• Joyce Antony, Anna Jolly Neriamparambil, and Norman Ma.
• Department of Neurosurgery, Queensland Children's Hospital, South Brisbane; School of Medicine, The University of Queensland, Brisbane; Department of Neurosurgery, Gold Coast University Hospital, Gold Coast, Queensland, Australia. Electronic address: joyce.antonysa@gmail.com.
• World Neurosurg. 2020 Nov 1; 143: 202-208.

BackgroundCervicothoracic myelomeningocele (MMC) is a rare entity with only 2 reported cases in the literature of anterior thoracic MMC.Case DescriptionWe 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.ConclusionsThis case highlights the unique multidisciplinary surgical management of the rare entity of anterior thoracic MMC without scoliosis correction for radiologic progression.Copyright © 2020 Elsevier Inc. All rights reserved.

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