1
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Chen S, Tu P, Mu L. Prenatal ultrasound diagnosis and prognosis of fetus with isolated filar cyst: a retrospective analysis. Front Med (Lausanne) 2024; 11:1304803. [PMID: 38318249 PMCID: PMC10839057 DOI: 10.3389/fmed.2024.1304803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 01/08/2024] [Indexed: 02/07/2024] Open
Abstract
Objective This study aimed to investigate the prenatal ultrasonographic diagnosis and prognosis of fetuses with isolated filar cysts (FCs). Methods The ultrasonographic features, reasons for missed diagnosis, and prognosis of eight isolated FCs diagnosed using ultrasound were analyzed retrospectively through follow-up. Results Eight isolated FCs showed round or fusiform cystic anechoic areas at the end of the conus medullaris. Among them, six cases were prenatally diagnosed and the other two cases were diagnosed after birth. Of the six cases diagnosed prenatally, four (66.7%) disappeared during pregnancy, and the shortest time to disappearance was 1 month after the first diagnosis. All patients were followed up without any clinical symptoms or functional abnormalities. Conclusion Isolated FCs may exhibit physiological variations that disappear spontaneously during pregnancy and usually have no clinical symptoms. They are usually benign and have a good prognosis. Ultrasonography is helpful for the diagnosis and follow-up of FCs.
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Affiliation(s)
| | | | - Lan Mu
- Department of Ultrasound, Chongqing Health Center for Women and Children, Women and Children’s Hospital of Chongqing Medical University, Chongqing, China
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2
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Menezes AH, Sato Y, Dlouhy BJ, Jones KA, Moore SA. Ventriculus terminalis cyst in an infant: a case report. J Med Case Rep 2023; 17:22. [PMID: 36683067 PMCID: PMC9869499 DOI: 10.1186/s13256-023-03759-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 01/02/2023] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Filar cysts are frequently found on neonatal ultrasound and are physiologically involuting structures with natural resolution. Hence, there has been no previous histologic correlation. Ventriculus terminalis is a focal central canal dilation in the conus medullaris and usually not clinically significant. Extra-axial cyst at the conus-filum junction connected to ventriculus terminalis is extremely rare, especially when associated with tethered lipomatous filum terminale and with progressive cyst enlargement. CASE PRESENTATION A Caucasian female neonate with abnormal gluteal cleft had ventriculus terminalis cyst with an extra-axial cyst at the conus-filar junction and taut lipomatous filum on ultrasound examination and magnetic resonance imaging. This persisted at 6-month follow up imaging. In light of the nonresolving extra-axial mass and thick taut lipomatous filum, the child underwent L1-L3 osteoplastic laminectomies. The extra-axial cyst expanded after bony decompression and furthermore on dural opening; visualized on ultrasound. It communicated with the central canal and was documented with intraoperative photomicrographs. It was excised and filum sectioned. Histological immunostaining of the cyst wall showed neuroglial and axonal elements. The child did well without deficits at 4-year follow up with normal urodynamics. CONCLUSION Progression dilation of ventriculus terminalis and extra-axial conofilar cyst with tethered lipomatous filum will likely progress to clinical significance and require surgical intervention. The embryologic basis for this pathology is discussed, with literature review.
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Affiliation(s)
- Arnold H. Menezes
- grid.412584.e0000 0004 0434 9816Department of Neurosurgery, University of Iowa Hospitals & Clinics and Stead Family Children’s Hospital, Iowa City, IA USA ,grid.412584.e0000 0004 0434 9816Department of Neurosurgery, University of Iowa Hospitals & Clinics, 200 Hawkins Drive, 1824 JPP, Iowa City, IA 52242 USA
| | - Yutaka Sato
- grid.412584.e0000 0004 0434 9816Department of Radiology, University of Iowa Hospitals & Clinics and Stead Family Children’s Hospital, Iowa City, IA USA
| | - Brian J. Dlouhy
- grid.412584.e0000 0004 0434 9816Department of Neurosurgery, University of Iowa Hospitals & Clinics and Stead Family Children’s Hospital, Iowa City, IA USA
| | - Karra A. Jones
- grid.412584.e0000 0004 0434 9816Department of Pathology, University of Iowa Hospitals & Clinics and Stead Family Children’s Hospital, Iowa City, IA USA
| | - Steven A. Moore
- grid.412584.e0000 0004 0434 9816Department of Pathology, University of Iowa Hospitals & Clinics and Stead Family Children’s Hospital, Iowa City, IA USA
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3
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Kim KH, Lee JY, Wang KC. Secondary Neurulation Defects: Retained Medullary Cord. Adv Tech Stand Neurosurg 2023; 47:215-223. [PMID: 37640876 DOI: 10.1007/978-3-031-34981-2_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
Retained medullary cord (RMC) is a defect resulting from impaired secondary neurulation. Intraoperatively, RMC is recognizable as an elongated cord-like structure caudal to the conus, that contains histologically confirmed neuroglial components and a lumen with an ependymal lining. It characteristically does not possess neurological function. This chapter aims to summarize (1) the mechanisms that lead to the occurrence of RMC; (2) the various forms of RMC, such as cystic RMC and 'possible RMC', and (3) the treatment strategies, especially untethering through limited exposure.
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Affiliation(s)
- Kyung Hyun Kim
- Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul, Republic of Korea
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ji Yeoun Lee
- Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul, Republic of Korea
- Department of Anatomy and Cell Biology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kyu-Chang Wang
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Republic of Korea.
- Neuro-oncology Clinic, National Cancer Center, Goyang, Republic of Korea.
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4
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Wu J. Spontaneous Disappearance of Filar Cysts Diagnosed by Transabdominal Ultrasonography: A Report of Three Cases. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:1009-1012. [PMID: 34156102 DOI: 10.1002/jum.15769] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 05/23/2021] [Accepted: 05/26/2021] [Indexed: 06/13/2023]
Abstract
Filar cysts (FCs) can be detected using ultrasound before or after delivery. They usually present as anechoic structures with a clear boundary just caudal to the lower end of the conus medullaris. They are generally considered a physiological variation and do not affect health. Some studies have pointed out that FCs in children can disappear spontaneously, as identified by ultrasound or magnetic resonance imaging. Three cases of FCs diagnosed by prenatal transabdominal ultrasound were reported in this study, and it was observed that FCs could disappear spontaneously in utero. The shortest time of disappearance was 4 weeks.
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Affiliation(s)
- Jingping Wu
- Department of Ultrasound, China-Japan Friendship Hospital, Beijing, China
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5
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Yang J, Lee JY, Kim KH, Yang HJ, Wang KC. Disorders of Secondary Neurulation: Suggestion of a New Classification According to Pathoembryogenesis. Adv Tech Stand Neurosurg 2022; 45:285-315. [PMID: 35976454 DOI: 10.1007/978-3-030-99166-1_9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Recently, advanced knowledge on secondary neurulation and its application to the clinical experience have led to the deeper insight into the pathoembryogenesis of secondary neurulation with new classifications of the caudal spinal dysraphic entities. Here, we summarize the dynamic changes in the concepts of disordered secondary neurulation over the last two decades. In addition, we suggest our new pathoembryogenetic explanations for a few entities based on the literature and the data from our previous animal research. Disordered secondary neurulation at each phase may cause various corresponding lesions, such as (1) failed junction with the primary neural tube (junctional neural tube defect and segmental spinal dysgenesis), (2) dysgenesis or duplication of the caudal cell mass associated with disturbed activity of caudal mesenchymal tissue (caudal agenesis and caudal duplication syndrome), (3) abnormal continuity of medullary cord to the surrounding layers, namely, failed ingression of the primitive streak to the caudal cell mass (myelomeningocele), focal limited dorsal neurocutaneous nondisjunction (limited dorsal myeloschisis and congenital dermal sinus), and neuro-mesenchymal adhesion (lumbosacral lipomatous malformation), and (4) regression failure spectrum of the medullary cord (thickened filum and filar cyst, retained medullary cord and low-lying conus, terminal myelocele, and terminal myelocystocele). It seems that almost every anomalous entity of the primary neural tube may occur in the area of secondary neurulation. Furthermore, the close association of the caudal cell mass with the activity of caudal mesenchymal tissue involves a wider range of surrounding structures in secondary neurulation than in primary neurulation. Although the majority of the data are from animals and many theories are still conjectural, these changing concepts of normal and disordered secondary neurulation will provoke further advancements in our management strategies as well as in the pathoembryogenetic understanding of anomalous lesions in this area.
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Affiliation(s)
- Jeyul Yang
- Neuro-Oncology Clinic, Center for Rare Cancers, National Cancer Center, Goyang, Kyounggi-do, South Korea
| | - Ji Yeoun Lee
- Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul, South Korea
- Department of Anatomy and Cell Biology, Seoul National University College of Medicine, Seoul, South Korea
| | - Kyung Hyun Kim
- Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul, South Korea
| | - Hee Jin Yang
- Department of Neurosurgery, SMG-SNU Boramae Medical Center, Seoul, South Korea
| | - Kyu-Chang Wang
- Neuro-Oncology Clinic, Center for Rare Cancers, National Cancer Center, Goyang, Kyounggi-do, South Korea.
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6
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Rees MA, Squires JH, Coley BD, Hoehne B, Ho ML. Ultrasound of congenital spine anomalies. Pediatr Radiol 2021; 51:2442-2457. [PMID: 34532816 DOI: 10.1007/s00247-021-05178-6] [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: 02/24/2021] [Revised: 07/07/2021] [Accepted: 08/02/2021] [Indexed: 10/20/2022]
Abstract
Ultrasonography (US) is the first-line imaging modality for screening neonates and young infants with suspected spinal abnormalities. Whether performed for a suspicious congenital skin lesion, such as a lumbosacral tract or lipomatous mass, or abnormal neurological findings, US can help define spinal anatomy, characterize congenital spine malformations, and direct further work-up and management. The purpose of this article is to review the diagnostic imaging approach to infant spine US, including technique and indications, normal anatomy and variants with a focus on embryological origins, and classification and diagnosis of congenital spine malformations.
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Affiliation(s)
- Mitchell A Rees
- Department of Radiology, Nationwide Children's Hospital,, ED Building, 4th Floor, 700 Children's Drive, Columbus, OH, 43205, USA.
| | - Judy H Squires
- Department of Radiology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Brian D Coley
- Department of Radiology,, Cincinnati Children's Hospital Medical Cente,, Cincinnati, OH, USA.,Department of Radiology,, University of Cincinnati College of Medicine,, Cincinnati, OH, USA
| | - Brad Hoehne
- Department of Radiology, Nationwide Children's Hospital,, ED Building, 4th Floor, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Mai-Lan Ho
- Department of Radiology, Nationwide Children's Hospital,, ED Building, 4th Floor, 700 Children's Drive, Columbus, OH, 43205, USA
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7
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Yang J, Lee JY, Kim KH, Wang KC. Disorders of Secondary Neurulation : Mainly Focused on Pathoembryogenesis. J Korean Neurosurg Soc 2021; 64:386-405. [PMID: 33906343 PMCID: PMC8128515 DOI: 10.3340/jkns.2021.0023] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 03/16/2021] [Indexed: 12/22/2022] Open
Abstract
Recent advancements in basic research on the process of secondary neurulation and increased clinical experience with caudal spinal anomalies with associated abnormalities in the surrounding and distal structures shed light on further understanding of the pathoembryogenesis of the lesions and led to the new classification of these dysraphic entities. We summarized the changing concepts of lesions developed from the disordered secondary neurulation shown during the last decade. In addition, we suggested our new pathoembryogenetic explanations for a few entities based on the literature and the data from our previous animal research. Disordered secondary neurulation at each phase of development may cause corresponding lesions, such as failed junction with the primary neural tube (junctional neural tube defect and segmental spinal dysgenesis), dysgenesis or duplication of the caudal cell mass associated with disturbed activity of caudal mesenchymal tissue (caudal agenesis and caudal duplication syndrome), failed ingression of the primitive streak to the caudal cell mass (myelomeningocele), focal limited dorsal neuro-cutaneous nondisjunction (limited dorsal myeloschisis and congenital dermal sinus), neuro-mesenchymal adhesion (lumbosacral lipomatous malformation), and regression failure spectrum of the medullary cord (thickened filum and filar cyst, low-lying conus, retained medullary cord, terminal myelocele and terminal myelocystocele). It seems that almost every anomalous entity of the primary neural tube may occur in the area of secondary neurulation. Furthermore, the close association with the activity of caudal mesenchymal tissue in secondary neurulation involves a wider range of surrounding structures than in primary neurulation. Although the majority of the data are from animals, not from humans and many theories are still conjectural, these changing concepts of normal and disordered secondary neurulation will provoke further advancements in our management strategies as well as in the pathoembryogenetic understanding of anomalous lesions in this area.
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Affiliation(s)
- Jeyul Yang
- Neuro-oncology Clinic, Center for Rare Cancers, National Cancer Center, Goyang, Korea
| | - Ji Yeoun Lee
- Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul, Korea.,Department of Anatomy, Seoul National University College of Medicine, Seoul, Korea
| | - Kyung Hyun Kim
- Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul, Korea
| | - Kyu-Chang Wang
- Neuro-oncology Clinic, Center for Rare Cancers, National Cancer Center, Goyang, Korea
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8
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Cyst of the Filum Terminale: Potpourri of 3 Prenatally Diagnosed Cases. JOURNAL OF FETAL MEDICINE 2020. [DOI: 10.1007/s40556-020-00269-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
AbstractThe filum terminale (FT) is an extension of pia mater, a fibrous band that connects the conus medullaris and the posterior body of the coccyx.
Current advanced technology in ultrasonography has enabled visualisation of the FT and small structures like a FT cyst can be diagnosed prenatally. Reports pf these cysts are rare. We report three cases of a FT cyst diagnosed prenatally. The objective of reporting these is to make clinicians aware of the importance of the relevance of this clinical entity.
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9
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Mukae N, Morioka T, Suzuki SO, Murakami N, Shimogawa T, Kanata A, Tsukamoto H, Mizoguchi M. Two Cases of Large Filar Cyst Associated with Terminal Lipoma: Relationship with Retained Medullary Cord. World Neurosurg 2020; 142:294-298. [PMID: 32668332 DOI: 10.1016/j.wneu.2020.07.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 07/04/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND A small, incidental filar cyst associated with terminal lipoma is thought to be caused by failure of secondary neurulation; however, the precise embryologic background is not fully understood. Retained medullary cord (RMC) also originates from late arrest of secondary neurulation. The central feature of RMC histopathology is a central canal-like ependyma-lined lumen with surrounding neuroglial core. CASE DESCRIPTION We surgically treated 2 patients with a large cyst in the rostral part of the filum and lipoma in the caudal filum. At cord untethering surgery, the filum was severed at the caudal part of the cyst. Histopathologically, the filar cyst was the cystic dilatation of the central canal-like structure at the marginal part of the lipoma. The central canal-like structure was continuous caudally in the lipoma, and its size decreased toward the caudal side. CONCLUSIONS The present findings support the idea raised by Pang et al that entities such as filar cyst, terminal lipomas, and RMC can all be considered consequences of a continuum of regression failure occurring during late secondary neurulation.
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Affiliation(s)
- Nobutaka Mukae
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
| | - Takato Morioka
- Department of Neurosurgery, Harasanshin Hospital, Fukuoka, Japan
| | | | - Nobuya Murakami
- Department of Neurosurgery, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Takafumi Shimogawa
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Akiko Kanata
- Department of Neurosurgery, Kitakyushu Municipal Medical Center, Kitakyushu, Japan
| | - Haruhisa Tsukamoto
- Department of Neurosurgery, Kitakyushu Municipal Medical Center, Kitakyushu, Japan
| | - Masahiro Mizoguchi
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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10
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Oh JE, Lim GY, Kim HW, Kim SY. Filum terminale lipoma revealed by screening spinal ultrasonography in infants with simple sacral dimple. Childs Nerv Syst 2020; 36:1037-1042. [PMID: 31807897 DOI: 10.1007/s00381-019-04430-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 10/29/2019] [Indexed: 01/30/2023]
Abstract
PURPOSE Spine ultrasound (US) examinations are widely performed in neonates and infants with sacral dimple to exclude associated congenital malformations. Increased utilization of, and improvements in, sonographic technology has resulted in the frequent identification of echogenic filum terminale (FT) containing fat below the conus medullaris, termed FT lipoma or fatty FT. We examined the value of screening US, especially for diagnosis of FT lipoma, in infants with "simple sacral dimple." METHODS This study was a retrospective review of spinal US and magnetic resonance imaging (MRI) findings performed in our hospital on full-term and preterm infants with simple sacral dimple. We reviewed the clinical records and spinal sonographic scans of 337 patients, and the MRI scans of 40 patients with simple sacral dimple. We evaluated the thickness and echogenicity of FT on US, and the presence of fat in the FT was determined by MRI. RESULTS In total, 50 of the 337 patients showed strong echogenic FT on US. Correlation with MRI data was possible in 40 of the 50 patients with strong echogenic FT. MRI scans of all 40 of these patients revealed the presence of fat in the FT. The maximum thickness in the strong echogenic area of the FT lipomas of these 40 patients was 1.7 ± 0.4 mm (range 1.2-2.5 mm), and the minimum thickness was 1.1 ± 0.2 mm (range 0.8-1.4 mm). Among the 40 infants, 13 (32%) had maximum FT thickness > 2 mm (mean thickness 2.2 ± 0.2 mm; range 2-2.5 mm) and 27 (68%) had echogenic FT < 2 mm thick (mean thickness 1.5 ± 0.2 mm; range 1-1.9 mm). The length of the echogenic segment on US was about 1.9-5.1 cm (mean length 3.4 ± 1.1 cm). All 40 patients showed FT lipoma without any associated abnormalities, such as cord tethering or low-lying conus. Among the total population of 337 patients, 30 (8.9%) showed borderline low-lying conus medullaris located at the L2-3 disc space or midpoint of the L3 vertebra. All 30 of these patients had borderline low-lying conus without other associated abnormalities. Filar cyst was noted in 36 of 337 patients (10.6%), without other associated abnormalities. No patient underwent surgery associated with a risk of neurological problems within a follow-up period of 10-37 months. CONCLUSIONS Although screening US in infants with simple sacral dimple yielded benign imaging findings, the presence of FT lipoma was common in these infants. Therefore, it is necessary to carefully observe changes in echogenicity during measurement of FT thickness on US. All FT lipomas were low risk and had no associated abnormalities, such as cord tethering or low-lying conus.
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Affiliation(s)
- Ji Eun Oh
- Department of Radiology, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Gye Yeon Lim
- Department of Radiology, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
| | - Hae Won Kim
- Department of Radiology, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - So Young Kim
- Pediatrics, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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11
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Kumar I, Sachan A, Aggarwal P, Verma A, Shukla RC. Structured MRI reporting in spinal dysraphism. Acta Radiol 2020; 61:1520-1533. [PMID: 32054289 DOI: 10.1177/0284185120903445] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Magnetic resonance evaluation of spinal dysraphism can be confusing for inexperienced radiologists and a detailed, step-by-step evaluation of the normal and abnormal imaging findings can help garner the diagnosis. The purpose of this article is to review the existing literature and to provide a comprehensive, structured, template checklist-style format for reporting spinal dysraphism that can help inexperienced radiologists to systematically analyze and report all the significant and ancillary findings in cases of spinal dysraphism and efficiently communicate the findings to the treating physician/surgeon.
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Affiliation(s)
- Ishan Kumar
- Department of Radiodiagnosis, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Ankita Sachan
- Department of Radiodiagnosis, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Priyanka Aggarwal
- Department of Pediatrics, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Ashish Verma
- Department of Radiodiagnosis, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Ram C Shukla
- Department of Radiodiagnosis, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
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12
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Seo K, Oguma H, Furukawa R, Gomi A. Filar cysts in rare cases may progress in size, particularly when associated with filar lipoma. Childs Nerv Syst 2019; 35:1207-1211. [PMID: 30972496 DOI: 10.1007/s00381-019-04148-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 04/02/2019] [Indexed: 12/01/2022]
Abstract
PURPOSE Filar cysts (FCs) are detected incidentally on ultrasonography (US) of the neonatal spine. Their clinical significance has not been widely discussed in the literature because FCs are usually asymptomatic. This study aimed to investigate the clinical features of FCs and distinguish FCs that warrant attention. METHODS We retrospectively analyzed 396 patients with lumbosacral skin stigmata. Patients who were younger than 1 month old at reference underwent US initially, and those older than 1 month of age underwent magnetic resonance imaging (MRI) at the age of 5-12 months. Patients with an FC in the US underwent subsequent MRI at the age of 5-12 months. Patients with an FC were followed clinically for at least 3 years. RESULTS FCs were identified in 56 (14.1%) patients. Of the 195 children who underwent US initially, FCs were detected in 49 (25.1%) children. FCs were detected in seven children who underwent MRI initially. Of the 50 children with FCs who underwent MRI at the age of 5-12 months, FCs in 20 patients (40%) showed natural regression and FCs in 30 patients (60%) remained. Two of these 30 patients showed progression in size of the FC, and in both cases, the FCs were associated with a filar lipoma; however, the resected cysts were not neoplastic and did not have obvious clinical significance. CONCLUSIONS Our study characterizes clinical features of filar cysts. Two-thirds of FCs remained in late infancy. The best sequence of MRI to follow-up FCs is heavily T2-weighted images.
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Affiliation(s)
- Kyoichi Seo
- Department of Neurosurgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, Japan
| | - Hirofumi Oguma
- Department of Neurosurgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, Japan
| | - Rieko Furukawa
- Department of Pediatric Medical Imaging, Jichi Children's Medical Center Tochigi, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, Japan
| | - Akira Gomi
- Department of Pediatric Neurosurgery, Jichi Children's Medical Center Tochigi, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, Japan.
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13
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Choi JH, Lee T, Kwon HH, You SK, Kang JW. Outcome of ultrasonographic imaging in infants with sacral dimple. KOREAN JOURNAL OF PEDIATRICS 2018; 61:194-199. [PMID: 29963103 PMCID: PMC6021363 DOI: 10.3345/kjp.2018.61.6.194] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 10/25/2017] [Accepted: 10/31/2017] [Indexed: 11/27/2022]
Abstract
Purpose Sacral dimples are a common cutaneous anomaly in infants. Spine ultrasonography (USG) is an effective and safe screening tool for patients with a sacral dimple. The aim of this study was to determine the clinical manifestations in patients with an isolated sacral dimple and to review the management of spinal cord abnormalities identified with USG. Methods We reviewed clinical records and collected data on admissions for a sacral dimple from March 2014 through February 2017 that were evaluated with spine USG by a pediatric radiologist. During the same period, patients who were admitted for other complaints, but were found to have a sacral dimple were also included. Results This study included 230 infants under 6-months-old (130 males and 100 females; mean age 52.8±42.6 days). Thirty-one infants with a sacral dimple had an echogenic filum terminale, and 57 children had a filar cyst. Twenty-seven patients had a low-lying spinal cord, and only one patient was suspected of having a tethered cord. Follow-up spine USG was performed in 28 patients, which showed normalization or insignificant change. Conclusion In this study, all but one infant with a sacral dimple had benign imaging findings. USG can be recommended in infants with a sacral dimple for its convenience and safety.
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Affiliation(s)
- Jin Hyuk Choi
- Department of Pediatrics, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Taekwan Lee
- Department of Pediatrics, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Hyeok Hee Kwon
- Department of Medical Science, Chungnam National University School of Medicine, Daejeon, Korea
| | - Sun Kyoung You
- Department of Radiology, Chungnam National University Hospital, Daejeon, Korea
| | - Joon Won Kang
- Department of Pediatrics, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea.,Department of Medical Science, Chungnam National University School of Medicine, Daejeon, Korea.,Brain Research Institute, Chungnam National University School of Medicine, Daejeon, Korea
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14
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Alvarado E, Leach J, Caré M, Mangano F, O Hara S. Pediatric Spinal Ultrasound: Neonatal and Intraoperative Applications. Semin Ultrasound CT MR 2017; 38:126-142. [PMID: 28347416 DOI: 10.1053/j.sult.2016.07.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The purpose of this article is to review the use of ultrasound as a screening tool for spinal diseases in neonates and infants and its intraoperative value in selected pediatric neurosurgical disorders. A review of spinal embryology followed by a description of common spinal diseases in neonates assessed with ultrasound is presented. Indications for spinal ultrasound in neonates, commonly identified conditions, and the importance of magnetic resonance imaging in selected cases are emphasized. Additionally, the use of ultrasound in selected neurosurgical spinal diseases in pediatric patients is presented with magnetic resonance imaging and intraoperative correlation. Technique, limitations, and pitfalls are discussed.
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Affiliation(s)
- Enrique Alvarado
- Department of Radiology, Cincinnati Children׳s Hospital Medical Center, Cincinnati, OH
| | - James Leach
- Department of Radiology, Cincinnati Children׳s Hospital Medical Center, Cincinnati, OH.
| | - Marguerite Caré
- Department of Radiology, Cincinnati Children׳s Hospital Medical Center, Cincinnati, OH
| | - Francesco Mangano
- Department of Neurosurgery, Cincinnati Children׳s Hospital Medical Center, Cincinnati, OH
| | - Sara O Hara
- Department of Radiology, Cincinnati Children׳s Hospital Medical Center, Cincinnati, OH
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15
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Naffaa L, Irani N, Saade C, Sreedher G. Congenital anomalies of lumbosacral spine: A pictorial review. J Med Imaging Radiat Oncol 2016; 61:216-224. [PMID: 27469617 DOI: 10.1111/1754-9485.12499] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 06/18/2016] [Indexed: 11/28/2022]
Abstract
Congenital malformations of the lumbosacral spine include spinal dysraphism and caudal anomalies. Most often, these malformations are discovered prenatally or in early infancy, but some are not diagnosed until late childhood or adulthood. The purpose of this pictorial review is to illustrate the multi-modality imaging characteristics in these complex anomalies and to provide a systematic radiological approach aiming at improving diagnostic accuracy.
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Affiliation(s)
- Lena Naffaa
- Department of Radiology, American University of Beirut, Beirut, Lebanon
| | - Neville Irani
- University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Charbel Saade
- Department of Radiology, American University of Beirut, Beirut, Lebanon
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16
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Kim YS, Jin DH, Shin JH, Lee EH, Choi BM, Hong YS, Je BG. Intraspinal and Urogenital Abnormalities in Infants with Sacral Cutaneous Lesions. NEONATAL MEDICINE 2015. [DOI: 10.5385/nm.2015.22.1.40] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Yu Seon Kim
- Department of Pediatrics, Korea University College of Medicine, Seoul, Korea
| | - Da Hee Jin
- Department of Pediatrics, Korea University College of Medicine, Seoul, Korea
| | - Jeong Hee Shin
- Department of Pediatrics, Korea University College of Medicine, Seoul, Korea
| | - Eun Hee Lee
- Department of Pediatrics, Korea University College of Medicine, Seoul, Korea
| | - Byung Min Choi
- Department of Pediatrics, Korea University College of Medicine, Seoul, Korea
| | - Young Sook Hong
- Department of Pediatrics, Korea University College of Medicine, Seoul, Korea
| | - Bo Gyeong Je
- Department of Radiology, Korea University College of Medicine, Seoul, Korea
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17
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Abstract
Ultrasound of the spine in the neonate is widely used as the initial modality to evaluate spinal canal anatomy, anatomical variants, and congenital malformations. The spinal canal and its contents are best visualized in the newborn and young infant owing to incomplete ossification of the posterior vertebral elements.
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Affiliation(s)
- Maria F Ladino Torres
- Department of Radiology, University of Michigan, C.S. Mott Children׳s Hospital, Ann Arbor, MI.
| | - Michael A DiPietro
- Department of Radiology, University of Michigan, C.S. Mott Children׳s Hospital, Ann Arbor, MI; John F. Holt Collegiate Professor of Radiology, Section of Pediatric Radiology, Department of Radiology, University of Michigan, MI; Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI
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18
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Thakur NH, Lowe LH. Borderline low conus medullaris on infant lumbar sonography: what is the clinical outcome and the role of neuroimaging follow-up? Pediatr Radiol 2011; 41:483-7. [PMID: 21079942 DOI: 10.1007/s00247-010-1889-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2010] [Revised: 09/25/2010] [Accepted: 10/04/2010] [Indexed: 11/28/2022]
Abstract
BACKGROUND Isolated borderline low conus medullaris is a frequent finding on screening lumbar sonography of unknown significance that often prompts further imaging and clinical follow-up. OBJECTIVE To determine the clinical outcome and utility of follow-up neuroimaging in infants with isolated borderline low conus on lumbar sonography. MATERIALS AND METHODS We reviewed 748 consecutive spinal sonograms identifying infants with conus terminating between L2-L3 disc space and mid-L3 level without other findings of tethered cord. We excluded infants with conditions associated with developmental delay and those who passed away, and compared the age of gross motor milestone achievement to normal ranges. Follow-up imaging was reviewed. RESULTS Isolated borderline low conus was found in 90 of 748 infants (12%) on sonography. Seventy of those infants met inclusion criteria. Follow-up imaging in 11 children (10 MRI, 1 sonogram), showed change in conus position to "normal" level in 10, no change in 1, and no new findings within lumbar spine. Clinical follow-up was available in 50 of 70 (71%) children meeting inclusion criteria, with normal motor milestones met in all 50 children. CONCLUSION Isolated borderline low conus is a common finding in infants who meet normal developmental milestones suggesting that follow-up evaluation has little utility and is likely unwarranted.
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Affiliation(s)
- Neil H Thakur
- University of Missouri-Kansas City, School of Medicine, 2411 Holmes St, Kansas City, MO 64108, USA.
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19
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Blondiaux E, Katorza E, Rosenblatt J, Nahama-Allouche C, Lenoir M, le Pointe HD, Garel C. Prenatal US evaluation of the spinal cord using high-frequency linear transducers. Pediatr Radiol 2011; 41:374-83. [PMID: 21221567 DOI: 10.1007/s00247-010-1922-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2010] [Revised: 10/07/2010] [Accepted: 11/02/2010] [Indexed: 01/04/2023]
Abstract
We illustrate the contribution of high-frequency linear abdominal transducers in the prenatal US examination of the spinal cord. After birth, such transducers are commonly used in US examination of the spinal cord. During the third trimester of gestation, the fetal spine is commonly facing anteriorly and US images of the spinal cord can be acquired using a high-frequency linear abdominal transducer. Images of the normal spinal cord, normal variants (ventriculus terminalis, cyst of filum terminale) and spinal cord abnormalities (myelomeningocele, meningocele, diastematomyelia, tethered spinal cord and caudal regression syndrome) are presented. In this pictorial essay, comparison between images acquired with low- and high-frequency transducers are provided as well as correlation with postnatal data. In the normal spine, anatomical details such as the conus medullaris, the filum terminale and the nerve root bundles are exquisitely depicted, making it possible to differentiate normal variants from abnormalities. In abnormal cases, the position of the conus medullaris, its shape and the nerve roots can be analyzed in detail. We describe the benefits of using high-frequency linear transducers in US examination of the spinal cord, which is common after birth but has not been hitherto reported in fetuses.
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Affiliation(s)
- Eléonore Blondiaux
- Radiology Department, Hopital d'Enfants Armand-Trousseau, Universite Paris VI Pierre and Marie Curie, 26-28 Avenue du docteur Arnold Netter, Paris, 75571, France
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20
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Guillerman RP. Infant craniospinal ultrasonography: beyond hemorrhage and hydrocephalus. Semin Ultrasound CT MR 2010; 31:71-85. [PMID: 20304317 DOI: 10.1053/j.sult.2010.01.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Ultrasonography is widely used for screening for neonatal intracranial hemorrhage, hydrocephalus, and cord tethering in young infants. Proper interpretation of infant cranial and spinal ultrasound examinations requires not only familiarity with the appearances of these disorders, but also recognition of imaging artifacts capable of mimicking pathology and awareness of developmental variants and conditions that occupy a borderline position along the spectrum from normal to abnormal. This article will review the current understanding of the ultrasonographic characteristics and clinical relevance of these imaging artifacts, developmental variants, and quasi-pathologic conditions to avoid diagnostic pitfalls and guide appropriate patient management.
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Affiliation(s)
- R Paul Guillerman
- Department of Diagnostic Imaging, Baylor College of Medicine, Texas Children's Hospital, Houston, TX 77030, USA.
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21
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Jha P, Chawla SC. Congenital persistent terminal ventricle and filar cyst. Pediatr Radiol 2009; 39:414. [PMID: 19132357 DOI: 10.1007/s00247-008-1089-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2008] [Revised: 10/11/2008] [Accepted: 11/21/2008] [Indexed: 10/21/2022]
Affiliation(s)
- Priyanka Jha
- Department of Radiology, San Francisco Medical Center, University of California, San Francisco, CA, USA
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