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Murakami N, Kurogi A, Shono T, Torio M, Shimogawa T, Mukae N, Morioka T, Yoshimoto K. Expanding Ventricular Diverticulum Overlying the Cerebral Hemisphere through an Open-Lip Schizencephalic Cleft: A Report of Two Pediatric Cases. Pediatr Neurosurg 2024; 59:102-108. [PMID: 38198761 DOI: 10.1159/000536188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 01/05/2024] [Indexed: 01/12/2024]
Abstract
INTRODUCTION Open-lip-type schizencephaly is characterized by trans-cerebral clefts filled with cerebrospinal fluid (CSF) between the subarachnoid space at the hemisphere surface and the lateral ventricles. Disorders related to CSF retention, including hydrocephalus and arachnoid cysts, have reportedly been associated with open-lip schizencephaly and have induced intracranial hypertension in some cases. However, detailed neuroimaging and surgical treatment findings have rarely been described. CASE PRESENTATION We report 2 cases of open-lip schizencephaly with an expanding CSF-filled cavity overlying the ipsilateral cerebral hemisphere that manifested as signs of intracranial hypertension. Detailed three-dimensional heavily T2-weighted imaging revealed thin borders between the CSF-filled cavity and the subarachnoid space, but no separating structures between the cavity and the lateral ventricle, suggesting that the cavity was directly connected to the lateral ventricle through the schizencephalic cleft but not to the subarachnoid space. Neuroendoscopic observation in case 1 confirmed this finding. Endoscopic fenestration of the cavity to the prepontine cistern was ineffective in case 1. Shunting between the lateral ventricle (case 1) or CSF-filled cavity (case 2) and the peritoneal cavity slightly decreased the size of the CSF-filled cavity. DISCUSSION We speculate that the thin borders along the margin of the CSF-filled cavity are membranes that previously covered the schizencephalic cleft and are now pushed peripherally. In addition, we believe that the cavity is a ventricular diverticulum protruding through the cleft and that shunting operation is effective against such expanding cavity. Detailed magnetic resonance imaging can be useful for evaluating patients with schizencephaly associated with CSF retention disorders.
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Affiliation(s)
- Nobuya Murakami
- Department of Neurosurgery, Fukuoka Children's Hospital, Fukuoka, Fukuoka, Japan
| | - Ai Kurogi
- Department of Neurosurgery, Fukuoka Children's Hospital, Fukuoka, Fukuoka, Japan
| | - Tadahisa Shono
- Department of Neurosurgery, Harasanshin Hospital, Fukuoka, Fukuoka, Japan
| | - Michiko Torio
- Department of Pediatric Neurology, Fukuoka Children's Hospital, Fukuoka, Fukuoka, Japan
| | - Takafumi Shimogawa
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Fukuoka, Japan
| | - Nobutaka Mukae
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Fukuoka, Japan
| | - Takato Morioka
- Department of Neurosurgery, Hachisuga Hospital, Munakata, Fukuoka, Japan
| | - Koji Yoshimoto
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Fukuoka, Japan
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Murakami N, Kurogi A, Suzuki SO, Shimogawa T, Mukae N, Yoshimoto K, Morioka T. Histopathological presence of dermal elements in resected margins of neural structures obtained from initial repair surgery for myelomeningocele. Surg Neurol Int 2023; 14:7. [PMID: 36751452 PMCID: PMC9899468 DOI: 10.25259/sni_989_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 12/23/2022] [Indexed: 01/09/2023] Open
Abstract
Background Development of dermoid or epidermoid cysts in myelomeningocele (MMC) sites is generally thought to occur in a delayed fashion due to implantation of dermal elements during initial repair surgery. Another theory is that dermal and dermoid elements may already be present within dysplastic neural structures at birth. Methods We experienced histopathological presence of dermal elements in resected tissues at initial repair surgery in four out of 18 cases with MMC who required resection of parts or margins of the neural structures to perform cord untethering. Since one of these cases has already been reported, we describe the clinicopathological findings for the remaining three cases. Results In Case1, cryptic dermoid elements were discovered in the terminal filum-like structure (FT-LS) caudal to the open neural placode (NP). The FT-LS had histopathological characteristics similar to the retained medullary cord. In Case 2, dermoid elements were discovered in the caudal margin of the dysplastic conus medullaris. In Case 3, a thin squamous epithelial layer overlapped the rostral margin of the NP where the NP was located near the skin. Case 1 developed an epidermoid cyst at 1 year and 2 months of age, which was totally resected. Conclusion Prenatally existing cryptic dermoid elements in the caudal portion of neural structures and remnants of dermal elements overlapping the rostral margin of the NP are associated with delayed occurrence of dermoid/ epidermoid cysts. Postoperative histopathological investigation of the resected specimens is recommended. Once dermal elements are revealed, repeated imaging examination and additional surgery should be considered.
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Affiliation(s)
- Nobuya Murakami
- Department of Neurosurgery, Fukuoka Children’s Hospital, Fukuoka, Japan,Corresponding author: Nobuya Murakami, Department of Neurosurgery, Fukuoka Children’s Hospital, Fukuoka, Japan.
| | - Ai Kurogi
- Department of Neurosurgery, Fukuoka Children’s Hospital, Fukuoka, Japan
| | | | - Takafumi Shimogawa
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Iizuka, Japan
| | - Nobutaka Mukae
- Department of Neurosurgery, Iizuka Hospital, Iizuka, Japan
| | - Koji Yoshimoto
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Iizuka, Japan
| | - Takato Morioka
- Department of Neurosurgery, Hachisuga Hospital, Fukuoka, Japan
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Kurogi A, Murakami N, Shimogawa T, Mukae N, Suzuki SO, Yamaguchi T, Yoshimoto K, Morioka T. Severe type of segmental spinal dysgenesis with complete disconnection of the spinal cord and vertebra associated with open neural tube defect. Surg Neurol Int 2023; 14:149. [PMID: 37151435 PMCID: PMC10159279 DOI: 10.25259/sni_156_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 04/05/2023] [Indexed: 05/09/2023] Open
Abstract
Background Severe type of segmental spinal dysgenesis (SSD) is a rare and complex anomaly in which the spinal cord completely disconnects at the portion of the spinal dysgenesis. Although closed spinal dysraphisms have been associated with SSD, to the best of our knowledge, the association between open neural tube defect (ONTD) and SSD is significantly rare, with only one case being reported to date. Case Description We report a case of an infant with severe SSD and a disconnected spinal cord and spinal column at the thoracolumbar junction associated with myelomeningocele (MMC) in the lumbosacral region. The patient presented severe neurological deficits in the legs and impaired bowel function. The spinal column of L1-L3 was absent. The lower spinal segment consisted of neural placode at the L5-S1 level and no connecting structure between the upper and lower spinal cords. A repair surgery for MMC, including cord untethering and dura plasty, was performed. Histopathological findings revealed a neural placode consisting of a neuroglial tissue and leptomeninges. Conclusion The management of severe SSD during the perinatal period is more challenging when it is associated with ONTD. We report detailed neuroradiological, intraoperative, and histological findings of such a case and discuss the embryopathogenesis of the associated ONTD and the treatment strategies.
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Affiliation(s)
- Ai Kurogi
- Department of Neurosurgery, Fukuoka Children’s Hospital, Fukuoka, Japan
- Corresponding author: Ai Kurogi, Department of Neurosurgery, Fukuoka Children’s Hospital, Fukuoka, Japan.
| | - Nobuya Murakami
- Department of Neurosurgery, Fukuoka Children’s Hospital, Fukuoka, Japan
| | | | - Nobutaka Mukae
- Department of Neurosurgery, Kyushu University, Fukuoka, Japan
| | | | - Toru Yamaguchi
- Department of Orthopedic Surgery, Fukuoka Children’s Hospital, Fukuoka, Japan
| | - Koji Yoshimoto
- Department of Neurosurgery, Kyushu University, Fukuoka, Japan
| | - Takato Morioka
- Department of Neurosurgery, Harasanshin Hospital, Fukuoka, Japan
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Myelomeningocele in one neonate from a fraternal triplet birth: Two case reports on neurosurgical and multidisciplinary treatment during the perinatal period. INTERDISCIPLINARY NEUROSURGERY 2022. [DOI: 10.1016/j.inat.2021.101372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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KUROGI A, MORIOKA T, MURAKAMI N, SHIMOGAWA T, MUKAE N, MATSUO Y, IMAMOTO N, TATEISHI Y, SUZUKI SO. Saccular Limited Dorsal Myeloschisis with Spinal Cord Deviation out of the Spinal Canal to the Sac. NMC Case Rep J 2021; 8:739-746. [PMID: 35079542 PMCID: PMC8769447 DOI: 10.2176/nmccrj.cr.2021-0168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 08/19/2021] [Indexed: 12/04/2022] Open
Abstract
Saccular limited dorsal myeloschisis (LDM) is characterized by a fibroneural stalk linking the saccular skin lesion to the underlying spinal cord. Since untethering surgery during the early postnatal period is often indicated to prevent sac rupture, saccular LDM should be distinguished from myelomeningocele (MMC) during the perinatal period. We treated two patients with the spinal cord deviation from the spinal canal to the sac, which mimicked a prolapse of the neural placode into the MMC sac. In patient 1, pre- and postnatal magnetic resonance imaging (MRI) revealed that the spinal cord was strongly tethered to the thick stalk. During surgery, the dorsally bent cord and stalk were united, and the border between these two was determined with intraoperative neurophysiological mapping (IONM). In patient 2, the spinal cord was tethered to two slender stalks close to each other, which was visible with the combined use of sagittal and axial postnatal three-dimensional heavily T2-weighted imaging (3D-hT2WI). The preoperative MRI hallmark of saccular LDM is the visualization of a stalk that links the bending cord and sac. Complete untethering surgery to return the cord into the spinal canal and correct its dorsal bending is recommended.
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Affiliation(s)
- Ai KUROGI
- Department of Neurosurgery, Fukuoka Children’s Hospital, Fukuoka, Fukuoka, Japan
| | - Takato MORIOKA
- Department of Neurosurgery, Harasanshin Hospital, Fukuoka, Fukuoka, Japan
| | - Nobuya MURAKAMI
- Department of Neurosurgery, Fukuoka Children’s Hospital, Fukuoka, Fukuoka, Japan
| | - Takafumi SHIMOGAWA
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Fukuoka, Japan
| | - Nobutaka MUKAE
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Fukuoka, Japan
| | - Yoshihiro MATSUO
- Department of Neurosurgery, Japan Community Health Care Organization (JCHO), Kyushu Hospital, Kitakyushu, Fukuoka, Japan
| | - Naoyuki IMAMOTO
- Department of Neurosurgery, Japan Community Health Care Organization (JCHO), Kyushu Hospital, Kitakyushu, Fukuoka, Japan
| | - Yuki TATEISHI
- Department of Pathology, Japan Community Health Care Organization (JCHO), Kyushu Hospital, Kitakyushu, Fukuoka, Japan
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Sankhe S, Dang G, Mathur S, Muzumdar D. Utility of CISS imaging in the management of tethered cord syndrome. Childs Nerv Syst 2021; 37:217-223. [PMID: 32803307 DOI: 10.1007/s00381-020-04789-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 07/01/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To compare the utility of constructive interference in steady-state (CISS) sequence over T2-weighted (T2W) sequence in the accurate delineation of the tethering element on magnetic resonance (MR) imaging in patients of tethered cord syndrome (TCS) and correlation with intraoperative findings. METHODS MR findings of fifty-six consecutive patients with operative findings of TCS were studied. The intraoperative findings of all patients were studied and compared with the preoperative imaging findings on T2W imaging and CISS images. RESULTS CISS images provided more information than T2W imaging. The overall sensitivity of CISS in MR evaluation of patients with TCS was higher (99.17%) as compared with the T2W sequence (71.48%) especially in the detection of precise position/extent of tethered cord, assessment of filum terminale thickening, detection of a fibrous spur in cases of split cord malformation, detection of dorsal dermal sinus, and evaluation of its precise extent and ramifications. The area under the ROC curve was higher with CISS (0.99) than with T2W sequence (0.85) which reflects its good predictive value as a screening test. This information was useful to the operating surgeon. CONCLUSION CISS sequence for imaging TCS can help enhance the overall surgical outcome of the patients ensuring completeness of the surgery. CISS should be routinely performed in the work-up of patients with tethered cord syndrome.
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Affiliation(s)
- Shilpa Sankhe
- Department of Radiology, King Edward Memorial Hospital, Mumbai, India
| | - Garima Dang
- Department of Radiology, King Edward Memorial Hospital, Mumbai, India.
| | - Shobhit Mathur
- Department of Radiology, King Edward Memorial Hospital, Mumbai, India
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Murakami N, Morioka T, Suzuki SO, Mukae N, Shimogawa T, Matsuo Y, Sasaguri T, Mizoguchi M. Clinicopathological findings of limited dorsal myeloschisis associated with spinal lipoma of dorsal-type. INTERDISCIPLINARY NEUROSURGERY 2020. [DOI: 10.1016/j.inat.2020.100781] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Morioka T, Murakami N, Yanagida H, Yamaguchi T, Noguchi Y, Takahata Y, Tsukamoto A, Suzuki SO. Terminal syringomyelia associated with lumbar limited dorsal myeloschisis. Childs Nerv Syst 2020; 36:819-826. [PMID: 31317225 DOI: 10.1007/s00381-019-04297-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 07/02/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE Limited dorsal myeloschisis (LDM) is characterized by a fibroneural tethering stalk linking the skin lesion to the underlying spinal cord. Terminal syringomyelia, which is located at the lower third of the cord, is often associated with a tethered cord caused by various spinal dysraphisms; however, terminal syringomyelia has not been documented in LDM. The purpose of this study was to clarify the pathophysiological mechanisms of syringomyelia in LDM. METHODS In our 16 patients with lumbar LDM, three patients had terminal syringomyelia. We retrospectively analyzed the clinical, neuroradiological, intraoperative, and histopathological findings for these patients, with particular attention to the clinical course of the syrinx. RESULTS Patient 1 had a saccular skin lesion and patients 2 and 3 had flat lesions. In all patients, the syringomyelic cavity was located in the lower thoracolumbar cord, immediately rostral to the stalk-cord attachment at the lumbar level. The caudal pole of the syrinx extended to the thickened stalk at the attachment instead of at the caudal cord. Patient 3 had another syrinx in the stalk itself. The longitudinal axis of the syrinx and central canal coincided with the traveling angle of the LDM stalk at the stalk-cord attachment. In patient 1, histology revealed an ependyma-lined central canal in both the LDM stalk and meningocele sac. Patients 1 and 2 underwent syringostomy, but long-term effects were not obtained. Preoperative spontaneous resolution occurred in patient 3. CONCLUSIONS The histological findings in patient 1 supported the idea that segmental myelocystocele is involved in the development of saccular LDM. The hydromyelic central canal herniates and distends the stalk, resulting in the formation of the myelocystocele. It is possible that the hydromyelic central canal also distends the stalk of flat LDM lesions. The syrinx in patient 3 differed from that in patients 1 and 2, in that the syrinx resolved spontaneously. Further studies are needed to clarify the outcomes of syrinxes associated with LDM stalks.
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Affiliation(s)
- Takato Morioka
- Department of Neurosurgery, Fukuoka Children's Hospital, 5-1-1 Kashii-teriha, Higashi-ku, Fukuoka, 813-0017, Japan.
| | - Nobuya Murakami
- Department of Neurosurgery, Fukuoka Children's Hospital, 5-1-1 Kashii-teriha, Higashi-ku, Fukuoka, 813-0017, Japan
| | - Haruhisa Yanagida
- Department of Orthopedics and Spine Surgery, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Toru Yamaguchi
- Department of Orthopedics and Spine Surgery, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Yushi Noguchi
- Department of Neonatology, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Yasushi Takahata
- Department of Neonatology, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Ayumi Tsukamoto
- Department of Plastic Surgery, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Satoshi O Suzuki
- Department of Neuropathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Morioka T, Murakami N, Suzuki SO, Takada A, Tajiri S, Shimogawa T, Mukae N, Iihara K. Neurosurgical Pathology and Management of Limited Dorsal Myeloschisis Associated with Congenital Dermal Sinus in Infancy. Pediatr Neurosurg 2020; 55:113-125. [PMID: 32615563 DOI: 10.1159/000507867] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 04/10/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Because of the shared origin of limited dorsal myeloschisis (LDM) and congenital dermal sinus (CDS), CDS elements may be found within the fibroneural LDM stalk. When part of the CDS invested in the intradural stalk is left during untethering surgery, inclusion tumors such as dermoid cysts may develop. However, the most appropriate surgical strategy for LDM with CDS is still under debate. METHODS Of 19 patients with LDM, 3 (15.8%) had histologically verified CDS elements. We retrospectively analyzed the clinicopathological findings of these patients. RESULTS In patient 1, the entire stalk including a tiny dermoid cyst at the intradural stalk could be resected through two-level laminectomy during untethering at 6 months of age. In patients 2 and 3, the stalk appeared to be a typical LDM stalk during the initial surgery at 18 and 7 days, respectively; however, CDS was histologically diagnosed in the proximal severed end of the stalk. Postoperative three-dimensional heavily T2-weighted imaging demonstrated spherical enlargement of the remnant stalk, and the entire length of the remnant stalk including newly developed dermoid was resected during the second surgery at 3 years 11 months and 11 months, respectively. Histopathologically, glial fibrillary acidic protein-immunopositive neuroglial tissues and CDS elements were mainly located at the proximal and distal sites of the stalk, respectively, supporting the "dragging down and pulling up" theory. In patients 2 and 3, however, the proximal head of the dermoid cyst passed the distal head of the neuroglial tissues and located at the stalk-cord attachment. CONCLUSION Surgeons should be aware of the approximately 10% possibility of the coexistence of CDS when managing infant LDM. However, the recommendation for excision of the entire length of the LDM stalk in all patients should be more carefully made because such a strategy may result in an unnecessary extent of laminotomy/laminectomy for most patients with pure LDM. However, once the postoperative histological examination reveals coexistence of CDS in the resected proximal part of the stalk, the entire length of the remnant stalk should be excised as soon as possible.
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Affiliation(s)
- Takato Morioka
- Department of Neurosurgery, Fukuoka Children's Hospital, Fukuoka, Japan,
| | - Nobuya Murakami
- Department of Neurosurgery, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Satoshi O Suzuki
- Department of Neuropathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Akira Takada
- Department of Neurosurgery, Kumamoto City Hospital, Kumamoto, Japan
| | - Seiji Tajiri
- Department of Neurosurgery, Kumamoto City Hospital, Kumamoto, Japan
| | - Takafumi Shimogawa
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Nobutaka Mukae
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Koji Iihara
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Li Z, Chen YA, Chow D, Talbott J, Glastonbury C, Shah V. Practical applications of CISS MRI in spine imaging. Eur J Radiol Open 2019; 6:231-242. [PMID: 31304197 PMCID: PMC6603258 DOI: 10.1016/j.ejro.2019.06.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 05/21/2019] [Accepted: 06/10/2019] [Indexed: 01/09/2023] Open
Abstract
Conventional spin echo imaging is limited by low spatial resolution and CSF pulsation artifact. CISS MRI enables submillimeter spatial resolution and myelographic contrast. Inherent flow compensation of the CISS technique reduces CSF pulsation artifact. CISS improves the delineation of a wide variety of spinal pathologies.
Routine magnetic resonance imaging evaluation of the spine is often limited by low spatial resolution and artifacts resulting from cerebrospinal fluid pulsation. Balanced steady-state free precession sequences can supplement routine spin echo sequences and provide exquisite anatomic detail and high cerebrospinal fluid-to-soft tissue contrast, adding significant diagnostic value to the evaluation of a wide variety of spine disorders.
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Affiliation(s)
- Zhixi Li
- Department of Radiology and Biomedical Imaging, University of California, 505 Parnassus Avenue, M-391, San Francisco, CA 94143-0628, USA
| | - Yingming Amy Chen
- Department of Radiology and Biomedical Imaging, University of California, 505 Parnassus Avenue, M-391, San Francisco, CA 94143-0628, USA
| | - Daniel Chow
- Department of Radiology and Biomedical Imaging, University of California, 505 Parnassus Avenue, M-391, San Francisco, CA 94143-0628, USA
| | - Jason Talbott
- Department of Radiology and Biomedical Imaging, University of California, 505 Parnassus Avenue, M-391, San Francisco, CA 94143-0628, USA
| | - Christine Glastonbury
- Department of Radiology and Biomedical Imaging, University of California, 505 Parnassus Avenue, M-391, San Francisco, CA 94143-0628, USA
| | - Vinil Shah
- Department of Radiology and Biomedical Imaging, University of California, 505 Parnassus Avenue, M-391, San Francisco, CA 94143-0628, USA
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Morioka T, Suzuki SO, Murakami N, Mukae N, Shimogawa T, Haruyama H, Kira R, Iihara K. Surgical histopathology of limited dorsal myeloschisis with flat skin lesion. Childs Nerv Syst 2019; 35:119-128. [PMID: 29934704 DOI: 10.1007/s00381-018-3870-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 06/15/2018] [Indexed: 12/25/2022]
Abstract
PURPOSE Limited dorsal myeloschisis (LDM) is characterized by two invariable features: a focal closed neural tube defect and a fibroneural stalk linking the skin lesion to the underlying spinal cord. Although detailed histopathological findings of the LDM stalk were originally described by Pang et al., the precise relationship between the histopathological findings and clinical manifestations including intraoperative findings has not been fully determined. METHODS We retrospectively analyzed the histopathological findings of the almost entire stalk and their relevance to the clinical manifestations in six Japanese LDM patients with flat skin lesions. RESULTS Glial fibrillary acidic protein (GFAP)-immunopositive neuroglial tissues were observed in three of the six patients. Unlike neuroglial tissues, peripheral nerve fibers were observed in every stalk. In four patients, dermal melanocytosis, "Mongolian spot," was seen surrounding the cigarette-burn lesion. In three of these four patients, numerous melanocytes were distributed linearly along the long axis of the LDM stalk, which might represent migration of melanocytes from trunk neural crest cells during formation of the LDM stalk. CONCLUSION Immunopositivity for GFAP in the LDM stalk was observed in as few as 50% of our patients, despite the relatively extensive histopathological examination. We confirm that the clinical diagnosis of LDM should be made based on comprehensive histopathological examination as well as clinical manifestations. The profuse network of peripheral nerve fibers in every stalk and the high incidence of melanocyte accumulation associated with dermal melanocytosis might assist the histopathological diagnosis of LDM.
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Affiliation(s)
- Takato Morioka
- Department of Neurosurgery, Fukuoka Children's Hospital, 5-1-1 Kashii-teriha, Higashi-ku, Fukuoka, 813-0017, Japan.
| | - Satoshi O Suzuki
- Department of Neuropathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Nobuya Murakami
- Department of Neurosurgery, Fukuoka Children's Hospital, 5-1-1 Kashii-teriha, Higashi-ku, Fukuoka, 813-0017, Japan
| | - Nobutaka Mukae
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takafumi Shimogawa
- Department of Neurosurgery, Fukuoka Children's Hospital, 5-1-1 Kashii-teriha, Higashi-ku, Fukuoka, 813-0017, Japan.,Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hironori Haruyama
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Ryutaro Kira
- Department of Pediatric Neurology, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Koji Iihara
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Tomita Y, Morioka T, Murakami N, Noguchi Y, Sato Y, Suzuki SO. Slender Stalk with Combined Features of Saccular Limited Dorsal Myeloschisis and Congenital Dermal Sinus in a Neonate. Pediatr Neurosurg 2019; 54:125-131. [PMID: 30654374 DOI: 10.1159/000495810] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 11/23/2018] [Indexed: 11/19/2022]
Abstract
Limited dorsal myeloschisis (LDM) and congenital dermal sinus (CDS) originate from incomplete disjunction between the cutaneous and neural ectoderms. Some LDM stalks have been found to have elements of a CDS or dermoid cyst. We surgically treated a saccular lesion in the lumbosacral region of a 7-day-old male neonate. Although fetal magnetic resonance imaging (MRI) failed to reveal a stalk, postnatal MRI including three-dimensional heavily T2-weighted imaging demonstrated a stalk originating from the lumbar cord and extending caudally to enter the lumbosacral meningocele sac. During untethering surgery, we found that the stalk was slender, with a diameter of 0.7-0.8 mm, but otherwise appeared to be a typical LDM stalk. Histopathological examination revealed that the fibrocollagenous stalk contained glial fibrillary acidic protein-immunopositive neuroglial tissues and stratified squamous epithelium. The present report describes the first documented case of a stalk with combined features of saccular LDM and CDS in a neonate. Since cutaneous ectodermal tissue is likely to remain in the remnant stalk, this patient requires careful monitoring to detect the potential development of a dermoid cyst.
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Affiliation(s)
- Yoshitaka Tomita
- Department of Neonatology, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Takato Morioka
- Department of Neurosurgery, Fukuoka Children's Hospital, Fukuoka, Japan,
| | - Nobuya Murakami
- Department of Neurosurgery, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Yushi Noguchi
- Department of Neonatology, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Yuka Sato
- Department of Obstetrics, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Satoshi O Suzuki
- Department of Neuropathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Enlargement of sacral subcutaneous meningocele associated with retained medullary cord. Childs Nerv Syst 2018; 34:1785-1790. [PMID: 29704125 DOI: 10.1007/s00381-018-3812-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 04/17/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND A retained medullary cord (RMC) is a rare closed spinal dysraphism with a robust elongated neural structure continuous from the conus and extending to the dural cul-de-sac. Four cases of RMC extending down to the base of an associated subcutaneous meningocele at the sacral level have been reported. CLINICAL PRESENTATION We report an additional case of RMC, in whom serial MRI examination revealed an enlargement of the meningocele associated with RMC over a 3-month period between 8 and 11 months of age, when he began to stand. At the age of 12 months, untethering of the cord was performed. Histologically, the presence of ependyma-lined central canals in the dense neuroglial cores was noted in all cord-like structures in the intradural and intrameningocele sacs and at the attachment to the meningocele. CONCLUSION It is conceivable that the hydrodynamic pressure with standing position and the check valve phenomenon were involved in meningocele enlargement. We should be mindful of these potential morphological changes.
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14
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Oliveira M, McConnell JF, Maddox TW, Sanchez-Masian D, Gonçalves R. Agreement between transverse T2-weighted and three-dimensional constructive interference in steady state sequences in the evaluation of spinal cord disease in dogs. Vet Rec 2018. [PMID: 29540556 DOI: 10.1136/vr.104583] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The constructive interference in steady state (CISS) sequence has been widely used in human neuroimaging. It has been shown to be advantageous in the evaluation of intra-axial and extra-axial cystic abnormalities, arteriovenous and dysraphic malformations and disturbances of cerebrospinal fluid circulation. To assess the utility of this technique in small animals, interpretations based on this sequence were compared with those based on T2-weighted (T2W) sequences in 145 dogs that underwent MRI of the spine for suspected spinal cord disease. Two sets of images (T2W and CISS) were reviewed separately by three observers in random order and intraobserver and interobserver agreements between both sequences were evaluated for several categorical variables. The overall agreement between T2W and CISS sequences was good. The highest agreement was observed for lesion diagnosis (0.739<k<0.928), treatment recommendation (0.715<k<0.833) and degree of spinal cord compression (0.772<k<0.952). The agreement for intramedullary intensity change (0.192<k<0.332) was lower compared with the other variables. Lesions that were predominantly characterised by focal hyperintense parenchymal changes on T2W were in some instances undetected on the CISS sequence while lesions consistent with spinal arachnoid diverticula on CISS sequences were occasionally missed on T2W. CISS enabled demonstration that lesions were directly affecting associated spinal nerves in some cases where T2W sequence was equivocal. Although CISS does not replace standard spin echo sequences, the results support inclusion of this sequence in small animal spinal MRI studies when subarachnoid diverticula or spinal nerve compression is suspected.
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Affiliation(s)
- Maria Oliveira
- Willows Veterinary Centre and Referral Service, Solihull, West Midlands, UK
| | - James Fraser McConnell
- Institute of Veterinary Science, Small Animal Teaching Hospital, University of Liverpool, Neston, UK
| | - Thomas W Maddox
- Institute of Veterinary Science, Small Animal Teaching Hospital, University of Liverpool, Neston, UK
| | - Daniel Sanchez-Masian
- Institute of Veterinary Science, Small Animal Teaching Hospital, University of Liverpool, Neston, UK
| | - Rita Gonçalves
- Institute of Veterinary Science, Small Animal Teaching Hospital, University of Liverpool, Neston, UK
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15
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Buch K, Caruso P, Ebb D, Rincon S. Balanced Steady-State Free Precession Sequence (CISS/FIESTA/3D Driven Equilibrium Radiofrequency Reset Pulse) Increases the Diagnostic Yield for Spinal Drop Metastases in Children with Brain Tumors. AJNR Am J Neuroradiol 2018; 39:1355-1361. [PMID: 29773567 DOI: 10.3174/ajnr.a5645] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 03/05/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Identification of spinal drop metastases is important in the staging and management of pediatric patients with primary brain tumors. Our aim was to assess the diagnostic utility of the balanced steady-state free precession (bSSFP) sequence (CISS/FIESTA/3D driven equilibrium radiofrequency reset pulse) for the detection of spinal drop metastases in pediatric patients with primary intracranial tumors. MATERIALS AND METHODS This was a retrospective study of 44 pediatric patients with primary intracranial tumors undergoing MR imaging spine evaluation for drop metastases before radiation treatment. All patients underwent a whole-spine MRI with both bSSFP and postcontrast T1WI sequences. Two neuroradiologists independently reviewed only the bSSFP sequence, then 1 week later only the postcontrast T1WI sequence. RESULTS Patients ranged from 1 to 18 years of age (mean, 7.1 ± 4.2 years) with 27 males and 17 females. The number of lesions per patient ranged from 1 to 13 and from 2 to 11 mm in size. Lesions suspicious for drop metastases were seen in 8 patients on the postcontrast T1WI (18%) compared with 10 patients on the bSSFP sequence (23%). Twenty-two drop metastases seen on the bSSFP sequence were not visible on the postcontrast T1WI, including nonenhancing drop metastases and multiple nodules of <3 mm. Interrater agreement was excellent for the bSSFP sequence (0.91) and the postcontrast T1 sequence (0.90). CONCLUSIONS The bSSFP sequence increased the diagnostic yield for the detection of drop metastases in pediatric patients with primary intracranial tumors and was particularly advantageous for small drop metastases (<3 mm) and nonenhancing metastases, and it decreased the number of false-positives. The bSSFP sequence may be an important adjunct to postcontrast T1WI for the evaluation of drop metastases.
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Affiliation(s)
- K Buch
- From the Department of Neuroradiology (K.B., P.C., S.R.), Massachusetts General Hospital, Boston, Massachusetts
| | - P Caruso
- From the Department of Neuroradiology (K.B., P.C., S.R.), Massachusetts General Hospital, Boston, Massachusetts
| | - D Ebb
- Department of Pediatrics (D.E.), Pediatric Cancer Care Center, Massachusetts General Hospital for Children, Boston, Massachusetts
| | - S Rincon
- From the Department of Neuroradiology (K.B., P.C., S.R.), Massachusetts General Hospital, Boston, Massachusetts
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16
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Morioka T, Suzuki SO, Murakami N, Shimogawa T, Mukae N, Inoha S, Sasaguri T, Iihara K. Neurosurgical pathology of limited dorsal myeloschisis. Childs Nerv Syst 2018; 34:293-303. [PMID: 29063264 DOI: 10.1007/s00381-017-3625-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 10/13/2017] [Indexed: 12/25/2022]
Abstract
PURPOSE The term limited dorsal myeloschisis (LDM) was used by Pang et al. (2010) to describe a distinct clinicopathological entity. LDMs are characterized by two invariable features: a focal-closed neural tube defect and a fibroneural stalk that links the skin lesion to the underlying spinal cord. METHODS We retrospectively analyzed the neurosurgical pathologic findings of four LDM patients. RESULTS Case 1 had a saccular skin lesion with nonterminal abortive myelocystocele at T11-12. Cases 2, 3, and 4 had a non-saccular (flat) skin lesion in the lumbosacral region. The morphologic features of the lesion in case 2 were those of meningocele manque. Cases 3 and 4 had accompanying non-LDM anomalies, caudal-type lipoma and type II split-cord malformation with neurenteric cyst, respectively. At preoperative diagnosis of the LDM stalk, magnetic resonance imaging, including 3D heavily T2-weighted image was useful; however, minute findings were often missed in the complicated cases 3 and 4. All patients had a favorable outcome following untethering of the stalk from the cord. The central histopathological feature of the LDM stalk is neuroglial tissue in the fibrocollagenous band; however, the stalk in cases 2 and 4 did not have glial fibrillary acidic protein-immunopositive neuroglial tissues. CONCLUSIONS Therefore, the diagnosis of LDM should be made based on comprehensive evaluation of histologic and clinical findings.
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Affiliation(s)
- Takato Morioka
- Department of Neurosurgery, Fukuoka Children's Hospital, 5-1-1 Kashii-teriha, Higashi-ku, Fukuoka, 813-0017, Japan.
| | - Satoshi O Suzuki
- Department of Neuropathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Nobuya Murakami
- Department of Neurosurgery, Fukuoka Children's Hospital, 5-1-1 Kashii-teriha, Higashi-ku, Fukuoka, 813-0017, Japan
| | - Takafumi Shimogawa
- Department of Neurosurgery, Fukuoka Children's Hospital, 5-1-1 Kashii-teriha, Higashi-ku, Fukuoka, 813-0017, Japan.,Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Nobutaka Mukae
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Satoshi Inoha
- Department of Neurosurgery, Japan Community Health Care Organization (JCHO), Kyushu Hospital, Kitakyushu, Japan
| | - Takakazu Sasaguri
- Department of Pathology, Japan Community Health Care Organization (JCHO), Kyushu Hospital, Kitakyushu, Japan
| | - Koji Iihara
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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17
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Murakami N, Morioka T, Ichiyama M, Nakamura R, Kawamura N. Lateral lipomyelomeningocele of the hemicord with split cord malformation type I revealed by 3D heavily T2-weighted MR imaging. Childs Nerv Syst 2017; 33:993-997. [PMID: 28247108 DOI: 10.1007/s00381-017-3350-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 01/19/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND Lipomyelomeningocele (LMMC) is defined by a low-lying tethered spinal cord protruding posteriorly from the spinal canal and terminating in a lipomatous mass in the subcutaneous meningeal sac. The coexistence of LMMC with split cord malformation (SCM) is rare. CLINICAL PRESENTATION We report on a patient with laterally protruded LMMC arising from the hemicord of SCM type I. Direct coronal and axial views (instead of sagittal views) of 3D heavily T2-weighted MR imaging (3D-hT2WI) clearly demonstrated the topographical relationship between both of the hemicords, the bony septum, and nerve roots in the right subcutaneous meningeal sac. CONCLUSION Combined use of axial and coronal images of 3D-hT2W is useful for visualization and surgery of such a complicated anomaly.
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Affiliation(s)
- Nobuya Murakami
- Department of Neurosurgery, Fukuoka Children's Hospital, 5-1-1 Kashii-teriha, Higashi-ku, Fukuoka, 813-0017, Japan.
| | - Takato Morioka
- Department of Neurosurgery, Fukuoka Children's Hospital, 5-1-1 Kashii-teriha, Higashi-ku, Fukuoka, 813-0017, Japan
| | - Masako Ichiyama
- Department of Neonatology, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Ryoko Nakamura
- Department of Pediatric Neurology, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Nobuko Kawamura
- Department of Clinical Radiology, Fukuoka Children's Hospital, Fukuoka, Japan
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18
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Sequential morphological change of Chiari malformation type II following surgical repair of myelomeningocele. Childs Nerv Syst 2016; 32:1069-78. [PMID: 26936599 DOI: 10.1007/s00381-016-3041-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 02/10/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE To document long-term morphological changes of Chiari type II malformation (CM-II) following closure of spina bifida manifesta (SBM). METHODS We retrospectively evaluated postnatal magnetic resonance images of the CM-II and posterior fossa (PF) in 28 consecutive cases. We measured changes in vertebral level and length of the cerebellar peg (CP), cerebrospinal fluid (CSF) spaces anterior and posterior to the cerebrospinal junction, PF area, and the anteroposterior diameters of the foramen magnum (FM) and C1 vertebra. We examined the morphological differences between the cases with and without ventriculoperitoneal (VP) shunting and derived predicted means by nonlinear mixed-effect modeling. RESULTS At birth, there were significant differences in CP length, PF area, and FM and C1 diameters between those who underwent VP shunting and those who did not. In cases with a CP below C1, VP shunting was required in every case but one. In those with visible CSF space at birth, VP shunts were not required. In 17 of 18 cases with a CP below C1, the vertebral level ascended by mean two vertebral levels (range 0-5 levels) within 4-6 months of delivery. In the remaining case, slowly progressive hydrocephalus and delayed CP descent required VP shunting at 8 months. Predicted mean CP length and FM and C1 diameters were greater in those who underwent VP shunting, but there was no difference in predicted mean PF area. CONCLUSION The morphology of CM-II and the presence of hydrocephalus influence each other in children who have undergone postnatal SBM repair.
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19
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Hashiguchi K, Morioka T, Murakami N, Yamashita K, Hiwatashi A, Ochiai M, Morokuma S, Iihara K. Clinical Significance of Prenatal and Postnatal Heavily T2-Weighted Magnetic Resonance Images in Patients with Myelomeningocele. Pediatr Neurosurg 2015; 50:310-20. [PMID: 26413833 DOI: 10.1159/000381746] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Accepted: 03/17/2015] [Indexed: 11/19/2022]
Abstract
PURPOSE To compare the utility and limitations of prenatal magnetic resonance (MR) imaging using half-Fourier acquisition single-shot turbo spin-echo (HASTE) with postnatal heavily T2-weighted imaging (hT2WI) for the evaluation of central nervous system abnormalities associated with myelomeningocele (MMC). METHODS Sixteen patients with MMC who had undergone pre- and postnatal MR imaging were included in this study. MR imaging, including HASTE, was undertaken in the 3rd trimester, and hT2WI was performed immediately after delivery. The precision with which each could distinguish MMC, hindbrain herniation and ventriculomegaly was compared retrospectively. RESULTS The skin defects and MMC sacs were clearly visible on prenatal HASTE images, although it was difficult to identify precisely the level of MMC compared with postnatal hT2WI, in which the detailed anatomical relationships of the spinal cord, neural placode and ventral nerve roots were evident in every case. Hindbrain herniation could be visualized on prenatal HASTE images, although its severity was difficult to evaluate because of the small size of the structures and neck flexion; again, the resolution was superior on postnatal hT2WI. For hydrocephalus, there were no significant differences in the diagnostic precision and ability to grade the severity between pre- and postnatal imaging. CONCLUSION Prenatal HASTE imaging permits the diagnosis and understanding of the gross anatomy of MMC and associated hindbrain herniation and ventriculomegaly, but postnatal hT2WI is superior for evaluating detailed anatomy.
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20
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Murakami N, Morioka T, Hashiguchi K, Yoshiura T, Hiwatashi A, Suzuki SO, Nakamizo A, Amano T, Hata N, Sasaki T. 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 2013; 29:1905-14. [PMID: 23673721 DOI: 10.1007/s00381-013-2140-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Accepted: 04/30/2013] [Indexed: 11/30/2022]
Abstract
PURPOSE The aim of this study was to evaluate the usefulness of three-dimensional T1-weighted spoiled gradient-recalled echo (3D T1-GRE) images for the preoperative anatomical evaluation of lumbosacral lipoma, thick filum terminale, and myelomeningocele as a means of compensating for the drawbacks of 3D heavily T2-weighted (3D hT2-W) images. METHODS Nine patients with lumbosacral lipomas, one patient with tight filum terminale, and five patients with myelomeningoceles were included in this study. 3D T1-GRE images were compared with 3D hT2-W images or conventional magnetic resonance images in terms of delineation of lipomas and other structures in the patients with lipomas and tight filum terminale. For patients with myelomeningoceles, 3D T1-GRE images were compared with 3D hT2-W images in terms of artifacts in the cerebrospinal fluid (CSF) space. RESULTS The 3D T1-GRE images demonstrated lipomas with good contrast to the spinal cord and CSF space and more clearly delineated the anatomical relationship between lipomas and these structures than did the 3D hT2-W images. The 3D T1-GRE images delineated dural defects through which extradural lipomas penetrated into the intradural space. The 3D T1-GRE images also demonstrated the presence or absence of lipomas in the filum terminale and the absence of artifact in the myelomeningoceles. Furthermore, they were useful for differentiating artifacts observed on the 3D hT2-W images from nerve elements. CONCLUSIONS The complementary use of 3D T1-GRE and 3D hT2-W images may compensate for the drawbacks of 3D hT2-W images and may eventually improve lesion visualization and surgical decision making.
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Affiliation(s)
- Nobuya Murakami
- Department of Neurosurgery, Kyushu University, Fukuoka, Japan,
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21
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Morioka T, Hashiguchi K, Mukae N, Sayama T, Sasaki T. Neurosurgical management of patients with lumbosacral myeloschisis. Neurol Med Chir (Tokyo) 2013; 50:870-6. [PMID: 20885122 DOI: 10.2176/nmc.50.870] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Myeloschisis is the most serious and complex congenital anomaly in spina bifida manifesta (cystica). However, with improvements in medical care and increased understanding of its pathophysiology, the associated long-term morbidity and mortality rates have been significantly reduced. This article reviews various issues associated with the neurosurgical management of patients with myeloschisis, such as perinatal management, repair surgery for myeloschisis, neurosurgical management of hydrocephalus, Chiari malformation type II, tethered cord syndrome and epilepsy, and intrauterine fetal surgery.
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Affiliation(s)
- Takato Morioka
- Department of Neurosurgery, Kyushu Rosai Hospital, 1-3-1 Kuzuhara-takamatsu, Fukuoka, Japan.
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22
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Yilmaz A, Müslüman AM, Dalgic N, Cavuşoğlu H, Kanat A, Colak I, Aydın Y. Shunt insertion in newborns with myeloschisis/myelomenigocele and hydrocephalus. J Clin Neurosci 2010; 17:1493-6. [PMID: 20869250 DOI: 10.1016/j.jocn.2010.03.042] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2009] [Revised: 01/20/2010] [Accepted: 03/09/2010] [Indexed: 11/16/2022]
Affiliation(s)
- Adem Yilmaz
- Neurosurgery Clinic, Şişli Etfal Education and Research Hospital, Şişli, İstanbul 34077, Turkey
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23
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Goshima S, Kanematsu M, Kondo H, Tsuge Y, Watanabe H, Shiratori Y, Onozuka M, Moriyama N. Detection and grading for esophageal varices in patients with chronic liver damage: comparison of gadolinium-enhanced and unenhanced steady-state coherent MR images. Magn Reson Imaging 2009; 27:1230-5. [PMID: 19559558 DOI: 10.1016/j.mri.2009.05.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2008] [Revised: 03/19/2009] [Accepted: 05/07/2009] [Indexed: 01/07/2023]
Abstract
The purpose of this study was to compare observer interpreted steady-state coherent coronal images and gadolinium-enhanced axial images in terms of the detection and grading of esophageal varices. Magnetic resonance imaging (MRI) and gastrointestinal endoscopy were performed within 2 weeks in 90 patients with chronic liver damage, including 55 with untreated esophageal varices, for periodic screening purposes. Two blinded readers retrospectively reviewed T1- and T2-weighted images with gadolinium-enhanced (gadolinium image set) and steady-state coherent (coherent image set) images. Sensitivity for the detection of esophageal varices was higher (P<.001) in the gadolinium image set (76%) than in the coherent image set (35%); on the other hand, specificity was higher (P<.001) in the coherent image set (91%) than in the gadolinium image set (66%). Furthermore, area under the ROC curve was higher for the gadolinium image set (Az=0.823) than the coherent image set (Az=0.761) (P=.48). Moderate and weak positive correlations with endoscopic grades were found for the gadolinium image (r=0.48, P<.01) and coherent image sets (r=0.34, P=.018). The addition of steady-state coherent imaging to the current routine liver imaging protocol did not improve the detection or grading of esophageal varices, whereas gadolinium-enhanced imaging was found to be potentially valuable. Nevertheless, endoscopy was confirmed to be mandatory in patients with esophageal varices suspected by MRI of the liver.
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Affiliation(s)
- Satoshi Goshima
- Department of Radiology, Gifu University School of Medicine, 1-1 Yanagido, Gifu 501-1193, Japan
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Morioka T, Hashiguchi K, Samura K, Yoshida F, Miyagi Y, Yoshiura T, Suzuki SO, Sasaki T. Detailed anatomy of intracranial venous anomalies associated with atretic parietal cephaloceles revealed by high-resolution 3D-CISS and high-field T2-weighted reversed MR images. Childs Nerv Syst 2009; 25:309-15. [PMID: 18839185 DOI: 10.1007/s00381-008-0721-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2008] [Revised: 07/11/2008] [Indexed: 10/21/2022]
Abstract
PURPOSE The advancement of magnetic resonance (MR) imaging technology has revealed that intracranial venous anomalies, such as vertical embryonic positioning of the straight sinus (VEP of SS), are associated with atretic parietal cephaloceles. However, the precise anatomical relationships among the venous anomalies, superior sagittal sinus (SSS), cistern, and cephalocele have not been demonstrated. We compared the imaging features of conventional MR images and high-resolution 3-dimensional (3-D) MR images, such as Fourier-transformation-constructive interference in steady-state (CISS) images and T2-weighted reversed (T2R) images obtained on a 3-T MR machine. METHODS Three patients ranging in age from 1 to 18 years, with midline subscalp lesions, participated in this study. In two cases, the lesions were surgically excised and subjected to pathological examination. RESULTS In two children, 3-D MR images more clearly demonstrated anomalous veins, including bilateral internal cerebral veins, the great vein of Galen and the vertical position of the straight sinus in the falx, extending superiorly within the CSF tract in the posterior interhemispheric fissure. While the vertical straight sinus drained into the SSS, the CSF tract maintained a position posterior to the anomalous veins, ran through the SSS and extended to the skull defect. In one patient, ascending positioning of the anomalous vein from the inferior sagittal sinus to the SSS in the CSF space was observed; this could not be depicted on conventional MR images. CONCLUSION Detailed findings of the venous anomalies on 3-D MR images provide clues to the diagnosis of atretic cephalocele.
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Affiliation(s)
- Takato Morioka
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan.
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25
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TOKUNAGA S, MORIOKA T, HASHIGUCHI K, SAMURA K, YOSHIDA F, MIYAGI Y, YOSHIURA T, YAMANOUCHI T, SASAKI T. Double Lumbosacral Lipomas of the Dorsal and Filar Types Associated With OEIS Complex -Case Report-. Neurol Med Chir (Tokyo) 2009; 49:487-90. [DOI: 10.2176/nmc.49.487] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- So TOKUNAGA
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University
| | - Takato MORIOKA
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University
| | - Kimiaki HASHIGUCHI
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University
| | - Kazuhiro SAMURA
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University
| | - Fumiaki YOSHIDA
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University
| | - Yasushi MIYAGI
- Division of Digital Patient, Digital Medicine Initiative, Kyushu University
| | - Takashi YOSHIURA
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University
| | | | - Tomio SASAKI
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University
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26
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Coexistence of a human tail and congenital dermal sinus associated with lumbosacral lipoma. Childs Nerv Syst 2009; 25:137-41. [PMID: 18690460 DOI: 10.1007/s00381-008-0693-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2008] [Indexed: 10/21/2022]
Abstract
We present a female baby with a human tail associated with congenital dermal sinus (CDS) at the caudal site of the tail. Magnetic resonance (MR) images with constructive interference in steady-state (CISS) sequencing clearly demonstrated a lumbosacral lipoma of caudal type, contiguous with the dermal sinus tract and not with the human tail. At 3 months old, the tail was surgically removed. The dermal sinus tract and contiguous lipoma were also resected, and untethering of the spinal cord was performed. Although both the human tail and CDS are frequently associated with spina bifida occulta, coexistence of the tail and CDS is exceedingly rare. CISS-MRI is useful for demonstrating the precise anatomical relationship between these complicated pathologies.
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27
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Morioka T, Hashiguchi K, Yoshida F, Matsumoto K, Miyagi Y, Nagata S, Yoshiura T, Masumoto K, Taguchi T, Sasaki T. Neurosurgical management of occult spinal dysraphism associated with OEIS complex. Childs Nerv Syst 2008; 24:723-9. [PMID: 17962955 DOI: 10.1007/s00381-007-0519-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2007] [Indexed: 10/22/2022]
Abstract
INTRODUCTION OEIS complex has been described as a combination of defects consisting of omphalocele (O), exstrophy of the cloaca (E), imperforate anus (I), and spinal defects (S). As the first three defects are life-threatening and treated on a priority basis, neurosurgical intervention for spinal defects is deferred until recuperation from abdominogenital repair. However, the best timing for neurosurgical operation has not been precisely described. MATERIALS AND METHODS We reviewed our neurosurgical management of three cases (case 1: myelomeningocele; cases 2 and 3: terminal myelocystocele). At 2-6 (3.6 on average) months after birth, neurosurgical procedures, including reduction of the size of the lumbosacral cystic lesion and untethering of the spinal cord, were performed. RESULTS During this period, the patients' weights increased from 1,911 to 3,368 g on average, and the lumbosacral cystic lesion was markedly enlarged. In all cases, no neurological deterioration was seen, and ventriculoperitoneal shunt was not indicated. CONCLUSION Thus, neurosurgical procedures can be performed in patients weighing 3-4 kg and/or at an age of 3 months, after confirming recuperated conditions from abdominogenital repair. Careful observation should be made of the size of the lumbosacral cystic lesion and neurological deterioration.
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Affiliation(s)
- Takato Morioka
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
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Bursal cyst (bursitis) of the coccygeal region clinically mimics sacrococcygeal meningocele. Childs Nerv Syst 2008; 24:533-5. [PMID: 18228026 DOI: 10.1007/s00381-007-0567-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2007] [Revised: 12/02/2007] [Indexed: 10/22/2022]
Abstract
CASE REPORT Bursal cysts (bursitis) are attributed to repeated microtrauma of the connective tissue around the synovial joint and are rare in the coccygeal region. MATERIALS AND METHODS A 10-year-old boy had a subcutaneous tumor at the midline of the buttock. He could not walk and slid himself in a seated position because of psychomotor retardation. MR images showed a cystic lesion overlying the coccygeal bone, the intensity of which was identical to cerebrospinal fluid (CSF). Although meningocele was suspected, constructive interference in steady-state (CISS) MR images clearly depicted a discontinuity between the cyst and CSF space. RESULTS AND CONCLUSION It was conceivable that repeated friction between the coccygeal bone, which projected posteriorly, and overlying subcutaneous tissue during movement resulted in the formation of a bursal cyst. In addition to total removal of the cyst, the coccygeal bone was planed away to prevent friction. We should keep this rare clinical entity in mind in cases that appear to be sacrococcygeal meningocele.
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