Meningocele manque'

Meningocele Manqué is a rare and subtle form of closed spinal dysraphism, part of the broader category of occult spinal dysraphism. Unlike classic meningoceles, which present as visible cystic swellings on the back, meningocele manqué does not form a visible sac. Instead, it involves a defective dura and arachnoid layer protruding minimally or being adherent to deeper tissues, often associated with tethered cord syndrome. Due to the absence of external bulge, this anomaly often goes undetected until the child develops neurological, orthopedic, or urological symptoms during growth. In many cases, it is found incidentally on MRI of the spine when evaluating symptoms such as back pain, leg weakness, or bladder dysfunction. 🌍 Meningocele Manqué in the Bangladesh Context In Bangladesh, meningocele manqué is frequently overlooked due to lack of visible signs, poor access to diagnostic imaging in rural areas, and limited awareness among frontline healthcare providers. Many children are labeled as having cerebral palsy or idiopathic scoliosis without adequate investigation. As a result, diagnosis is delayed, leading to permanent neurological deficits. Dr. Md. Nafaur Rahman, a leading pediatric neurosurgeon in Bangladesh, is actively managing these complex and subtle forms of spinal dysraphism using state-of-the-art imaging, intraoperative neuromonitoring, and microsurgical techniques, ensuring timely diagnosis and effective intervention. 🧬 Pathophysiology Result of improper closure of the neural tube during embryogenesis Represents a "failed meningocele", where meninges attempt to herniate but remain embedded within surrounding tissues Frequently accompanied by: Thickened filum terminale Low-lying conus medullaris Tethered spinal cord Fatty filum or lipoma Dermal sinus tracts or epidermoid cysts 🧒 Clinical Features Due to its hidden nature, clinical suspicion is crucial. Symptoms may begin in infancy or present later in childhood: Abnormal gait, toe-walking, or leg stiffness Foot deformities (clubfoot, high arch, limb length discrepancy) Back pain or stiffness Urinary incontinence or constipation Delayed toilet training Weakness or numbness in the lower limbs Skin stigmata such as: Hairy patch Midline dimple Pigmented or lipomatous lesions over the lower spine 🔍 Diagnostic Approach 🧠 MRI of Lumbosacral Spine The gold standard for diagnosis Shows low-lying conus, tethered cord, and fibrous adhesions May detect accompanying anomalies like lipomas or split cord malformation 🧬 Urodynamic Studies Evaluates bladder function if there are urinary complaints 🧪 Neurological Evaluation Detailed lower limb neurological assessment 🛠️ Surgical Treatment The goal of surgery is to release tethered neural elements, remove associated adhesions or tracts, and restore free spinal cord movement. ✂️ Microsurgical Detethering: Safe and precise dissection of fibrous bands or adhesions Excision of lipoma or abnormal meningeal tissues Closure of dural defect to prevent retethering Intraoperative neuromonitoring improves safety in delicate spinal surgery Early surgery improves outcomes and prevents further neurological deterioration. 🔄 Postoperative Outcome Most children show improvement or stabilization of neurological and bladder symptoms Improved gait and posture Reduction in leg pain or tightness Long-term follow-up necessary to monitor: Retethering Spinal deformity progression Urinary function 👨‍⚕️ Why Choose Dr. Md. Nafaur Rahman? One of Bangladesh’s most trusted pediatric neurosurgeons for occult spinal dysraphism Expert in microsurgical detethering for subtle spinal anomalies Operates with advanced intraoperative neuromonitoring tools Offers comprehensive pediatric care at NINS and Bangladesh Paediatric Neurocare Centre Devoted to raising awareness and enabling early detection of hidden spinal conditions in Bangladesh 📞 For Appointments or Surgical Consultation Dr. Md. Nafaur Rahman Assistant Professor, Pediatric Neurosurgery, National Institute of Neurosciences & Hospital (NINS) Chief Consultant, Bangladesh Paediatric Neurocare Centre 📞 Serial Call: 01912988182 | 01607033535 🌐 Website: www.neurosurgeonnafaur.com