Symptomatic dermal inclusion cysts in infants following fetal surgery for myelomeningocele: report of two cases and review of the literature.

INTRODUCTION: It remains unclear if fetal repair of myelomeningocele (MM) is associated with a greater risk of developing symptomatic dermal inclusion cysts (IC) at the neural placode. We report two infants treated with fetal surgery who developed symptomatic IC at less than one year of age and we discuss the current literature on symptomatic IC in children with myelomeningocele.

CASE PRESENTATION: Two infants underwent fetal myelomeningocele repair at 24 weeks gestational age. Case 1 was born at 30 weeks and had two revisions of the MM wound early in life. At 8 months of age the patient presented with meningismus and imaging findings of an IC, which was resected at the time of presentation. At 3 years of age this patient was found to have recurrence of the IC after presenting with worsening bladder function and underwent repeat debulking with no recurrence at 6 years of age. Case 2 was born at 32 weeks gestational age with uncomplicated recovery. At 8 months of age the patient presented with irritability and fullness at the lumbar repair site. Imaging showed a large IC with restricted diffusion and extension into the subcutaneous tissue; this was resected completely at the time of presentation, see intra-operative photographs. There has been no sign of recurrence at age 15 months.

CONCLUSIONS: Careful monitoring for IC in infancy in myelomeningocele patients who have had fetal surgery is recommended.