Ryan P Morton, Tanya Z Filardi and Trent L Tredway
Background: Myelomeningocele is the most common open spinal dysraphism eligible for surgical repair. Traditionally, myelomeningocele patients that received no surgical intervention had a dismal prognosis. Before 1970, 80% of untreated infants were dead at 3 months, while after 1970 more untreated children survived infancy but usually did not live past adolescence. Adult presentation of myelomeningocele is exceedingly rare. Case presentation: We present a 74 years Caucasian female was transferred to our institution for evaluation of purulent drainage around an unrepaired myelomeningocele site. Per the patients report, she was offered no surgical treatment for her myelomeningocele as a newborn, but was instead treated with percutaneous needle drainage of the lumbar fluid collection on a weekly basis for several months. Examination of her back was notable for a large 6 cm×6 cm fluid filled mass in the lumbosacral region with an abnormal epithelialized covering and purulent drainage. Her brain MRI revealed arrested hydrocephalus and a Chiari II malformation. Due to the infection, she underwent surgical correction of the myelomeningocele. At 6 month follow up she had a well healed wound and no complications from the surgery. Conclusion: The present case adds to the small body of literature describing adult presentation of spinal dysraphism. To our knowledge, this is the oldest patient to undergo primary repair of a congenital myelomeningocele. Primary repair, even in the elderly, is possible and can be done safely.
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