & Cardiovascular Surgery, Vol. 44, No. 5, 2011, pp. 383-386. http://dx.doi.org/10.5090/kjtcs.2011.44.5.383
[6]	E. C. Allibone, R. S. Illingworth and T. Wright, “Neurosis Fibromatosis (von Recklinghausen’s Disease) of the Vertebral Column,” Archives of Disease in Childhood, Vol. 35, 1960, pp. 153-158. http://dx.doi.org/10.1136/adc.35.180.153
[7]	P. G. Calzavara, A. Carlino, G. P. Anzola and M. P. Pasolini, “Segmental Neurofibromatosis. Case Report and Review of the Literature,” Neurofibromatosis, Vol. 1, No. 5-6, 1988, pp. 318-322.
[8]	J. Mizuno, H. Nakagawa, T. Yamada and T. Watabe, “Intrathoracic Giant Meningocele Developing Hydrothorax: A Case Report,” Journal of Spinal Disorders & Techniques, Vol. 15, No. 6, 2002, pp. 529-532. http://dx.doi.org/10.1097/00024720-200212000-00018
[9]	P. Rukskul, “Lumbo-Peritoneal Shunting Improved Spinal Cord Compression Due to a Large Anterior Sacral Meningocele,” Journal of the Medical Association of Thailand, Vol. 88, No. 2, 2005, pp. 265-268.
[10]	C. Kondageski, D. Thompson, M. Reynolds and R. D. Hayward, “Experience with the Strata Valve in the Management of Shunt Overdrainage,” Journal of Neurosurgery, Vol. 106, No. 2, 2007, pp. 95-102.