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Khaladkar S, Ajmera P, Rathi S. Utility of 3D-T2 space MRI sequence in diagnosing a rare cause of lower backache: horseshoe cord and meningocoele manqué in a case of composite split cord malformation. BMJ Case Rep 2022; 15:e248615. [PMID: 35351760 PMCID: PMC8966560 DOI: 10.1136/bcr-2021-248615] [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] [Accepted: 03/13/2022] [Indexed: 11/04/2022] Open
Abstract
Diastematomyelia is the asymmetric or symmetric lateral duplication of the spinal cord into two hemicords. Pang divided it into three types: type-1, type-2 and composite split cord malformation (SCM). Composite SCMs are uncommon and are defined by the coexistence of multiple types of split cord with normal cord in between. When partially bridged, they are called a horseshoe cord. We report a case of a young woman who presented with backache and was diagnosed with composite SCM with horseshoe cord and type-2 SCM with intervening normal cord. In our case, 3D-SPACE due to its superior topographical evaluation, allowed us to visualise and characterise the thin meningocoele manque bands and detect horseshoe cords, asymmetric cords and demarcate the precise extent of syrinx, which were suboptimally imaged on isolated T2 and T1WI sequences. If left untreated during surgery, bands can be the potential cause for persistent backache.
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Affiliation(s)
- Sanjay Khaladkar
- Radiology, Dr D Y Patil Medical College Hospital and Research Centre, Pune, Maharashtra, India
| | - Pranav Ajmera
- Radiology, Dr D Y Patil Medical College Hospital and Research Centre, Pune, Maharashtra, India
| | - Snehal Rathi
- Radiology, Mahatma Gandhi Mission's Institute of Health Sciences, Navi Mumbai, Maharashtra, India
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2
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Bohiltea RE, Ducu I, Mihai BM, Iordache AM, Dima V, Vladareanu EM, Bacalbasa N, Bohiltea AT, Salmen T, Varlas V. First-Trimester Diagnosis of Supernumerary Hemivertebra. Diagnostics (Basel) 2022; 12:diagnostics12020373. [PMID: 35204464 PMCID: PMC8871345 DOI: 10.3390/diagnostics12020373] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 01/18/2022] [Accepted: 01/29/2022] [Indexed: 02/04/2023] Open
Abstract
Hemivertebra is a common cause of congenital scoliosis and results from a lack of formation of one-half of the vertebral body. This condition is very rare and can present as solitary or as a syndrome component: i.e., the split notochord syndrome, which often implies vertebral defects, from a bifid vertebra to hemivertebrae, or fused vertebrae. We describe a case of supernumerary lateral hemivertebra detected prenatally at 12 weeks of gestation and the ultrasonography specifics that lead to early and accurate diagnosis, monitoring during pregnancy, and follow-up at the 4-year period. The case is presented to specify the importance of an early assessment of fetal spine and diagnosis of various conditions, including hemivertebrae, considering the significant association with other anomalies (cardiovascular, urinary, skeletal, gastrointestinal, and central nervous systems), which are most commonly involved. Moreover, the need to counsel future parents on the risks implied by this anomaly is important for the obstetrician. We underline the inclusion of these types of congenital conditions in high-risk pregnancy because of the frequent association with high cesarean delivery rates, growth restriction, delivery before term, and higher morbidity rates.
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Affiliation(s)
- Roxana Elena Bohiltea
- Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy Bucharest, 37 Dionisie Lupu, 020021 Bucharest, Romania; (N.B.); (V.V.)
- Department of Obstetrics, Gynecology and Neonatology, Filantropia Hospital, 11-13 Ion Mihalache Blv., Sector 1, 011171 Bucharest, Romania;
- Correspondence: (R.E.B.); (I.D.); (A.-M.I.); (V.D.); (T.S.)
| | - Ionita Ducu
- Department of Obstetrics and Gynecology, University Emergency Hospital, 169 Splaiul Independentei Bld., Sector 5, 050098 Bucharest, Romania
- Correspondence: (R.E.B.); (I.D.); (A.-M.I.); (V.D.); (T.S.)
| | - Bianca Margareta Mihai
- Department of Obstetrics, Gynecology and Neonatology, Filantropia Hospital, 11-13 Ion Mihalache Blv., Sector 1, 011171 Bucharest, Romania;
| | - Ana-Maria Iordache
- Optospintronics Department, National Institute for Research and Development in Optoelectronics-INOE 2000, 409 Atomistilor, 077125 Magurele, Romania
- Correspondence: (R.E.B.); (I.D.); (A.-M.I.); (V.D.); (T.S.)
| | - Vlad Dima
- Department of Obstetrics, Gynecology and Neonatology, Filantropia Hospital, 11-13 Ion Mihalache Blv., Sector 1, 011171 Bucharest, Romania;
- Correspondence: (R.E.B.); (I.D.); (A.-M.I.); (V.D.); (T.S.)
| | - Emilia Maria Vladareanu
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy Bucharest, 37 Dionisie Lupu, 020021 Bucharest, Romania;
| | - Nicolae Bacalbasa
- Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy Bucharest, 37 Dionisie Lupu, 020021 Bucharest, Romania; (N.B.); (V.V.)
| | | | - Teodor Salmen
- Department of Diabetes, Nutrition and Metabolic Diseases, “Prof. Dr. N.C.Paulescu” National Institute of Diabetes, Nutrition and Metabolic Diseases, 030167 Bucharest, Romania
- Correspondence: (R.E.B.); (I.D.); (A.-M.I.); (V.D.); (T.S.)
| | - Valentin Varlas
- Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy Bucharest, 37 Dionisie Lupu, 020021 Bucharest, Romania; (N.B.); (V.V.)
- Department of Obstetrics, Gynecology and Neonatology, Filantropia Hospital, 11-13 Ion Mihalache Blv., Sector 1, 011171 Bucharest, Romania;
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Soh HT. Adult-onset presentation of cervicothoracic split cord malformation: illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2021; 2:CASE21415. [PMID: 35854789 PMCID: PMC9265236 DOI: 10.3171/case21415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 08/17/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND A 60-year-old female presented with a 6-month history of progressive lower limb pain, weakness, and declining mobility. She was initially diagnosed as having possible hip osteoarthritis or ligamental knee injury. She was eventually seen by a neurologist, who admitted her to a tertiary hospital with new-onset upper motor neuron signs and urinary incontinence. Magnetic resonance imaging of the whole spine revealed evidence of C7–T2 type 1 split cord malformation (SCM) necessitating urgent spinal surgery. She had an excellent outcome with intensive rehabilitation and returned to her premorbid level of function and mobility. OBSERVATIONS The patient presented with nonspecific symptoms, which led to multiple referrals and a significant delay in her diagnosis. LESSONS Clinicians should be aware of the importance of a detailed history with thorough neurological and spinal examinations.
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Affiliation(s)
- Huei Ti Soh
- Department of Rehabilitation Medicine, Nepean Hospital, Sydney, New South Wales, Australia
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4
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Abstract
Spinal cord diseases in pediatric patients are highly variable in terms of presentation, pathology, and prognosis. Not only do they differ with respect to each other but so too with their adult equivalents. Some of the most common diseases are autoimmune (ie, multiple sclerosis, acute disseminated encephalomyelitis, and acute transverse myelitis), congenital (ie, dysraphism with spina bifida, split cord malformation, and tethered cord syndrome), tumor (ie, juvenile pilocytic astrocytoma, ependymoma, and hem-angioblastoma), and vascular (ie, cavernous malformations, arteriovenous malformations, and dural arteriovenous fistulas) in nature. These each require their own niche treatment paradigm and prognosis. Furthermore, presentation of different spinal cord diseases in children can be difficult to discern without epidemiologic and imaging data. Interpretation of these data is crucial to facilitating a timely and accurate diagnosis. Correspondingly, the aim of this review was to highlight the most pertinent features of the most common spinal cord diseases in the pediatric population.
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Affiliation(s)
- Victor M Lu
- Department of Neurological Surgery, Nicklaus Children's Hospital, Miami, FL.,Department of Neurological Surgery, University of Miami, Miami, FL
| | - Toba N Niazi
- Department of Neurological Surgery, Nicklaus Children's Hospital, Miami, FL.,Department of Neurological Surgery, University of Miami, Miami, FL
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Kobets AJ, Oliver J, Cohen A, Jallo GI, Groves ML. Split cord malformation and tethered cord syndrome: case series with long-term follow-up and literature review. Childs Nerv Syst 2021; 37:1301-1306. [PMID: 33242106 DOI: 10.1007/s00381-020-04978-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 11/17/2020] [Indexed: 01/17/2023]
Abstract
PURPOSE To date, the description of the natural course of concurrent tethered cord syndrome with a low-lying conus medullaris and split cord malformation is lacking in the literature. We report a cohort of adult and pediatric patients with concurrent malformations and long-term follow-up. METHODS Patients with concurrent diagnoses of split cord malformation and tethered cord (radiographic evidence supporting clinical symptomatology) were identified between 2000 and 2020. Patients without sufficient documentation or at least 6-month follow-up were excluded. RESULTS Nine patients were identified with an average of 8.9 years follow-up (range 2-31 years). The most common symptoms were radiating leg pain and lower extremity paresthesias, occurring in 44% of patients; and bladder/bowel dysfunction, worsening scoliosis, and acute motor deterioration were less common. Two patients were successfully treated conservatively for mild leg pain and paresthesias. For those who underwent surgery, all experienced symptomatic relief upon first follow-up. Two had late symptomatic recurrence; one 4 and 8 years after initial surgery; and the other, 11, 26, and 31 years after initial surgery. CONCLUSION The rarity of concurrent split cord and tethered cord syndrome with a low-lying conus makes management difficult to formulate. This series supplements our knowledge of the long-term outcomes and lessons learned from the management of these patients. Approximately 25% of patients were managed conservatively and had symptomatic improvement. For surgically managed patients, with intractable pain or worsening neurological function, symptoms can still recur over a decade after intervention. Reoperation, however, can still be beneficial, can provide years of relief, and should be considered.
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Affiliation(s)
- Andrew J Kobets
- Department of Neurosurgery, Division of Pediatric Neurosurgery, Johns Hopkins School of Medicine, 600 N Wolfe Street, Phipps Building, 5th Floor, Baltimore, MD, USA.
| | - Jeffrey Oliver
- Department of Neurosurgery, Division of Pediatric Neurosurgery, Johns Hopkins School of Medicine, 600 N Wolfe Street, Phipps Building, 5th Floor, Baltimore, MD, USA
| | - Alan Cohen
- Department of Neurosurgery, Division of Pediatric Neurosurgery, Johns Hopkins School of Medicine, 600 N Wolfe Street, Phipps Building, 5th Floor, Baltimore, MD, USA
| | - George I Jallo
- Department of Neurosurgery, Division of Pediatric Neurosurgery, Johns Hopkins School of Medicine, 600 N Wolfe Street, Phipps Building, 5th Floor, Baltimore, MD, USA.,Department of Neurosurgery, Division of Pediatric Neurosurgery, All Children's Hospital, St. Petersburg, FL, USA
| | - Mari L Groves
- Department of Neurosurgery, Division of Pediatric Neurosurgery, Johns Hopkins School of Medicine, 600 N Wolfe Street, Phipps Building, 5th Floor, Baltimore, MD, USA
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Incidentally discovered type 1 split cord malformation in an adult patient. Radiol Case Rep 2020; 15:1756-1758. [PMID: 32774575 PMCID: PMC7399242 DOI: 10.1016/j.radcr.2020.07.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 07/07/2020] [Accepted: 07/07/2020] [Indexed: 11/20/2022] Open
Abstract
Split spinal cord syndrome (SCM), an entity of spinal dysraphisms, occurs rarely in adults and is associated with tethered cord syndrome, which commonly presents with back pain. Besides clinical findings, neuroimaging by Magnetic resonance imaging or computed tomography is needed for diagnosis. We report a case of a previously healthy 51-year-old man who presented for right upper abdominal quadrant pain. A computed tomography scan of the abdomen and pelvis incidentally discovered the diagnosis of type 1 SCM. This case highlights that SCM can remain asymptomatic throughout life to be diagnosed at one point by neuroimaging. Whenever no clinical complications exist, no surgical intervention might be indicated.
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7
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Srinivasan ES, Mehta VA, Smith GC, Than KD, Terry AR. Klippel-Feil Syndrome with Cervical Diastematomyelia in an Adult with Extensive Cervicothoracic Fusions: Case Report and Review of the Literature. World Neurosurg 2020; 139:274-280. [PMID: 32339744 DOI: 10.1016/j.wneu.2020.04.148] [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] [Received: 02/11/2020] [Revised: 04/17/2020] [Accepted: 04/18/2020] [Indexed: 11/27/2022]
Abstract
Split cord malformation (SCM) is a developmental disorder that is usually symptomatic and diagnosed in childhood. The majority of these lesions are in the thoracic and lumbar spine, with only 1%-3% of cases found in the cervical spine. This is a case report of a 55-year-old female patient with an unremarkable medical history who presented with neck pain. Upon workup, she was found to have extensive developmental anomalies throughout her cervical and thoracic spine, including an incidentally found type 2 SCM and multiple autofused vertebrae. There are only 6 similar studies published in the literature. There was extensive facet degeneration in her cervical spine, which was suspected to be the etiology of her neck pain. This case illustrates the rare finding of asymptomatic adult cervical SCM and the likely significance of her autofused vertebrae causing accelerated symptomatic facet spondylosis.
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Affiliation(s)
| | - Vikram A Mehta
- Duke University School of Medicine, Durham, North Carolina, U.S.A; Division of Spine, Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, U.S.A..
| | - Gabriel C Smith
- Duke University School of Medicine, Durham, North Carolina, U.S.A; Division of Spine, Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, U.S.A
| | - Khoi D Than
- Duke University School of Medicine, Durham, North Carolina, U.S.A; Division of Spine, Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, U.S.A
| | - Anna R Terry
- Duke University School of Medicine, Durham, North Carolina, U.S.A; Division of Spine, Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, U.S.A
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8
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Abstract
Spinal dysraphism is an umbrella term that encompasses a number of congenital malformations that affect the central nervous system. The etiology of these conditions can be traced back to a specific defect in embryological development, with the more disabling malformations occurring at an earlier gestational age. A thorough understanding of the relevant neuroembryology is imperative for clinicians to select the correct treatment and prevent complications associated with spinal dysraphism. This paper will review the neuroembryology associated with the various forms of spinal dysraphism and provide a clinical-pathological correlation for these congenital malformations.
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9
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Górriz-Martín L, Neßler J, Voelker I, Reinartz S, Tipold A, Distl O, Beineke A, Rehage J, Heppelmann M. Split spinal cord malformations in 4 Holstein Friesian calves. BMC Vet Res 2019; 15:307. [PMID: 31455313 PMCID: PMC6712784 DOI: 10.1186/s12917-019-2055-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Accepted: 08/19/2019] [Indexed: 05/30/2023] Open
Abstract
Background The split spinal cord malformation (SSCM) is an uncommon congenital malformation of the vertebral canal in which parts of the spinal cord are longitudinally duplicated. In SSCM Type I, each spinal cord has its own dura tube. In the SSCM Type II, both parts of the spinal cord are surrounded by a common dura tube. Cases presentation During the clinical examination one calf showed ambulatory paresis and 3 calves non-ambulatory paraparesis. Calf 4 additionally had a congenital tremor. The examination of calf 4 using magnetic resonance imaging (MRI) showed a median hydrosyringomyelia at the level of the 4th lumbar vertebra. The caudal part of this liquid-filled cavity was split longitudinally through a thin septum. From there, the spinal cord structures duplicated with an incomplete division, so that the transverse section of the spinal cord appeared peanut-shaped and in each half a central canal could be observed. The pathological-anatomical examination after euthanasia showed a duplication of the spinal cord in the area of the lumbar vertebral column in all calves. The histopathological examination revealed two central lumbar vertebral column channels. The two spinal cord duplicates were each surrounded by two separate meninges in calf 2 (SSCM type I); in the other calves (1, 3, 4, and) the two central canals and the spinal cord were covered by a common meninx (SSCM type II). A pedigree analysis of calves 2, 3 and 4 showed a degree of relationship suggestive of a hereditary component. This supports the hypothesis of a possible recessive inheritance due to common ancestors, leading to partial genetic homozygosity. Conclusions The clinical appearance of SSCM can vary widely. In calves with congenital paralysis SSCM should always be considered as a differential diagnosis. A reliable diagnosis intra vitam is possible only with laborious imaging procedures such as MRI. Further studies on the heritability of this malformation are necessary to confirm a genetic cause of this disease.
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Affiliation(s)
- Lara Górriz-Martín
- Clinic for Cattle, University of Veterinary Medicine Hannover, Hanover, Germany.
| | - Jasmin Neßler
- Department Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Hanover, Germany
| | - Iris Voelker
- Institute for Pathology, University of Veterinary Medicine Hannover, Hanover, Germany
| | - Sina Reinartz
- Institute for Animal Breeding and Genetics, University of Veterinary Medicine Hannover, Hanover, Germany
| | - Andrea Tipold
- Department Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Hanover, Germany
| | - Ottmar Distl
- Institute for Animal Breeding and Genetics, University of Veterinary Medicine Hannover, Hanover, Germany
| | - Andreas Beineke
- Institute for Pathology, University of Veterinary Medicine Hannover, Hanover, Germany
| | - Juergen Rehage
- Clinic for Cattle, University of Veterinary Medicine Hannover, Hanover, Germany
| | - Maike Heppelmann
- Clinic for Cattle, University of Veterinary Medicine Hannover, Hanover, Germany
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Meena RK, Doddamani RS, Sharma R. Contiguous Diastematomyelia with Lipomyelomeningocele in Each Hemicord—an Exceptional Case of Spinal Dysraphism. World Neurosurg 2019; 123:103-107. [DOI: 10.1016/j.wneu.2018.11.225] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 11/26/2018] [Accepted: 11/27/2018] [Indexed: 11/17/2022]
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Mikhaylovskiy MV, Dubousset J, Novikov VV, Vasyura AS, Udalova IG, Sadovoi MA. STUDY DESIGN: CASE SERIES OF 19 PATIENTS OPERATED FOR SEVERE SCOLIOSIS AND DIASTEMATOMYELIA. COLUNA/COLUMNA 2019. [DOI: 10.1590/s1808-185120191801201849] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: Diastematomyelia is a rare congenital spine and spinal cord malformation in which the spinal cord is divided into two parts by the osseous or fibrous septum. The incidence of diastematomyelia in patients with the most severe forms of congenital scoliosis is much higher than its general incidence in the population. When performing surgeries to correct scoliotic deformities, the question arises regarding the choice of a strategy for managing the septum. An unambiguous answer to this question does not exist, since the disease is very rare and heterogeneous. The aim was to summarize the data on different surgical strategies for detecting diastematomyelia. Methods: Literature review and retrospective analysis of our own clinical data. Results: We present our own experience of treating 19 patients with diastematomyelia and severe congenital scoliosis. Posture disorder was corrected in all cases; the septum was removed in none of the cases. Significant correction was achieved for all patients, and no neurological complications were observed in the short- and long-term follow-up. Conclusions: Surgical nonremoval of the spur enables compensation to be achieved, without neurological complications either in the immediate postoperative period or in the long-term (more than 2 years) follow-up. Level of Evidence IV; Case seriesh.
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Affiliation(s)
| | - Jean Dubousset
- Tsiv'yan Novosibirsk Research Institute of Traumatology and Orthopedics, Russia
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Cagnotti G, Sammartano F, Bertone I, Capucchio MT, Nicola I, Sacchi P, Bellino C, D'Angelo A. Imaging and genetic investigations of neural tube defect in a calf: case report and review of the literature. J Vet Diagn Invest 2019; 31:228-234. [PMID: 30852979 DOI: 10.1177/1040638718823037] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
A 15-d-old female crossbreed calf was referred because of paraplegia since birth. Clinical examination revealed a skin defect covered by hair on the dorsal midline in the thoracic area of the spine. Thoracolumbar spinal cord neuroanatomic localization was determined based on neurologic examination. Computed tomography of the thoracolumbar spine revealed incomplete fusion of the vertebral arches from T6 to T10 and duplication of the vertebral arch of T7. At the level of T6-T7, duplication of the spinal cord with 2 segments completely separated by a septum of hyperattenuating, probably cartilaginous, tissue was noted. Histologically, the spinal segments had different degrees of duplication. Three central canals were detected in one region. Genetic investigation for the presence of methylenetetrahydrofolate reductase (MTHFR) polymorphism, which has been investigated in both human and veterinary medicine as a possible cause of neural tube defects and abortion, was carried out and was negative in both the calf and her dam.
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Affiliation(s)
- Giulia Cagnotti
- Department of Veterinary Science, University of Turin, Grugliasco, Torino, Italy
| | - Federica Sammartano
- Department of Veterinary Science, University of Turin, Grugliasco, Torino, Italy
| | - Iride Bertone
- Department of Veterinary Science, University of Turin, Grugliasco, Torino, Italy
| | | | - Isabella Nicola
- Department of Veterinary Science, University of Turin, Grugliasco, Torino, Italy
| | - Paola Sacchi
- Department of Veterinary Science, University of Turin, Grugliasco, Torino, Italy
| | - Claudio Bellino
- Department of Veterinary Science, University of Turin, Grugliasco, Torino, Italy
| | - Antonio D'Angelo
- Department of Veterinary Science, University of Turin, Grugliasco, Torino, Italy
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Beuriat PA, Di Rocco F, Szathmari A, Mottolese C. Management of split cord malformation in children: the Lyon experience. Childs Nerv Syst 2018; 34:883-891. [PMID: 29582170 DOI: 10.1007/s00381-018-3772-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Accepted: 03/01/2018] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Split cord malformation (SCM) is a rare congenital spinal abnormality. Clinical presentation varies. Other congenital defects can be associated. Management is surgical. MATERIAL AND METHODS We retrospectively reviewed all our SCM cases and reported our experience for its management. From 1990 to 2014, 37 patients were operated. Five situations lead to the diagnosis (orthopedic disorders (n = 8), orthopedic and neurological disorders (n = 16), pure neurological disorders (n = 5), no symptoms except cutaneous signs (n = 7), antenatal diagnosis (n = 1)). Scoliosis was the most common associated condition. The level of the spur was always under T7 except in one case. There were more type I (n = 22) than type II (n = 15) SCM. RESULTS Patients with preoperative neurological symptoms (n = 21) were improved in 71.4%. Five out of nine patients that had preoperative bladder dysfunction were improved. Eleven patients needed surgical correction of the scoliosis. CONCLUSIONS For us, the surgical procedure is mandatory even in case of asymptomatic discovery in order to avoid late clinical deterioration. In any case, the filum terminale need to be cut in order to untether completely the spinal cord. In case a surgical correction of a spinal deformity is needed, we recommend a two-stage surgery, for both SCM type. The SCM surgery can stop the evolution of the scoliosis and it may just need an orthopedic treatment with a brace.
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Affiliation(s)
- Pierre-Aurélien Beuriat
- Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, Hospice Civil de Lyon, 59 Boulevard Pinel, 69677, Lyon Cedex, France
| | - Federico Di Rocco
- Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, Hospice Civil de Lyon, 59 Boulevard Pinel, 69677, Lyon Cedex, France
| | - Alexandru Szathmari
- Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, Hospice Civil de Lyon, 59 Boulevard Pinel, 69677, Lyon Cedex, France
| | - Carmine Mottolese
- Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, Hospice Civil de Lyon, 59 Boulevard Pinel, 69677, Lyon Cedex, France.
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Saker E, Loukas M, Fisahn C, Oskouian RJ, Tubbs RS. Historical Perspective of Split Cord Malformations: A Tale of Two Cords. Pediatr Neurosurg 2017; 52:1-5. [PMID: 27806370 DOI: 10.1159/000450584] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 09/02/2016] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Our appreciation and understanding of what is now known as the split cord malformation (SCM) have a long history. The oldest known example of SCM is from roughly AD 100. Other isolated examples can be found in the large body of work of the pathologists of the 1800s, where the SCMs were found incidentally during autopsies. CONCLUSIONS SCM has a rich history and has intrigued physicians for over 200 years. Many well-known figures from the past such as Chiari and von Recklinghausen, both pathologists, made early postmortem descriptions of SCM. With the advent of MRI, these pathological embryological derailments can now often be detected and appreciated early and during life. Our understanding and ability to treat these congenital malformations as well as the terminology used to describe them have changed over the last several decades.
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Affiliation(s)
- Erfanul Saker
- Department of Anatomical Sciences, St. George's University, True Blue, Grenada
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15
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Shankar P, Zamora C, Castillo M. Congenital malformations of the brain and spine. HANDBOOK OF CLINICAL NEUROLOGY 2016; 136:1121-1137. [PMID: 27430461 DOI: 10.1016/b978-0-444-53486-6.00058-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
In this chapter we briefly address the most common congenital brain and spinal anomalies as well as their most salient imaging, especially magnetic resonance, findings. Some of them, such as Chiari II, and open spinal defects, have become relatively rare due to their detection in utero and repair of the spinal malformation. Regardless of the type of brain anomaly, the most common clinical symptoms are mental retardation, hydrocephalus, and seizure; the latter two may need to be surgically and medically addressed. The most commonly found spinal congenital anomalies include the filum terminale lipoma which is generally asymptomatic and incidental and the caudal regression syndrome for which no primary treatment exists. Any spinal congenital anomaly may present in adulthood as a consequence of spinal cord tethering and/or development of syringomyelia.
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Affiliation(s)
- Prashant Shankar
- Division of Neuroradiology, Department of Radiology, University of North Carolina, Chapel Hill, NC, USA
| | - Carlos Zamora
- Division of Neuroradiology, Department of Radiology, University of North Carolina, Chapel Hill, NC, USA
| | - Mauricio Castillo
- Division of Neuroradiology, Department of Radiology, University of North Carolina, Chapel Hill, NC, USA.
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Barutçuoğlu M, Selçuki M, Umur AS, Mete M, Gurgen SG, Selcuki D. Scoliosis may be the first symptom of the tethered spinal cord. Indian J Orthop 2016; 50:80-6. [PMID: 26955181 PMCID: PMC4759880 DOI: 10.4103/0019-5413.173506] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Tethered cord syndrome (TCS) is a progressive clinical entity that arises from abnormal spinal cord tension. Scoliosis may be a unique symptom in TCS. The aim of this study is to investigate prognosis after releasing the filum terminale in scoliosis due to TCS with/without findings in magnetic resonance imaging (MRI) and to draw attention to the importance of somatosensorial evoked potentials (SSEP) on the differential diagnosis of idiopathic scoliosis versus scoliosis due to TCS with normal appearance of filum terminale and conus medullaris. MATERIALS AND METHODS Eleven female and seven male patients with progressive scoliosis were included in the study. They were evaluated radiologically, SSEP and urodynamical studies. Preoperative and postoperative anteroposterior full spine X-rays were obtained for measuring the Cobb's angle. MRI was performed in all cases for probable additional spinal abnormalities. All patients underwent filum terminale sectioning through a L5 hemilaminectomy. The resected filum terminale were subjected to histopathological examination. RESULTS The mean Cobb angle was 31.6° (range 18°-45°). Eight patients (44.45%) had a normal appearance of filum terminale and normal level conus medullaris in MRI, but conduction delay and/or block was seen on SSEP. In the histopathological examination of filum terminale dense collagen fibers, hyaline degeneration and loss of elastic fibers were observed. Postoperatively none of the patients showed worsening of the Cobb angle. Three patients showed improvement of scoliosis. CONCLUSION In TCS presented with scoliosis, untethering must be performed prior to the corrective spinal surgery. Absence of MRI findings does not definitely exclude TCS. SSEP is an important additional guidance in the diagnosis of TCS. After untethering, a followup period of 6 months is essential to show it untethering helps in stopping the progress of the scoliotic curve. In spite of non progression (curve stopped lesser than 45°) or even improvement of scoliosis, there may be no need for major orthopedic surgical intervention.
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Affiliation(s)
- Mustafa Barutçuoğlu
- Department of Neurosurgery, Celal Bayar University School of Medicine, Turkey,Address for correspondence: Dr. Mustafa Barutçuoğlu, Department of Neurosurgery, School of Medicine, Celal Bayar University, Turkey. E-mail:
| | - Mehmet Selçuki
- Department of Neurosurgery, Celal Bayar University School of Medicine, Turkey
| | - Ahmet Sukru Umur
- Department of Neurosurgery, Celal Bayar University School of Medicine, Turkey
| | - Mesut Mete
- Department of Neurosurgery, Celal Bayar University School of Medicine, Turkey
| | - Seren Gulsen Gurgen
- Department of Histology and Embryology, Celal Bayar University Vocational School of Health Services, Turkey
| | - Deniz Selcuki
- Department of Neurology, Celal Bayar University School of Medicine, Turkey
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Babu R, Reynolds R, Moreno JR, Cummings TJ, Bagley CA. Concurrent split cord malformation and teratoma: dysembryology, presentation, and treatment. J Clin Neurosci 2013; 21:212-6. [PMID: 24161341 DOI: 10.1016/j.jocn.2013.04.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Revised: 04/08/2013] [Accepted: 04/13/2013] [Indexed: 10/26/2022]
Abstract
Split cord malformation (SCM) is a rare form of spinal dysraphism in which the spinal cord is divided in the sagittal plane, forming a double neural tube. In addition to being associated with a variety of malformations, SCM may occur with spinal cord tumors, with only exceptional cases involving teratomas. As only eight patients with a teratoma associated with SCM have been reported, their presentation characteristics and treatment are currently unclear. We review the literature of all patients with SCM with concurrent spinal teratoma, discuss the potential dysembryology, and report the first case of SCM with concurrent spinal teratoma in an elderly patient. The mean age of those with concurrent SCM and teratomas was 39.4 years, with 55.6% occurring in females. The lumbar spine was the most frequent location for teratomas (66.7%), with the Type II malformation more commonly occurring with these tumors (75%). The duration of symptoms varied widely, ranging from 1 month to 5 years, with the average duration being nearly 2 years. Back pain (87.5%) and lower extremity weakness (75%) were the most common presenting symptoms. As SCM may be associated with progressive neurological deterioration and teratomas can contain immature or malignant components, surgery should be attempted with the goal of gross total resection. Nonetheless, in patients with a concurrent tumor and spinal dysraphism, spinal teratomas should be considered in the differential diagnosis. Gross total resection of these lesions may be safely achieved even in the presence of SCM using intraoperative electrophysiologic monitoring.
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Affiliation(s)
- Ranjith Babu
- Division of Neurosurgery, Department of Surgery, Duke University Medical Center 3807, Durham, NC 27710, USA
| | - Renee Reynolds
- Division of Neurosurgery, Department of Surgery, Duke University Medical Center 3807, Durham, NC 27710, USA
| | - Jessica R Moreno
- Division of Neurosurgery, Department of Surgery, Duke University Medical Center 3807, Durham, NC 27710, USA
| | - Thomas J Cummings
- Department of Pathology, Duke University Medical Center, Durham, NC, USA
| | - Carlos A Bagley
- Division of Neurosurgery, Department of Surgery, Duke University Medical Center 3807, Durham, NC 27710, USA.
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Erşahin Y. Split cord malformation types I and II: a personal series of 131 patients. Childs Nerv Syst 2013; 29:1515-26. [PMID: 24013321 DOI: 10.1007/s00381-013-2115-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Accepted: 04/15/2013] [Indexed: 11/30/2022]
Abstract
PURPOSE A personal series of 131 patients with split cord malformation (SCM) operated on is presented. METHODS Age, gender, symptoms and signs, radiological and operative findings, complications, associated anomalies, outcome, and pathological specimens were analyzed. RESULTS There were 88 girls (73 %) and 43 boys (27 %). The female predominance was slightly more remarkable in type I SCMs than in type II SCMs. The presenting symptoms can be summarized as skin lesions, spina bifida aperta, scoliosis or kyphoscoliosis, sphincter disturbance, foot deformities and weakness, and/or atrophy in the lower extremities. The ages of patients with neurological deficits and orthopedic deformities were significantly older than those without deficits (P = 0.030). The duration of symptoms was longer in the patients with neurological deficits and orthopedic deformities than that in those without deficits (P = 0.00095). In six patients, composite SCMs were present. Only one patient with a type II SCM did not have an associated spinal cord lesion. A type I SCM was more frequently encountered in patients with spina bifida (P < 0.0005). Transient postoperative complications were seen in 29 patients (22 %). There was no permanent complication. Retethered cord syndrome developed in five patients with a type I SCM. CONCLUSIONS The risk of neurological and orthopedic deficits increases with the age of the patient. The risk of permanent deficit after surgery is very low. The whole spine must be examined for additional lesions. All patients should be surgically treated when diagnosed, especially before the development of orthopedic and neurological manifestations, and all associated lesions should also be treated at the same session.
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Affiliation(s)
- Yusuf Erşahin
- Department of Neurosurgery, Faculty of Medicine, Ege University, 1394 Sokak, No. 14 Baysak 2 Is Merkezi, D. 5, Alsancak, Izmir 35220, Turkey.
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Affiliation(s)
- Sameer S Futane
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Hui H, Luo ZJ, Yan M, Ye ZX, Tao HR, Wang HQ. Non-fusion and growing instrumentation in the correction of congenital spinal deformity associated with split spinal cord malformation: an early follow-up outcome. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2013; 22:1317-25. [PMID: 23558579 DOI: 10.1007/s00586-013-2757-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2012] [Revised: 01/11/2013] [Accepted: 03/15/2013] [Indexed: 11/30/2022]
Abstract
STUDY DESIGN A retrospective case review. INTRODUCTION To evaluate the safety and efficacy of the non-fusion technique in achieving and maintaining the proper correction for congenital spinal deformity (CSD) and allowing normal spinal growth in patients with split spinal cord malformation (SSCM). MATERIALS AND METHODS Seven patients who had CSD and SSCM were adopted, with a mean age of 8 years. All the patients in this study received Halo-gravity traction (HGT) prior to expansion of the spine and instrumentation with vertical expandable titanium prosthetic rib, growing rod or their hybrid. Five of them underwent opening wedge thoracoplasty simultaneously. And the two patients with type I SSCM underwent bony spur excision in the initial surgery before corrective manipulation. Then all the patients received a lengthened operation every six months. Changes of their major curve and length of T1-S1 spine were measured, and complications, neurological status were recorded. All the patients were followed up with an average of 32.6 months. RESULTS Their mean major curve improved from 90.1° to 58.6° with a correction rate of 34.9 %. The T1-S1 length increased from 26.3 to 34.7 cm at final follow-up. Especially, one of the type I SSCM patients whose neurological deterioration was found preoperatively was significantly improved. CONCLUSION Preoperative Halo-gravity traction followed by non-fusion and growing instrumentation may be effective and safe for young children of CSD associated with SSCM. But it is an ongoing study and additional large multicenter studies are necessary to further assess the safety and efficacy of non-fusion and growing instrumentation.
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Affiliation(s)
- Hua Hui
- Department of Orthopaedic Surgery, Xijing Hospital, The Fourth Military Medical University, No. 127 Changle road, Xi'an, Shaanxi, 710032, People's Republic of China
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Safety and efficacy of 1-stage surgical treatment of congenital spinal deformity associated with split spinal cord malformation. Spine (Phila Pa 1976) 2012; 37:2104-13. [PMID: 22648030 DOI: 10.1097/brs.0b013e3182608988] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective clinical study. OBJECTIVE The aim of this study was to evaluate retrospectively the safety and efficacy of 1-stage surgical treatment of 45 consecutive patients, who had progressive congenital spinal deformity associated with split spinal cord malformation (SSCM). SUMMARY OF BACKGROUND DATA For correction of progressive congenital spinal deformity with SSCM, it has been reported that all SSCM should be operated on before any orthopedic intervention, and then surgery for correction and stabilization of the spinal deformity should be performed 3 to 6 months later. Recently, different viewpoints have been approved, and the common treatment of these 2 associated conditions needs to be re-evaluated. METHODS Patients had 1-stage surgery. After exposure of the determined levels and placement of instruments, bony spur was resected in the patients of type 1; in patients of type 2, we did nothing to the SSCM. In the corrective stage of surgery, posterior fusion surgery was performed in 38 patients; nonfusion surgery was performed in 7 patients. RESULTS Thirty-six female patients and 9 male patients formed the basis of the study. The mean age was 14 years, and the mean follow-up period was 31 months. Type 1 SSCM was in 15 patients, and type 2 SSCM was in 30 patients. Seven patients had progressive neurological deteriorations preoperatively. The mean major curves were corrected from an average of 73.7° to 33.5°, with a correction rate of 54.5%. The overall complication was transient, including 2 patients of neurological compromise and 1 patient of cerebrospinal fluid leakage. The average loss of correction at final follow-up was 2.5° for major curves. CONCLUSION The 1-stage surgical treatment of congenital spinal deformity associated with SSCM provides a satisfactory option to improve the spinal deformity without significant complications effectively. Neurosurgical interventions are recommended to patients with type 1 SSCM before spinal deformity surgery; however, patients with type 2 SSCM can be treated safely without a need of neurosurgical intervention.
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Abstract
Diastematomyelia is a rare congenital abnormality of the spinal cord. This paper summarises more than 30 years' experience of treating this condition. Data were collected retrospectively on 138 patients with diastematomyelia (34 males, 104 females) who were treated at our hospital from May 1978 to April 2010. A total of 106 patients had double dural tubes (type 1 diastematomyelia), and 32 patients had single dural tubes (type 2 diastematomyelia). Radiographs, CT myelography, and MRI showed characteristic kyphoscoliosis, widening of the interpedicle distance, and bony, cartilaginous, and fibrous septum. The incidences of symptoms including characteristic changes of the dorsal skin, neurological disorders, and congenital spinal or foot deformity were significantly higher in type 1 than in type 2. Surgery is more effective for patients with type 1 diastematomyelia; patients without surgery showed no improvement.
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Affiliation(s)
- B Cheng
- Second Affiliated Hospital, Xi'an Jiaotong University Medical College, Department of Orthopedic Surgery, No. 157 Xiwulu, Xi'an 710004, Shaanxi, China
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Rufener S, Ibrahim M, Parmar HA. Imaging of congenital spine and spinal cord malformations. Neuroimaging Clin N Am 2012; 21:659-76, viii. [PMID: 21807317 DOI: 10.1016/j.nic.2011.05.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
This article reviews normal embryologic development of the spine and spinal cord and the imaging features of congenital abnormalities of the spine and spinal cord, with particular focus on magnetic resonance imaging. The authors discuss spinal dysraphisms, a heterogeneous group of congenital abnormalities of the spine and spinal cord, and provide information to expand understanding of these complex entities.
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Affiliation(s)
- Stephanie Rufener
- Department of Radiology, University of Michigan Health System, Ann Arbor, MI 48109, USA
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Abstract
Split cord malformation and fatty filum are completely different clinical entities and thought to arise via different pathophysiologies. Recognition of these distinct lesions in the same patient is important for appropriate diagnosis and management. A 3 year-old boy presented with skin lesions and mild leg weakness suggestive of spinal malformation. Magnetic resonance imaging revealed type II split cord malformation at T12-L1, syringomyelia at T8-T10 levels associated with tethered cord and fatty filum terminale. The patient underwent a T12-L1 laminotomy for the removal of fibrous band between the 2 hemicords and L4-L5 laminotomy for transection of the fatty filum. Histopathological examination of the filum confirmed the presence of bone, fat, and ciliated epithelial cells associated with meningothelial proliferation in the same specimen. We report an unusual case of type II split cord malformation coexisting with a fatty filum which have different histological patterns. To the best of our knowledge, this histological appearance of a fatty filum has not yet been reported and this raises the question of a possible associative or causative relationship between these distinct pathologies.
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Salunke P, Kovai P, Malik V, Sharma M. Mixed split cord malformation: are we missing something? Clin Neurol Neurosurg 2011; 113:774-8. [PMID: 21885185 DOI: 10.1016/j.clineuro.2011.07.023] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2010] [Revised: 02/22/2011] [Accepted: 07/27/2011] [Indexed: 11/29/2022]
Abstract
BACKGROUND The new classification for split cord malformation, based on the unified theory of embryogenesis includes two types Type I and II defined on the basis of the nature of the medium septum and the state of the dural tube. According to this, these are the only two essential features needed for typing and there is never an overlap between the two main forms. We have described two cases that defy this theory. CASE REPORT We present two patients with split cord malformation who appear to have a combination of features specific to Type I and Type II. Both patients had a partial bony spur within a single dural sac. CONCLUSION An overlap between the two forms of split cord malformation does exist. The role of meninx primitiva in the formation of median bony septum is debatable.
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Affiliation(s)
- Pravin Salunke
- Neurosurgery, PGIMER, Chandigarh 160012, India. drpravin
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Macht S, Chapot R, Bieniek F, Hänggi D, Turowski B. Unique sacral location of an arteriovenous fistula of the filum terminale associated with diastematomyelia and lowered spinal cords. Neuroradiology 2011; 54:517-9. [PMID: 21701867 DOI: 10.1007/s00234-011-0899-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2011] [Accepted: 06/14/2011] [Indexed: 11/27/2022]
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Alberio N, Pentimalli L, Alessandrello R, Lipani R, Maiello M, Morabito A, Spitaleri A, Zambuto MR, Soma P, Francaviglia N. An exceptional case of complete lumbosacral spine duplication and open myelomeningocele in adulthood. J Neurosurg Spine 2010; 13:659-61. [PMID: 21039160 DOI: 10.3171/2010.5.spine08962] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The authors describe the case of a 47-year-old woman with a wide (14 × 12-cm) ulcerated lumbosacral myelomeningocele. The patient had sought medical attention for a sudden copious CSF leak from the lumbosacral sac followed by clinical signs of CSF leakage. After admission, neuroradiological assessment (spinal MR and 3D CT imaging) revealed the uncommon finding of a complex malformation characterized by a complete spine duplication originating at the L2-3 level, both hemicords having a separate dural sac. The myelomeningocele sac originated medially at the L-2 level. Surgical repair of the lumbosacral myelomeningocele was performed. The placement of a ventriculoperitoneal shunt became necessary to treat secondary hydrocephalus. After reviewing accredited classifications on spinal cord malformations, the authors believe that, to date, complete duplication and separation of the spine and dural sac seems exceptional, and its report in adulthood appears exceedingly rare.
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Affiliation(s)
- Nicola Alberio
- Department of Neurosurgery, S. Elia General Hospital, Caltanissetta, Catania, Italy
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Higashida T, Sasano M, Sato H, Sekido K, Ito S. Myelomeningocele associated with split cord malformation type I -three case reports-. Neurol Med Chir (Tokyo) 2010; 50:426-30. [PMID: 20505305 DOI: 10.2176/nmc.50.426] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Three neonates presented with split cord malformation (SCM) associated with myelomeningocele (MMC), complicated with various coexisting anomalies. All patients were female and classified as SCM type I. All patients had a syrinx located rostral to the SCM. One patient had hydrocephalus and Chiari malformation causing serious respiratory problems. Two patients had partial hypertrichosis located close to the MMC, suggesting association with SCM. One patient had sacral hypoplasty and right kidney agenesis, suggesting that some embryologic errors may affect not only neural but also mesodermal development. All patients underwent surgical treatment for SCM after detailed evaluation and management of concomitant anomalies, and developed no new neurological deficits. Delayed surgery is an alternative treatment strategy for SCM in patients with both SCM and MMC with similar complications.
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Affiliation(s)
- Tetsuhiro Higashida
- Department of Neurosurgery, Kanagawa Children's Medical Center, Yokohama, Kanagawa.
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Abstract
The educational objectives of this self-assessment module are for the participants to exercise, self-assess, and improve their understanding of the most important features of congenital spine and spinal cord malformations.
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Hsu AR, Hou LC, Veeravagu A, Barnes PD, Huhn SL. Resolution of syringomyelia after release of tethered cord. ACTA ACUST UNITED AC 2009; 72:657-61. [DOI: 10.1016/j.surneu.2009.05.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2009] [Accepted: 05/13/2009] [Indexed: 10/20/2022]
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Is it necessary to operate all split cord malformations before corrective surgery for patients with congenital spinal deformities? Spine (Phila Pa 1976) 2009; 34:2413-8. [PMID: 19829255 DOI: 10.1097/brs.0b013e3181b9c61b] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective case series. OBJECTIVES To evaluate the necessity of neurosurgical interventions for split cord malformations (SCMs) before correction and instrumentation for patients with congenital spinal deformity(CSD)s. SUMMARY OF BACKGROUND DATA SCMs are commonly associated with CSD. As pathology of SCMs understood well, the common belief of all SCM must be operated before any orthopedic intervention is needed to be revised. MATERIALS AND METHODS Sixty-one consecutive patients with CSD and spinal dysraphism treated by correction and posterior instrumentation between 1994 and 2005 were retrospectively evaluated. Inclusion criteria were patients with CSD and SCM, who were treated with long segment instrumentation (more than 6 functional units) with at least 2 years of follow-up. Thirty-two patients (8 male and 24 female) with an age average of 11 years +8 months (4-18 years) fulfilled the criteria. While all patients with Type I SCM were managed with neurosurgical intervention (spur excision and dural reconstruction) before corrective surgery, Type II SCM cases were treated by instrumented fusion without neurologic intervention. RESULTS There were 18 patients with Type I and 14 patients with Type II SCM. The average follow-up was 52 (24-144) months. The correction rate of deformity was 44% in type I and 47% in Type II SCM. Two patients with Type II SCM had transient neurologic deterioration while there were no neurologic events in patients with Type II SCM. CONCLUSION Due to high incidence of SCMs, all patients with CSDs must be evaluated with MRI, before surgery. Neurosurgical interventions are recommended even for neurologically asymptomatic Type I SCM before spinal deformity surgery; however, patients with Type II SCM can be treated safely without a need of neurosurgical intervention.
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Ansari S, Nejat F, Yazdani S, Dadmehr M. Split cord malformation associated with myelomeningocele. J Neurosurg 2007; 107:281-5. [PMID: 17941491 DOI: 10.3171/ped-07/10/281] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The coexistence of split cord malformations (SCMs) and myelomeningoceles (MMCs) can be misdiagnosed or ignored and can cause spinal cord tethering. The authors investigated cases involving the coexistence of SCMs and MMCs in patients from the Children's Hospital Medical Center in Tehran. METHODS Of the 330 patients with MMCs who underwent operations at the Children's Hospital Medical Center between January 2001 and June 2005, 33 (10%) had an associated SCM. These 33 cases were retrospectively reviewed. RESULTS Eighteen patients (55%) were female, and the mean age of the patients at presentation was 2.9 months. In 17 of the 33 patients, the SCM occurred at the level of the neural placode. A Type I SCM was found in 26 children. Two patients had hypertrichosis. Eight patients had unilateral leg paresis. The MMC sac was located in the lumbar region in 14 cases. Two patients had double spinal dysraphism with meningoceles at the thoracic level. All patients underwent simultaneous repair of both lesions at the time of surgery. CONCLUSIONS Patients with MMCs, especially those with unusual manifestations such as unilateral paresis or skin lesions, should undergo a preoperative clinical examination to check for the presence of an SCM. Use of spinal magnetic resonance imaging can help in identifying the associated abnormalities. The neural placode and the rostral and caudal spinal cord segments should be carefully inspected for dysraphic lesions such as SCMs during the operation to repair the MMC. In this paper, the authors hope to show the wisdom of identifying these anomalies at the time of the initial repair of the MMC.
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Affiliation(s)
- Saeed Ansari
- Department of Neurosurgery, Children's Hospital Medical Center, Medical Sciences/University of Tehran, Iran
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Ansari S, Nejat F, Yazdani S, Dadmehr M. Split cord malformation associated with myelomeningocele. J Neurosurg 2007. [DOI: 10.3171/ped.2007.107.4.281] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Porensky P, Muro K, Ganju A. Adult presentation of spinal dysraphism and tandem diastematomyelia. Spine J 2007; 7:622-6. [PMID: 17905326 DOI: 10.1016/j.spinee.2006.08.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2006] [Revised: 06/25/2006] [Accepted: 08/09/2006] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Diastematomyelia is a split-cord malformation often accompanied by other cord or column anomalies. PURPOSE To report on an adult patient with diastematomyelia and discuss the embryological basis and related developmental sequelae of this split-cord malformation. STUDY DESIGN Case report. METHODS A summary of the management of a 54-year-old woman with recent clinical symptomatology related to an undiagnosed split-cord malformation is presented with accompanying literature review. RESULTS A rare adult presentation of diastematomyelia with accompanying intradural extramedullary epidermoid tumor was repaired with resection of the soft-tissue mass and excision of the fibro-osseous septum. CONCLUSION Initial presentation of diastematomyelia is rarely seen in adults; accompanying pathology includes scoliosis, tethered cord, and intradural tumors. Effective treatment involves identification of the primary pathology.
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Affiliation(s)
- Paul Porensky
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, 244 E. Pearson St. #1705, Chicago, Illinois 60611, USA.
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Abstract
Spinal dysraphism, an incomplete closure of the neural tube, can be open, exposing the neural elements to the environment, or can be closed, covered with skin. Abnormal development of the spine occurs early in life and also interferes with usual development of the skin. This often creates cutaneous markers or stigmata over the area. Cutaneous markers may include a subcutaneous mass, abnormal hair growth, skin dimple, tag or sinus, or unusual pigmentation. Recognizing these markers is important because, although many closed spinal dysraphisms are asymptomatic at birth, neurological sequelae can occur. The sequelae are insidious and often permanent. This article, Part 3 in a series of articles devoted to spinal assessment, reviews closed spinal dysraphisms. The article emphasizes identification of various cutaneous markers associated with closed spinal dysraphisms. Early detection and follow-up may prevent neurologic sequelae for the infant later in life.
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Affiliation(s)
- M Colleen Brand
- Neonotal Nurse Practitioner Service, Texas Children's Hospital, 6621 Fannin, MC:AB480.04, Houston, TX 77030, USA.
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Mut M, Shaffrey ME, Bourne TD, Jagannathan J, Shaffrey CI. Unusual presentation of an adult intramedullary spinal teratoma with diplomyelia. ACTA ACUST UNITED AC 2007; 67:190-4. [PMID: 17254890 DOI: 10.1016/j.surneu.2006.04.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2005] [Accepted: 04/09/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND Spinal teratomas are rare lesions. The authors present an intramedullary spinal teratoma associated with diplomyelia. CASE DESCRIPTION This 34-year-old female patient presented with right lower extremity weakness, left lower extremity sensory deficit, and urinary retention. Magnetic resonance imaging showed a focally expansile, intramedullary lesion at L1-2 levels with exophytic component, which was located at the apex of diplomyelia separating the cord into equal hemicords and low-lying spinal cord ending at L3 level. Intraoperative electrophysiologic monitoring was used. Tumor was composed of both intramedullary solid/cystic parts and exophytic fatty infiltrated tissue. There was diplomyelia located caudal to intramedullary lesion and harboring an exophytic lobule at the junction of the nondiplomyelic and the diplomyelic cord. A complete removal was not accomplished because of presence of functional neural tissue within the exophytic component of the lesion. Histopathological examination revealed a mature teratoma. This is the fourth intramedullary teratoma associated with SCM to be reported in the literature. CONCLUSIONS Teratomas should be taken into consideration in differential diagnosis of intramedullary lesions associated with SCM. Neuroimaging is helpful, but definitive diagnosis is done by histopathological examination. Radical resection should be the aim; however, excision should be tailored according to intraoperative electrophysiologic monitoring. A truly intramedullary teratoma and an exophytic midline fatty infiltrated tissue bisecting spinal cord is another unique feature of the present case that supports the dysembryogenic origin of spinal teratomas.
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Affiliation(s)
- Melike Mut
- Department of Neurosurgery, University of Virginia, Charlottesville, VA 22903, USA.
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Hamasaki T, Makino K, Morioka M, Hasegawa S, Kurino M, Kuratsu JI. Histological study of paramedian dorsal root ganglia in an infant with split cord malformation. Case report. J Neurosurg 2006; 104:415-8. [PMID: 16776377 DOI: 10.3171/ped.2006.104.6.415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The authors present a histological study of resected tissue obtained from an 18-month-old girl with split cord malformation Type II whose right foot was smaller than her left. Magnetic resonance imaging revealed duplication of the spinal cord below the level of L-1. On laminectomy it was discovered that the cord was tethered in the lumbosacral region. The resected tissue contained the cluster of paramedian dorsal root ganglia unique to this congenital anomaly. On histological examination, the ganglion cells expressed not only neuronal markers but also a marker for muscle cells indicative of pathological development of the midline structure. Further histological study is necessary to gain a deeper insight into this congenital disease and to obtain additional information for use in surgical planning.
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Affiliation(s)
- Tadashi Hamasaki
- Department of Neurosurgery, Kumamoto University Medical School, Japan.
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Valentini LG, Visintini S, Mendola C, Casali C, Bono R, Scaioli W, Solero CL. The role of intraoperative electromyographic monitoring in lumbosacral lipomas. Neurosurgery 2006; 56:315-23; discussion 315-23. [PMID: 15794828 DOI: 10.1227/01.neu.0000156783.03809.8a] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2004] [Accepted: 12/02/2004] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To demonstrate the role of intraoperative multichannel electromyographic (EMG) monitoring to reduce postoperative deterioration and achieve full untethering of complex occult dysraphisms. METHODS A retrospective analysis was performed on 66 patients who underwent operation for lumbosacral lipomas. Twenty recent cases were submitted to EMG monitoring and stimulation. RESULTS All patients presented symptoms at the time of surgery, and 74% exhibited progressive deterioration during the lengthy preoperative period. Postoperative surgery-related deterioration was observed in 6% of patients. This number was reduced to zero with the introduction of intraoperative EMG monitoring. CONCLUSION Intraoperative multichannel EMG monitoring can be carried out and requires only minimal changes to anesthetic procedures. With this method, it is possible to better identify the neural structures of complex malformations, reducing the risks of surgical damage and incomplete detethering.
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Emmez H, Tokgöz N, Dogulu F, Yilmaz MB, Kale A, Baykaner MK. Seven distinct coexistent cranial and spinal anomalies. Pediatr Neurosurg 2006; 42:316-9. [PMID: 16902346 DOI: 10.1159/000094070] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2005] [Accepted: 11/09/2005] [Indexed: 11/19/2022]
Abstract
UNLABELLED Existence of multiple cranial and spinal anomalies in spina bifida is well known; however, coexistence of seven different severe anomalies is extremely rare. The location of the anomalies, the patient's age and presentation are other interesting aspects of the presented case. CASE REPORT A 1-year-old girl with an enlarged head and big, infected lumbosacral myelomeningocele (MMC) was admitted to the emergency department in a comatose state. Further investigations revealed hydrocephalus, Chiari malformation, syringohydromyelia, split cord malformation, dermal sinus tract, lumbosacral MMC, and tethered cord. Unfortunately, the patient died 3 days after admission because of meningitis and sepsis. DISCUSSION Coexistence of seven different craniospinal anomalies is extremely unusual. Further investigations with magnetic resonance imaging for associated anomalies, early shunt placement and MMC repair are required to prevent this life-threatening condition in spina bifida.
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Affiliation(s)
- Hakan Emmez
- Department of Neurosurgery, Gazi University School of Medicine, Ankara, Turkey.
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van Aalst J, Beuls EAM, Vles JSH, Cornips EMJ, van Straaten HWM. The intermediate type split cord malformation: hypothesis and case report. Childs Nerv Syst 2005; 21:1020-4. [PMID: 15864598 DOI: 10.1007/s00381-005-1159-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2004] [Indexed: 11/26/2022]
Abstract
METHODS A patient is described in which a complete osteofibrotic dorsally implanted septum was found in combination with a split cord malformation in a single dural tube. This case cannot be explained using the widely used theory as proposed by Pang et al. [Pang D, Dias MS, Ahab-Barmada M (1992) Split cord malformation, part I: A unified theory of embryogenesis for double spinal cord malformations. Neurosurgery 31:451-480] but must be regarded as a combination of type I and II split cord malformation. RESULTS The authors state that all types of split cord malformation can be reduced to a single derailment during development, with various degrees of severity. CONCLUSIONS The configuration of the malformation is determined by the way the median parts of the mesoderm come to development. Type I and II split cord malformation are not distinct entities.
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Affiliation(s)
- J van Aalst
- Department of Neurosurgery, University Hospital Maastricht, P. Debyelaan 25, P. O. Box 5800, 6202 AZ, Maastricht, The Netherlands.
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Vitarbo EA, Sultan A, Wang D, Morcos JJ, Levi AD. Split cord malformation with associated Type IV spinal cord perimedullary arteriovenous fistula. J Neurosurg Spine 2005; 3:400-4. [PMID: 16302637 DOI: 10.3171/spi.2005.3.5.0400] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
✓ The authors describe the case of a 62-year-old woman with a Type II split cord malformation (SCM). At the initial time of workup, the authors observed an associated Klippel—Feil deformity at the level of the SCM and a low-lying conus medullaris; however, they discovered an associated Type IV perimedullary spinal cord arteriovenous fistula (AVF) only after the patient continued to deteriorate following a spinal cord untethering procedure. Although prominent blood vessels have been reported within the median cleft of SCMs, an angiographically and surgically proven perimedullary AVF has not previously been described. The potential coexistence of SCM and perimedullary AVF has significant clinical implications and its recognition is critically important prior to surgical treatment.
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Affiliation(s)
- Elizabeth A Vitarbo
- Department of Neurological Surgery, School of Medicine, University of Miami, Miami, Florida 33136, USA
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Takagi H, Matsunami K, Imai A. Satisfactory pregnancy outcome in a patient with myelomeningocele. J OBSTET GYNAECOL 2005; 24:824-5. [PMID: 15763803 DOI: 10.1080/01443610400009634] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- H Takagi
- Department of Obstetrics and Gynaecology, Matsunami General Hospital, Gifu University School of Medicine, Tsukasamachi, Gifu 500-8705, Japan
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Korinth MC, Kapser A, Nolte K, Gilsbach JM. Cervical diastematomyelia associated with an intradural epidermoid cyst between the hemicords and multiple vertebral body anomalies. Pediatr Neurosurg 2004; 40:253-6. [PMID: 15687742 DOI: 10.1159/000082303] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Marcus C Korinth
- Department of Neurosurgery, University Hospital RWTH Aachen, Pauwelsstrasse 30, DE-52057 Aachen, Germany.
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Emmez H, Güven C, Kurt G, Kardes O, Dogulu F, Baykaner K. Terminal Syringomyelia: Is It As Innocent As It Seems?-Case Report-. Neurol Med Chir (Tokyo) 2004; 44:558-61. [PMID: 15633471 DOI: 10.2176/nmc.44.558] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A 5-day-old newborn girl presented with cutaneous signs of hypertrichosis, skin dimple, and subcutaneous lipoma in the lumbar region. Magnetic resonance (MR) imaging of the thoracolumbar spine demonstrated spinal dermal sinus, type II split cord malformation, and tethered cord. A small terminal syringeal cavity was also present. Five months after the diagnosis, weakness in dorsal flexion of the bilateral feet and toes was detected. Surgery to untether the cord was performed. Her deficits resolved completely. Nearly 4 years later, she was admitted with weakness in dorsal flexion of the right foot and toe. MR imaging of the spine showed holocord syringomyelia, postoperative changes, and tethered cord. No Chiari malformation was seen. Syringosubarachnoid shunt placement was performed. Terminal syringomyelia is common in cases of occult spinal dysraphism, but the natural history and management remain unclear. Progression, regression, or persistence of terminal syringeal cavity can occur whether untethering is performed or not. Progression of the terminal syrinx occurred after tethered cord release and the enlargement of the cavity involved the entire spinal cord in the present case. Terminal syringomyelia requires close follow up for a long time even in asymptomatic cases. Surgical treatment should be considered in symptomatic cases.
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Affiliation(s)
- Hakan Emmez
- Department of Neurosurgery, Gazi University School of Medicine, Besevler, Ankara, Turkey.
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