Lipomeningocele in A 3-Year-Old Girl: A Case Report with initial Suspicion of Sacrococcygeal Teratoma

Abstract

BACKGROUND: Lipomeningocele is a complex form of closed spinal dysraphism that results from an error in early embryological development. It presents at birth as a lumbosacral mass and carries a high risk of progressive neurological, urological, and orthopedic deterioration due to the tethering of the spinal cord. While surgery is the primary treatment, the timing of intervention in asymptomatic patients is a key consideration.

CASE PRESENTATION: A 3-year-old girl presented with a large, skin-covered congenital mass in the lumbosacral region that had been present since birth. While motor and sensory functions were intact, neurological examination revealed bilateral Babinski reflexes, an early sign of neurological compromise. The diagnostic workup included an ultrasound and CT scan, which provided an initial differential diagnosis. A definitive diagnosis was established with a lumbosacral MRI, which confirmed a lipomeningocele with the conus medullaris tethered at the L5 level. The patient underwent surgical resection and defect closure. However, nine days postoperatively, she presented with wound dehiscence and a cerebrospinal fluid (CSF) leak, which necessitated a second surgical procedure for debridement and watertight dural repair.

CONCLUSION: This case highlights the essential role of MRI as the definitive imaging modality for diagnosing lipomeningocele and planning surgery. It reinforces the strong rationale for early surgical intervention, even in minimally symptomatic patients, to untether the spinal cord and prevent irreversible neurological decline. Finally, it serves as a critical reminder that this complex surgery carries significant risks, such as CSF leakage, which demand vigilant postoperative monitoring and prompt re-intervention.