Anterior Cervical Meningocele: Systematic Review of the Literature and Illustrative Case

TL;DR

This paper reviews the rare condition of anterior cervical meningocele, analyzing clinical cases and management strategies to guide treatment decisions.

Contribution

The study provides a systematic review and illustrative case of ACM, offering insights into its clinical presentation and management outcomes.

Findings

ACM typically presents with neck pain and upper limb sensory symptoms, with a predominance of female patients.

Conservative management is common, while surgery carries risks like CSF leak and meningitis.

Surgical intervention is recommended for vertebral instability or compressive symptoms despite its risks.

Abstract

Background/Objectives: Anterior cervical meningocele (ACM) is a rare congenital condition characterized by the herniation of the meninges through a defect in the anterior vertebral column. ACM clinical management is not standardized because this condition is rare, and guidelines are missing. Hereby, a systematic literature review is performed to determine management options and outcomes. Methods: The case of a 62-year-old patient with incidental diagnosis of C3-C5 ACM is presented. A systematic review was conducted using standard PRISMA (preferred reporting items for systematic reviews and meta-analyses) guidelines for all cases of anterior cervical meningocele from 1837 to 2025. Results: The review provided nine clinical cases and our illustrative case. The median age was 47 years, with a predominance of female patients (70%). The most common presenting symptom was neck pain (60%), followed by paresthesia and hypoesthesia in the upper limbs. Four patients underwent conservative management with clinical and radiological follow-up, while four patients underwent neurosurgical intervention. Surgical treatment was complicated by cerebrospinal fluid (CSF) leak in two patients, and one of them developed meningitis. Conclusions: ACM is typically associated with mesodermal dysplasia and dural ectasia. ACM usually has a benign clinical course, requiring neurological follow-up and conservative management alone. However, a surgical approach should be considered in cases of vertebral instability or symptoms related to upper airway compression or upper gastrointestinal tract compression despite the high risk of CSF leak when surgical repair is attempted.

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