Meningocele is a congenital neural tube defect (spina bifida) in which only the meninges (with CSF) herniate through a vertebral arch defect, forming a fluid-filled sac without spinal cord involvement.
Meningocele causes milder neurologic impairment than myelomeningocele and generally has an excellent prognosis. Early recognition and surgical repair prevent complications like CSF leak, infection, and tethered cord syndrome.
Newborn with a dorsal midline, fluid-filled sac over the lumbar spine, often covered by intact skin. Lower-extremity strength and sensation are usually normal (only meninges protrude).
Prenatal findings may include moderately elevated maternal AFP and ultrasound visualization of a cystic spinal protrusion. Fetal MRI can confirm a meningeal sac without neural tissue.
Most meningoceles occur at the lumbosacral spine. The sac is often covered by skin, in contrast to myelomeningocele which may have exposed neural tissue.
Differentiate from myelomeningocele by imaging: if MRI shows no spinal cord or nerves in the sac, diagnosis is meningocele (better prognosis). If neural elements are present, suspect myelomeningocele.
Handle the sac gently and avoid vaginal delivery if diagnosed prenatally (C-section to protect sac). Position infant prone with sac protected to reduce CSF leak.
Plan neurosurgical closure in the neonatal period. After repair, follow development and screen for tethered cord or other anomalies.
Refer to pediatric neurosurgery for closure within the first days of life.
Post-repair: long-term follow-up of neurologic, orthopedic, and urologic function (watch for tethered cord).
Photograph of a newborn's back with a CSF-filled sac covered by skin at the lumbar region (meningocele).
Prenatal ultrasound: anechoic spinal bulge, elevated AFP, but normal intracranial anatomy (banana/lemon signs absent).
Diagram of spina bifida types: meningocele shows sac with meninges only (cord in place), compared to myelomeningocele.
Case 1
A newborn is noted to have a 3-cm fluid-filled sac on the lumbosacral spine covered by intact skin. Neurologic exam shows normal leg movement and sensation. Prenatal AFP was mildly elevated.
Adult with large congenital meningocele on the right face
