Retained medullary cord with sacral subcutaneous meningocele and congenital dermal sinus

  • Takato MoriokaEmail author
  • Nobuya Murakami
  • Akiko Kanata
  • Haruhisa Tsukamoto
  • Satoshi O Suzuki
Case Report



A retained medullary cord (RMC) is a rare closed spinal dysraphism with a robust elongated cord-like structure extending continuously from the conus medullaris to the dural cul-de-sac that is caused by late arrest of secondary neurulation. Five patients with RMC extending to an associated sacral subcutaneous meningocele have been reported.

Case presentation

We report an additional patient with RMC, in whom a congenital dermal sinus (CDS) was found in the caudal portion of the RMC. At the age of 3 days, the patient underwent surgery consisting of meningocele excision and cord untethering, and CDS was noted histologically in the proximal cut end of the RMC. During a second surgery at the age of 5 months, after determining the exact border of the nonfunctional RMC and the true conus by neurophysiological mapping, we removed the entire length of the remnant RMC, including newly developed epidermoid cysts in the CDS.


Although the exact pathoembryogenesis of concurrent RMC and CDS is unknown, an associated subcutaneous meningocele, caused by failure of primary neurulation, could be involved. Surgeons should be aware of the possibility of the coexistence of CDS when dealing with RMCs that extend out to the extradural space.


Primary neurulation Secondary neurulation Neuroglial tissue Limited dorsal myeloschisis 



We thank Dr. Naoko Matsumoto, Department of Neonatology, Kitakyushu Municipal Medical Center, and Dr. Nobuko Kawamura, Department of Radiology, Fukuoka Children’s Hospital, for supporting our study. We thank Jane Charbonneau, DVM, from Edanz Group ( for editing a draft of this manuscript.

Funding information

This work was partly supported by the Research Foundation of Fukuoka Children’s Hospital.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

Informed consent was obtained from the family of the infant described in this report.


  1. 1.
    Pang D, Zovickian J, Moes GS (2011) Retained medullary cord in humans: late arrest of secondary neurulation. Neurosurgery 68:1500–1519CrossRefGoogle Scholar
  2. 2.
    Murakami N, Morioka T, Shimogawa T, Hashiguchi K, Mukae N, Uchihashi K, Suzuki SO, Iihara K (2018) Retained medullary cord extending to a sacral subcutaneous meningocele. Childs Nerv Syst 34:527–533CrossRefGoogle Scholar
  3. 3.
    Murakami N, Morioka T, Shimogawa T, Mukae N, Inoha S, Sasaguri T, Suzuki SO, Iihara K (2018) Ependyma-lined canal with surrounding neuroglial tissues in lumbosacral lipomatous malformations: relationship with retained medullary cord. Pediatr Neurosurg 53:387–394CrossRefGoogle Scholar
  4. 4.
    Shirozu N, Morioka T, Inoha S, Imamoto N, Sasaguri T (2018) Enlargement of sacral subcutaneous meningocele associated with retained medullary cord. Childs Nerv Syst 34:1785–1790CrossRefGoogle Scholar
  5. 5.
    Murakami N, Morioka T, Hashiguchi K, Yoshiura T, Hiwatashi A, Suzuki SO, Nakamizo A, Amano T, Hata N, Sasaki T (2013) Usefulness of three-dimensional T1-weighted spoiled gradient-recalled echo and three-dimensional heavily T2-weighted images in preoperative evaluation of spinal dysraphism. Childs Nerv Syst 29:1905–1914CrossRefGoogle Scholar
  6. 6.
    Pang D, Zovickian J, Oviedo A, Moes GS (2010) Limited dorsal myeloschisis: a distinctive clinicopathological entity. Neurosurgery 67:1555–1579CrossRefGoogle Scholar
  7. 7.
    Pang D, Zovickian J, Wong ST, Hou YJ, Moes GS (2013) Limited dorsal myeloschisis: a not-so-rare form of primary neurulation defect. Childs Nerv Syst 29:1459–1484CrossRefGoogle Scholar
  8. 8.
    Eibach S, Moes G, Zovickian J, Pang D (2017) Limited dorsal myeloschisis associated with dermoid elements. Childs Nerv Syst 33:55–67CrossRefGoogle Scholar
  9. 9.
    Lee JY, Park S-H, Chong S, Phi JH, Kim S-K, Cho B-K, Wang K-C (2019) Congenital dermal sinus and limited dorsal myeloschisis: “Spectrum disorders” of incomplete dysjunction between cutaneous and neural ectoderms. Neurosurgery 84:428–434CrossRefGoogle Scholar
  10. 10.
    Tomita Y, Morioka T, Murakami N, Noguchi Y, Sato Y, Suzuki OS (2019) Slender stalk with combined features of saccular limited dorsal myeloschisis and congenital dermal sinus in a neonate. Pediatr Neurosurg 54:125–131CrossRefGoogle Scholar
  11. 11.
    Sala F, Barone G, Tramontano V, Gallo P, Ghimenton C (2014) Retained medullary cord confirmed by intraoperative neurophysiological mapping. Childs Nerv Syst 30:1287–1291CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of NeurosurgeryFukuoka Children’s HospitalFukuokaJapan
  2. 2.Department of NeurosurgeryKitakyushu Municipal Medical CenterKitakyushuJapan
  3. 3.Department of Neuropathology, Graduate School of Medical SciencesKyushu UniversityFukuokaJapan

Personalised recommendations