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Taheri F, Joushi S, Esmaeilpour K, Ebrahimi MN, Taherizadeh Z, Taheri P, Sheibani V. Transmission of behavioral and cognitive impairments across generations in rats subjected to prenatal valproic acid exposure. Birth Defects Res 2024; 116:e2309. [PMID: 38343145 DOI: 10.1002/bdr2.2309] [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] [Received: 10/26/2023] [Revised: 01/10/2024] [Accepted: 01/18/2024] [Indexed: 02/15/2024]
Abstract
BACKGROUND Autism spectrum disorder (ASD) represents an inheritable neurodevelopmental condition characterized by social communication deficits and repetitive behaviors. Numerous studies have underscored the significant roles played by genetic and environmental factors in the etiology of ASD, and these factors are known to perpetuate behavioral impairments across generations. OBJECTIVES The primary objective of this study was to assess the behavioral and cognitive attributes in the second filial (F2) generation of male and female rats, with a particular focus on those whose parents had been exposed to valproic acid (VPA) during embryonic development. METHODS In this study, a cohort of 32 male and 32 female rats from the second filial (F2) generation, referred to as Mother.ASD, Father.ASD, or Both.ASD, was examined. These designations indicate whether the mother, father, or both parents had experienced embryonic exposure to valproic acid (600 mg/kg, i.p.). During adolescence, the F2 pups underwent behavioral and cognitive assessments, including open field testing, marble burying, social interaction evaluations, and Morris water maze tasks. RESULTS Our data revealed that while both the Mother.ASD and Father.ASD groups, regardless of sex, exhibited elevated anxiety-like behavior in the open field test. Only the Mother.ASD group displayed repetitive behaviors and deficits in social memory. Additionally, spatial memory impairments were observed in both sexes. These findings highlight the transmission of autistic-like behaviors in the offspring of Mother.ASD rats from both sexes. Nevertheless, future research endeavors should be more targeted in identifying the specific genes responsible for this transmission. CONCLUSION In summary, our findings underscore the transmission of autistic-like behaviors, including anxiety-like behavior, repetitive actions, impairments in social interactions, and deficits in memory, to the offspring of the Mother.ASD group, irrespective of their sex.
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Affiliation(s)
- Farahnaz Taheri
- Neuroscience Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
| | - Sara Joushi
- Neuroscience Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
| | - Khadijeh Esmaeilpour
- Neuroscience Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
- Public health school, University of Waterloo, Waterloo, Ontario, Canada
| | - Mohammad Navid Ebrahimi
- Neuroscience Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
| | - Zahra Taherizadeh
- Neuroscience Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
| | - Parichehr Taheri
- Neuroscience Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
| | - Vahid Sheibani
- Neuroscience Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
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Reynolds RA, Vance EH, Shlobin NA, Bowman R, Rosseau G. Transitioning care for adolescents with spina bifida in the US: challenges for management. Childs Nerv Syst 2023; 39:3123-3130. [PMID: 37099139 DOI: 10.1007/s00381-023-05955-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 04/05/2023] [Indexed: 04/27/2023]
Abstract
Open spina bifida (OSB) is a common neural tube defect. Medical and surgical care involves addressing the baseline orthopedic, urologic, and neurological dysfunction as well as the changes or declines that may occur as the patient ages. Given the complexity of this disease, coordinated, multidisciplinary care involving specialists in neurosurgery, orthopedics, urology, rehabilitation and physical medicine, pediatrics, and psychology is necessary to establish and optimize baseline function. Traditionally in the US, pediatric multispecialty spina bifida clinics have provided the patient with a coordinated medical support system. Unfortunately, this coordinated, medical home has been difficult to establish during the transition from pediatric to adult care. Medical professionals must have a strong understanding of OSB to properly manage the disease and detect and prevent associated complications. In this manuscript, we (1) describe the changing needs and challenges of people living with OSB over a lifespan, (2) delineate current practices in the transition of care for people with OSB from childhood to adulthood, and (3) provide recommendations for best practices in navigating the transition process for clinicians who provide care for those afflicted with this most complex congenital abnormality of the nervous system compatible with long term survival.
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Affiliation(s)
- Rebecca A Reynolds
- Department of Neurological Surgery, Johns Hopkins All Children's Hospital, 601 5th Street South, Suite 511, Saint Petersburg, FL, 33705, USA.
| | - E Haley Vance
- Department of Neurological Surgery, Johns Hopkins All Children's Hospital, 601 5th Street South, Suite 511, Saint Petersburg, FL, 33705, USA
| | - Nathan A Shlobin
- Division of Pediatric Neurosurgery, Department of Neurological Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Robin Bowman
- Division of Pediatric Neurosurgery, Department of Neurological Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Gail Rosseau
- Department of Neurological Surgery, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
- Barrow Neurological Institute, Phoenix, AZ, USA
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Janik K, Smith GM, Krynska B. Identification of Neurocan and Phosphacan as Early Biomarkers for Open Neural Tube Defects. Cells 2023; 12:1084. [PMID: 37048157 PMCID: PMC10093370 DOI: 10.3390/cells12071084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/29/2023] [Accepted: 04/01/2023] [Indexed: 04/14/2023] Open
Abstract
Open neural tube defects (NTDs) such as myelomeningocele (MMC) are debilitating and the most common congenital defects of the central nervous system. Despite their apparent clinical importance, the existing early prenatal diagnostic options for these defects remain limited. Using a well-accepted retinoic-acid-induced model of MMC established in fetal rats, we discovered that neurocan and phosphacan, the secreted chondroitin sulfate proteoglycans of the developing nervous system, are released into the amniotic fluid (AF) of fetal rats displaying spinal cord defects. In contrast to normal controls, elevated AF levels of neurocan and phosphacan were detected in MMC fetuses early in gestation and continued to increase during MMC progression, reaching the highest level in near-term fetuses. The molecular forms of neurocan and phosphacan identified in the AF of MMC fetuses and those found in MMC spinal cords were qualitatively similar. In summary, this is the first report demonstrating the presence of neurocan and phosphacan in the AF of MMC fetuses. The identification of elevated levels of neurocan and phosphacan in the AF of MMC fetuses provides two prospective biomarkers with the potential for early prenatal diagnosis of open NTDs.
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Affiliation(s)
- Karolina Janik
- Shriners Hospitals Pediatric Research Center, Lewis Katz School of Medicine, Temple University, 3500 North Broad Street, Philadelphia, PA 19140, USA
- Department of Neural Sciences, Lewis Katz School of Medicine, Temple University, 3500 North Broad Street, Philadelphia, PA 19140, USA
| | - George M. Smith
- Shriners Hospitals Pediatric Research Center, Lewis Katz School of Medicine, Temple University, 3500 North Broad Street, Philadelphia, PA 19140, USA
- Department of Neural Sciences, Lewis Katz School of Medicine, Temple University, 3500 North Broad Street, Philadelphia, PA 19140, USA
| | - Barbara Krynska
- Shriners Hospitals Pediatric Research Center, Lewis Katz School of Medicine, Temple University, 3500 North Broad Street, Philadelphia, PA 19140, USA
- Department of Neural Sciences, Lewis Katz School of Medicine, Temple University, 3500 North Broad Street, Philadelphia, PA 19140, USA
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[Diagnosis and surgical treatment of tethered cord syndrome accompanied by congenital dermal sinus tract in adults]. BEIJING DA XUE XUE BAO. YI XUE BAN = JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2022. [PMID: 36533349 PMCID: PMC9761806 DOI: 10.19723/j.issn.1671-167x.2022.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To summarize the clinical manifestations, imaging characteristics and experience of surgical treatment of tethered cord syndrome (TCS) accompanied by dermal sinus tract (DST) in adulthoods. METHODS The authors retrospectively analyzed a series of 25 adult patients with TCS due to DST that were surgically treated under microscope from September 2010 to October 2019. There were 10 males and 15 females with an average age of 29.7 years (rang, 18-48 years). Characterized cutaneous malformation and dermal sinus were found in the lumbosacral region in all the 25 patients. Clinically, all the patients presented with chronic back and lower-extremity pain, numbness and weakness of lower limbs, and bowel and bladder dysfunction. Two cases were admitted to the emergency room with acute infectious cerebral spinal fluid (CSF) leakage complicated with meningitis. According to magnetic resonance imaging (MRI) images, the subdural course of DST whose traction of the spinal cord, the location of the conus medullaris, the presence of subdural lesions, and the diameter of the internal filum terminale were evaluated. The surgical procedure included separating and excising of the DST, section of the internal filum terminale, detethering of the TCS, and reconstruction of the dural sac under microscopy. The patients remained in prone position in 7 days postoperation. RESULTS MRI showed that the position of the conus medullaris was lower than the level of lumbar 2 vertebrae, and the distal part of the DST entered the subdural stretched part of the spinal cord, to constitute one of the factors of TCS in all the 25 patients. Twenty patients had fatty infiltration of internal filum terminale and another patient had thickened (approximately 5 mm in diameter) internal filum terminale resulting in tightening the conus medullaris. A total of 25 operations were performed including completely dissection and resection of the DST through the skin down to the subdural space, section of the internal filum terminale, detethering of the TCS, and the subdural dermoid cysts were removed in two patients. There were no postoperative complications. The postoperative pathology was consistent with the structure of the DST and internal filum terminale. The local pain was relieved, and the lower-extremity weakness and bowel and bladder dysfunction were gradually relieved postoperatively. The period of follow-up ranged from 3 months to 9 years (mean, 3.9 years). The neurological function of all the patients was intact, and MRI showed that the physiological curvature of the thoracolumbar spine remained normal. There was no recurrence of TCS observed during the follow-up. CONCLUSION The adult TCS accompanied with DST is characterized by typical cutaneous malformation in the lumbosacral region and tethering of the spinal cord. The patients are usually combined with internal filum terminale enlargement tightening of conus medullaris as well. The surgical treatment including totally resection of the DST and section of the internal filum terminale to detethering the TCS at the same time under microscopy. The outcome of surgical treatment is satisfactory.
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Sivasangari K, Rajan KE. Prenatal exposure to valproic acid alters Reelin, NGF expressing neuron architecture and impairs social interaction in their autistic-like phenotype male offspring. Exp Brain Res 2022; 240:2005-2016. [PMID: 35648200 DOI: 10.1007/s00221-022-06386-8] [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] [Received: 02/01/2022] [Accepted: 05/08/2022] [Indexed: 11/26/2022]
Abstract
Maternal exposure to anti-epileptic drug Valproic acid (VPA) during pregnancy increases the risk for the development of autism spectrum disorders (ASD). In this study, we have examined whether prenatal exposure to VPA will alter expression of key genes, synaptic morphology of nerve growth factor (NGF) and Reelin expressing neurons in the cortex of male offspring. To characterize in animal models, rat fetuses were exposed to VPA on 12.5 gestational day. The offspring of the VPA-exposed individuals (42%) resembles ASD-related phenotype (facial malformation, crooked-like tail, flattened paw, toenails and in-turning-ankles). Furthermore, we have observed deficit in social interaction accompanied by deregulation in expression of genes such as Caspase-3, focal adhesion kinase (FAK), Reelin, glial fibrillary acidic protein (GFAP), proliferating cell nuclear antigen (PCNA) and NGF. Subsequently, immunohistochemistry analysis revealed that exposure to VPA alters the cytoarchitecture (area, diameter) and reduced the dendritic arborization of Reelin, NGF expressing neurons in cortex. The compromised neurodevelopment by altered expression of Caspase-3, FAK, Reelin, GFAP, PCNA and NGF may cause defects in neuronal architecture, synaptic formation, synaptic plasticity and neuronal communication which could be linked with observed ASD-like phenotype and deficit social interaction.
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Affiliation(s)
- Karunanithi Sivasangari
- Behavioural Neuroscience Laboratory, Department of Animal Science, School of Life Sciences, Bharathidasan University, Tiruchirappalli, 620024, Tamil Nadu, India
| | - Koilmani Emmanuvel Rajan
- Behavioural Neuroscience Laboratory, Department of Animal Science, School of Life Sciences, Bharathidasan University, Tiruchirappalli, 620024, Tamil Nadu, India.
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Shalita C, Sankey EW, Bergin SM, McManigle J, Buckley AF, Radtke R, Torres C, Dear GL, Thompson EM. Successful Neonatal, Intraoperative Neuromonitoring in the Surgical Correction of a Thoracic Dermal Sinus Tract: Technical Note. Pediatr Neurosurg 2022; 57:295-300. [PMID: 35512661 DOI: 10.1159/000524924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 04/29/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Intraoperative neuromonitoring (IONM) is commonly used during surgery of the spine and spinal cord for early surveillance of iatrogenic injury to the central and peripheral nervous system. However, for infants and young children under 3 years of age, the use of IONM is challenging due to incomplete central and peripheral myelination. CASE PRESENTATION We report a case of a T4-T6 dermal sinus tract (DST) that was resected on day of life 23, with the successful use of IONM. CONCLUSION To our knowledge, this is the youngest reported case of the use of IONM in the surgical correction of a DST in a neonatal patient. This case demonstrates the potential efficacy of IONM in neonatal spine surgery and the techniques used to adapt the technology to an immature nervous system.
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Affiliation(s)
- Chidyaonga Shalita
- Duke University School of Medicine, Duke University, Durham, North Carolina, USA
| | - Eric W Sankey
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Stephen M Bergin
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - John McManigle
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Anne F Buckley
- Department of Pathology, Duke University Medical Center, Durham, North Carolina, USA
| | - Rodney Radtke
- Department of Neurology, Duke University Medical Center, Durham, North Carolina, USA
| | - Claudia Torres
- Neurodiagnostic Services, Duke University Medical Center, Durham, North Carolina, USA
| | - Guy L Dear
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Eric M Thompson
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
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Cohrs G, Blumenröther AK, Sürie JP, Synowitz M, Held-Feindt J, Knerlich-Lukoschus F. Fetal and perinatal expression profiles of proinflammatory cytokines in the neuroplacodes of rats with myelomeningoceles: A contribution to the understanding of secondary spinal cord injury in open spinal dysraphism. J Neurotrauma 2021; 38:3376-3392. [PMID: 34541905 DOI: 10.1089/neu.2021.0091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The cellular and molecular mechanisms that presumably underlie the progressive functional decline of the myelomeningocele (MMC) placode are not well understood. We previously identified key players in posttraumatic spinal cord injury cascades in human MMC tissues obtained during postnatal repair. In this study we conducted experiments to further investigate these mediators in the prenatal time course under standardized conditions in a retinoic-acid-induced MMC rat model. A retinoic acid MMC model was established using time-dated Sprague-Dawley rats, which were gavage-fed with all-trans retinoic acid (RA; 60 mg/kg) dissolved in olive oil at E10. Control animals received olive oil only. Fetuses from both groups were obtained at E16, E18, E22. The spinal cords (SCs) of both groups were formalin-fixed or snap-frozen. Tissues were screened by real-time RT-PCR for the expression of cytokines and chemokines known to play a role in the lesion cascades of the central nervous system after trauma. MMC placodes exhibited inflammatory cells and glial activation in the later gestational stages. At the mRNA level, IL-1b, TNFa, and TNF-R1 exhibited significant induction at E22. IL1-R1 mRNA was induced significantly at E16 and E22. Double labeling experiments confirmed the costaining of these cytokines and their receptors with Iba1 (i.e., inflammatory cells), Vimentin, and Nestin in different anatomical SC areas and NeuN in ventral horn neurons. CXCL12 mRNA was elevated in control and MMC animals at E16 compared to E18 and E22. CX3CL1 mRNA was lower in MMC tissues than in control tissues on E16. The presented findings contribute to the concept that pathophysiological mechanisms, such as cytokine induction in the neuroplacode, in addition to the "first hit", promote secondary spinal cord injury with functional loss in the late fetal time course. Furthermore, these mediators should be taken into consideration in the development of new therapeutic approaches for open spinal dysraphism.
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Affiliation(s)
- Gesa Cohrs
- Universitatsklinikum Schleswig-Holstein Campus Kiel, 15056, Dept. of Neurosurgery, Arnold-Heller-Straße 3, Kiel, Germany, 24105;
| | - Ann-Kathrin Blumenröther
- Universitätsklinikum Schleswig-Holstein, 54186, Neurosurgery, Kiel, Schleswig-Holstein, Germany;
| | - Jan-Philip Sürie
- Universitätsklinikum Schleswig-Holstein, 54186, Neurosurgery, Kiel, Schleswig-Holstein, Germany;
| | - Michael Synowitz
- Universitatsklinikum Schleswig-Holstein Campus Kiel, 15056, Neurosurgery, Kiel, Schleswig-Holstein, Germany;
| | - Janka Held-Feindt
- Universitatsklinikum Schleswig-Holstein Campus Kiel, 15056, Neurosurgery, Kiel, Schleswig-Holstein, Germany;
| | - Friederike Knerlich-Lukoschus
- Universitätsklinikum Schleswig-Holstein, 54186, Neurosurgery, Kiel, Schleswig-Holstein, Germany.,Asklepios Kinderklinik Sankt Augustin, 248587, Pediatric Neurosurgery, Sankt Augustin, Nordrhein-Westfalen, Germany;
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Kingsley-Godwin MJ, Tenev A, Uchikova E, Velkova K, Belovezhdov V, Stoeva M. Evaluation of the Significance of MRI in the Prenatal Diagnosis of Neural Tube Defects. J Med Biol Eng 2021. [DOI: 10.1007/s40846-021-00657-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Sarkar S, Rajshekhar V. Clinical Presentation and Surgical Outcomes Based on Age and Tumor Topography in 59 Patients With Spinal Dermoid Cysts. World Neurosurg 2021; 151:e438-e446. [PMID: 33892167 DOI: 10.1016/j.wneu.2021.04.048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 04/12/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Differences in presentation and outcomes in children and adults with spinal dermoid tumors have not been documented. Surgical outcomes for dermoid tumors in different spinal cord planes have also not been studied. METHODS Retrospective review of 59 consecutive patients who underwent surgery for intraspinal dermoid tumors at a single institution. Tumors were categorized as purely extramedullary (n = 15), purely intramedullary (n = 28) or intramedullary-extramedullary (n = 16) based on intraoperative and imaging findings. RESULTS The cohort was composed of 45 children and 14 adults. The presence of a dermal sinus and prior history of meningitis was significantly associated with childhood presentation (P = 0.001 and P = 0.013, respectively). Most adults had purely intramedullary tumors (n = 12, 85.7%) as compared to children (35.6%, P = 0.001). Gross total resection (GTR) was achieved in 33.3% and 41.7% of children and adults, respectively (P = 1.000). Factors associated with GTR on logistic regression analysis included short segment (≤3 levels) dermoid cysts (P = 0.037) and absence of an intramedullary component (P = 0.027). Forty-seven patients were followed up over a mean period of 72.9 ± 8.3 months. Preoperative motor deficits were more likely to improve in children than in adults (P = 0.005). Recurrences were seen in 14.9% of cases (all with intramedullary tumors) at a median interval of 58 months (range: 40-166 months) after surgery, with no differences in recurrence-free survival between children and adults (P = 0.936). CONCLUSIONS Presentation of dermoid cysts is distinctively different in children and adults. GTR is a challenge for intramedullary and large tumors. Recurrences may manifest several years after surgery, mandating life-long surveillance.
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Affiliation(s)
- Sauradeep Sarkar
- Department of Neurological Sciences, Christian Medical College, Vellore, India
| | - Vedantam Rajshekhar
- Department of Neurological Sciences, Christian Medical College, Vellore, India.
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Kritikos TK, Stiles-Shields C, Shapiro JB, Holmbeck GN. Benefit-finding among young adults with spina bifida. J Health Psychol 2021; 27:1176-1186. [PMID: 33541148 PMCID: PMC10403805 DOI: 10.1177/1359105321990804] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
The purpose of the current study was to examine benefit-finding in a sample of young adults with SB and assess relationships between demographic and medical variables and benefit-finding. Young adults with SB (N = 329), ranging in age from 18 to 30 (M = 23.44 ± 2.93), completed the Benefit-Finding Scale (BFS), a 17-item self-report questionnaire, and reported on demographic and medical information related to their SB diagnosis. Participants endorsed a range of benefits associated with living with SB. The most frequently endorsed benefits were related to personal strengths, interpersonal relationships, and life philosophy. Younger age, majority race, higher education level, and employment were significantly associated with higher BFS scores. Young adults with SB report benefits associated with their chronic condition. Future research should examine these benefits in relation to psychosocial outcomes.
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Affiliation(s)
| | | | - Jenna B Shapiro
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
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Trapp B, de Andrade Lourenção Freddi T, de Oliveira Morais Hans M, Fonseca Teixeira Lemos Calixto I, Fujino E, Alves Rojas LC, Burlin S, Cerqueira Costa DM, Carrete Junior H, Abdala N, Tobaru Tibana LA, Takehara ET, Dalul Gomez G. A Practical Approach to Diagnosis of Spinal Dysraphism. Radiographics 2021; 41:559-575. [PMID: 33449837 DOI: 10.1148/rg.2021200103] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Spinal dysraphisms (SDs) are congenital malformations of the spinal cord, determined by derangement in the complex cascade of embryologic events involved in spinal development. They represent a heterogeneous group ranging from mild clinical manifestations-going unnoticed or being discovered at clinical examination-to a causal factor of life quality impairment, especially when associated with musculoskeletal, gastrointestinal, genitourinary, or respiratory system malformations. Knowledge of the normal embryologic development of the spinal cord-which encompasses three main steps (gastrulation, primary neurulation, and secondary neurulation)-is crucial for understanding the pathogenesis, neuroradiologic scenarios, and clinical-radiologic classification of congenital malformations of the spinal cord. SDs can be divided with clinical examination or neuroradiologic study into two major groups: open SDs and closed SDs. Congenital malformations of the spinal cord include a wide range of abnormalities that vary considerably in imaging and clinical characteristics and complexity and therefore may represent a diagnostic challenge, even for the experienced radiologist. Online supplemental material is available for this article. ©RSNA, 2021.
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Affiliation(s)
- Bárbara Trapp
- From the Department of Diagnostic Imaging, Division of Neuroradiology, Universidade Federal de São Paulo (UNIFESP), Rua Napoleão de Barros 800, São Paulo SP 04024-002, Brazil (B.T., M.d.O.M.H., I.F.T.L.C., E.F., L.C.A.R., S.B., D.M.C.C., H.C.J., N.A., L.A.T.T., E.T.T., G.D.G.); Department of Diagnostic Imaging, Division of Neuroradiology, Hospital do Coração (HCor), São Paulo, Brazil (T.d.A.L.F.); and Department of Diagnostic Imaging, Division of Neuroradiology, Fundação Instituto de Pesquisa e Estudo de Diagnóstico por Imagem (FIDI), São Paulo, Brazil (B.T., M.d.O.M.H., I.F.T.L.C., L.C.A.R., S.B., L.A.T.T.)
| | - Tomás de Andrade Lourenção Freddi
- From the Department of Diagnostic Imaging, Division of Neuroradiology, Universidade Federal de São Paulo (UNIFESP), Rua Napoleão de Barros 800, São Paulo SP 04024-002, Brazil (B.T., M.d.O.M.H., I.F.T.L.C., E.F., L.C.A.R., S.B., D.M.C.C., H.C.J., N.A., L.A.T.T., E.T.T., G.D.G.); Department of Diagnostic Imaging, Division of Neuroradiology, Hospital do Coração (HCor), São Paulo, Brazil (T.d.A.L.F.); and Department of Diagnostic Imaging, Division of Neuroradiology, Fundação Instituto de Pesquisa e Estudo de Diagnóstico por Imagem (FIDI), São Paulo, Brazil (B.T., M.d.O.M.H., I.F.T.L.C., L.C.A.R., S.B., L.A.T.T.)
| | - Monique de Oliveira Morais Hans
- From the Department of Diagnostic Imaging, Division of Neuroradiology, Universidade Federal de São Paulo (UNIFESP), Rua Napoleão de Barros 800, São Paulo SP 04024-002, Brazil (B.T., M.d.O.M.H., I.F.T.L.C., E.F., L.C.A.R., S.B., D.M.C.C., H.C.J., N.A., L.A.T.T., E.T.T., G.D.G.); Department of Diagnostic Imaging, Division of Neuroradiology, Hospital do Coração (HCor), São Paulo, Brazil (T.d.A.L.F.); and Department of Diagnostic Imaging, Division of Neuroradiology, Fundação Instituto de Pesquisa e Estudo de Diagnóstico por Imagem (FIDI), São Paulo, Brazil (B.T., M.d.O.M.H., I.F.T.L.C., L.C.A.R., S.B., L.A.T.T.)
| | - Isadora Fonseca Teixeira Lemos Calixto
- From the Department of Diagnostic Imaging, Division of Neuroradiology, Universidade Federal de São Paulo (UNIFESP), Rua Napoleão de Barros 800, São Paulo SP 04024-002, Brazil (B.T., M.d.O.M.H., I.F.T.L.C., E.F., L.C.A.R., S.B., D.M.C.C., H.C.J., N.A., L.A.T.T., E.T.T., G.D.G.); Department of Diagnostic Imaging, Division of Neuroradiology, Hospital do Coração (HCor), São Paulo, Brazil (T.d.A.L.F.); and Department of Diagnostic Imaging, Division of Neuroradiology, Fundação Instituto de Pesquisa e Estudo de Diagnóstico por Imagem (FIDI), São Paulo, Brazil (B.T., M.d.O.M.H., I.F.T.L.C., L.C.A.R., S.B., L.A.T.T.)
| | - Emi Fujino
- From the Department of Diagnostic Imaging, Division of Neuroradiology, Universidade Federal de São Paulo (UNIFESP), Rua Napoleão de Barros 800, São Paulo SP 04024-002, Brazil (B.T., M.d.O.M.H., I.F.T.L.C., E.F., L.C.A.R., S.B., D.M.C.C., H.C.J., N.A., L.A.T.T., E.T.T., G.D.G.); Department of Diagnostic Imaging, Division of Neuroradiology, Hospital do Coração (HCor), São Paulo, Brazil (T.d.A.L.F.); and Department of Diagnostic Imaging, Division of Neuroradiology, Fundação Instituto de Pesquisa e Estudo de Diagnóstico por Imagem (FIDI), São Paulo, Brazil (B.T., M.d.O.M.H., I.F.T.L.C., L.C.A.R., S.B., L.A.T.T.)
| | - Laila Cristina Alves Rojas
- From the Department of Diagnostic Imaging, Division of Neuroradiology, Universidade Federal de São Paulo (UNIFESP), Rua Napoleão de Barros 800, São Paulo SP 04024-002, Brazil (B.T., M.d.O.M.H., I.F.T.L.C., E.F., L.C.A.R., S.B., D.M.C.C., H.C.J., N.A., L.A.T.T., E.T.T., G.D.G.); Department of Diagnostic Imaging, Division of Neuroradiology, Hospital do Coração (HCor), São Paulo, Brazil (T.d.A.L.F.); and Department of Diagnostic Imaging, Division of Neuroradiology, Fundação Instituto de Pesquisa e Estudo de Diagnóstico por Imagem (FIDI), São Paulo, Brazil (B.T., M.d.O.M.H., I.F.T.L.C., L.C.A.R., S.B., L.A.T.T.)
| | - Stênio Burlin
- From the Department of Diagnostic Imaging, Division of Neuroradiology, Universidade Federal de São Paulo (UNIFESP), Rua Napoleão de Barros 800, São Paulo SP 04024-002, Brazil (B.T., M.d.O.M.H., I.F.T.L.C., E.F., L.C.A.R., S.B., D.M.C.C., H.C.J., N.A., L.A.T.T., E.T.T., G.D.G.); Department of Diagnostic Imaging, Division of Neuroradiology, Hospital do Coração (HCor), São Paulo, Brazil (T.d.A.L.F.); and Department of Diagnostic Imaging, Division of Neuroradiology, Fundação Instituto de Pesquisa e Estudo de Diagnóstico por Imagem (FIDI), São Paulo, Brazil (B.T., M.d.O.M.H., I.F.T.L.C., L.C.A.R., S.B., L.A.T.T.)
| | - Danilo Manuel Cerqueira Costa
- From the Department of Diagnostic Imaging, Division of Neuroradiology, Universidade Federal de São Paulo (UNIFESP), Rua Napoleão de Barros 800, São Paulo SP 04024-002, Brazil (B.T., M.d.O.M.H., I.F.T.L.C., E.F., L.C.A.R., S.B., D.M.C.C., H.C.J., N.A., L.A.T.T., E.T.T., G.D.G.); Department of Diagnostic Imaging, Division of Neuroradiology, Hospital do Coração (HCor), São Paulo, Brazil (T.d.A.L.F.); and Department of Diagnostic Imaging, Division of Neuroradiology, Fundação Instituto de Pesquisa e Estudo de Diagnóstico por Imagem (FIDI), São Paulo, Brazil (B.T., M.d.O.M.H., I.F.T.L.C., L.C.A.R., S.B., L.A.T.T.)
| | - Henrique Carrete Junior
- From the Department of Diagnostic Imaging, Division of Neuroradiology, Universidade Federal de São Paulo (UNIFESP), Rua Napoleão de Barros 800, São Paulo SP 04024-002, Brazil (B.T., M.d.O.M.H., I.F.T.L.C., E.F., L.C.A.R., S.B., D.M.C.C., H.C.J., N.A., L.A.T.T., E.T.T., G.D.G.); Department of Diagnostic Imaging, Division of Neuroradiology, Hospital do Coração (HCor), São Paulo, Brazil (T.d.A.L.F.); and Department of Diagnostic Imaging, Division of Neuroradiology, Fundação Instituto de Pesquisa e Estudo de Diagnóstico por Imagem (FIDI), São Paulo, Brazil (B.T., M.d.O.M.H., I.F.T.L.C., L.C.A.R., S.B., L.A.T.T.)
| | - Nitamar Abdala
- From the Department of Diagnostic Imaging, Division of Neuroradiology, Universidade Federal de São Paulo (UNIFESP), Rua Napoleão de Barros 800, São Paulo SP 04024-002, Brazil (B.T., M.d.O.M.H., I.F.T.L.C., E.F., L.C.A.R., S.B., D.M.C.C., H.C.J., N.A., L.A.T.T., E.T.T., G.D.G.); Department of Diagnostic Imaging, Division of Neuroradiology, Hospital do Coração (HCor), São Paulo, Brazil (T.d.A.L.F.); and Department of Diagnostic Imaging, Division of Neuroradiology, Fundação Instituto de Pesquisa e Estudo de Diagnóstico por Imagem (FIDI), São Paulo, Brazil (B.T., M.d.O.M.H., I.F.T.L.C., L.C.A.R., S.B., L.A.T.T.)
| | - Luís Antônio Tobaru Tibana
- From the Department of Diagnostic Imaging, Division of Neuroradiology, Universidade Federal de São Paulo (UNIFESP), Rua Napoleão de Barros 800, São Paulo SP 04024-002, Brazil (B.T., M.d.O.M.H., I.F.T.L.C., E.F., L.C.A.R., S.B., D.M.C.C., H.C.J., N.A., L.A.T.T., E.T.T., G.D.G.); Department of Diagnostic Imaging, Division of Neuroradiology, Hospital do Coração (HCor), São Paulo, Brazil (T.d.A.L.F.); and Department of Diagnostic Imaging, Division of Neuroradiology, Fundação Instituto de Pesquisa e Estudo de Diagnóstico por Imagem (FIDI), São Paulo, Brazil (B.T., M.d.O.M.H., I.F.T.L.C., L.C.A.R., S.B., L.A.T.T.)
| | - Eduardo Takashi Takehara
- From the Department of Diagnostic Imaging, Division of Neuroradiology, Universidade Federal de São Paulo (UNIFESP), Rua Napoleão de Barros 800, São Paulo SP 04024-002, Brazil (B.T., M.d.O.M.H., I.F.T.L.C., E.F., L.C.A.R., S.B., D.M.C.C., H.C.J., N.A., L.A.T.T., E.T.T., G.D.G.); Department of Diagnostic Imaging, Division of Neuroradiology, Hospital do Coração (HCor), São Paulo, Brazil (T.d.A.L.F.); and Department of Diagnostic Imaging, Division of Neuroradiology, Fundação Instituto de Pesquisa e Estudo de Diagnóstico por Imagem (FIDI), São Paulo, Brazil (B.T., M.d.O.M.H., I.F.T.L.C., L.C.A.R., S.B., L.A.T.T.)
| | - Gustavo Dalul Gomez
- From the Department of Diagnostic Imaging, Division of Neuroradiology, Universidade Federal de São Paulo (UNIFESP), Rua Napoleão de Barros 800, São Paulo SP 04024-002, Brazil (B.T., M.d.O.M.H., I.F.T.L.C., E.F., L.C.A.R., S.B., D.M.C.C., H.C.J., N.A., L.A.T.T., E.T.T., G.D.G.); Department of Diagnostic Imaging, Division of Neuroradiology, Hospital do Coração (HCor), São Paulo, Brazil (T.d.A.L.F.); and Department of Diagnostic Imaging, Division of Neuroradiology, Fundação Instituto de Pesquisa e Estudo de Diagnóstico por Imagem (FIDI), São Paulo, Brazil (B.T., M.d.O.M.H., I.F.T.L.C., L.C.A.R., S.B., L.A.T.T.)
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Tadesse AW, Kassa AM, Aychiluhm SB. Determinants of Neural Tube Defects among Newborns in Amhara Region, Ethiopia: A Case-Control Study. Int J Pediatr 2020; 2020:5635267. [PMID: 33193764 PMCID: PMC7648700 DOI: 10.1155/2020/5635267] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 10/20/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Worldwide, an estimated 300,000 neonates are born with neural tube defects (NTDs) each year. However, NTDs are underreported in Ethiopia though it causes substantial mortality, morbidity, disability, and psychological and economic cost in the country. Moreover, the factors attributed to NTDs were not addressed. Hence, this study intended to identify the determinants of neural tube defects in Amhara Region, Ethiopia. METHODS A case-control study design was conducted among 400 newborns (133 cases and 267 controls) who were born at randomly selected public hospitals. Cases were identified using the physician diagnosis of confirmed NTDs, and the two consecutive controls were selected using a simple random sampling technique. The data analysis was done using Stata 14.0. Variables with p value < 0.25 in the bivariate analysis were entered into the multivariable logistic regression model, and a corresponding 95% confidence interval was used to identify the predictors of NTDs. RESULTS In this study, fifty percent (48%) of the cases were contributed by anencephaly. After controlling the covariates, living in rural areas (AOR = 1.78: 95% CI 1.02, 3.11), being illiterate (AOR = 1.81: 95% CI 1.07, 4.61), being female newborn (AOR = 1.95: 95% CI 1.09, 3.50), having no ANC follow-up (AOR = 1.93: 95% CI 1.17, 5.04), and having a previous history of NTDs (AOR = 4.39: 95% CI 2.42, 7.96) were the risk factors for NTDs. However, being supplemented with folic acid or multivitamins before or during pregnancy (AOR = 0.37: 95% CI 0.21, 0.65), never having taken any substance during pregnancy (AOR = 0.42: 95% CI 0.21, 0.88), and being free from medical illnesses during pregnancy (AOR = 0.27: 95% CI 0.11, 0.69) were the protective factors of NTDs. CONCLUSION The study revealed different factors associated with NTDs among newborns in the region. Therefore, comprehensive preventive strategies focused on identified risk factors are needed at regional and national levels.
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Affiliation(s)
- Abay Woday Tadesse
- Samara University, College of Medical and Health Sciences, Department of Public Health, Samara, Afar Region, Ethiopia
| | | | - Setognal Birara Aychiluhm
- Samara University, College of Medical and Health Sciences, Department of Public Health, Samara, Afar Region, Ethiopia
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13
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Doctor P, Ang J, Asmar B, McGrath E. Spinal Abscess in a Patient with Undiagnosed Congenital Dermal Sinus Tract. Glob Pediatr Health 2020; 7:2333794X20953324. [PMID: 33029551 PMCID: PMC7522820 DOI: 10.1177/2333794x20953324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 08/02/2020] [Accepted: 08/04/2020] [Indexed: 11/21/2022] Open
Affiliation(s)
- Pezad Doctor
- Office of Pediatric Education, Children's Hospital of Michigan Residency Program, Detroit, MI, USA.,Children's Hospital of Michigan, Detroit, MI, USA
| | - Jocelyn Ang
- Children's Hospital of Michigan, Detroit, MI, USA.,Department of Pediatrics, Division of Infectious Diseases, Wayne State University School of Medicine, Detroit, MI, USA
| | - Basim Asmar
- Children's Hospital of Michigan, Detroit, MI, USA.,Department of Pediatrics, Division of Infectious Diseases, Wayne State University School of Medicine, Detroit, MI, USA
| | - Eric McGrath
- Children's Hospital of Michigan, Detroit, MI, USA.,Department of Pediatrics, Division of Infectious Diseases, Wayne State University School of Medicine, Detroit, MI, USA
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Janik K, Manire MA, Smith GM, Krynska B. Spinal Cord Injury in Myelomeningocele: Prospects for Therapy. Front Cell Neurosci 2020; 14:201. [PMID: 32714152 PMCID: PMC7340150 DOI: 10.3389/fncel.2020.00201] [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: 02/28/2020] [Accepted: 06/09/2020] [Indexed: 01/10/2023] Open
Abstract
Myelomeningocele (MMC) is the most common congenital defect of the central nervous system and results in devastating and lifelong disability. In MMC, the initial failure of neural tube closure early in gestation is followed by a progressive prenatal injury to the exposed spinal cord, which contributes to the deterioration of neurological function in fetuses. Prenatal strategies to control the spinal cord injury offer an appealing therapeutic approach to improve neurological function, although the definitive pathophysiological mechanisms of injury remain to be fully elucidated. A better understanding of these mechanisms at the cellular and molecular level is of paramount importance for the development of targeted prenatal MMC therapies to minimize or eliminate the effects of the injury and improve neurological function. In this review article, we discuss the pathological development of MMC with a focus on in utero injury to the exposed spinal cord. We emphasize the need for a better understanding of the causative factors in MMC spinal cord injury, pathophysiological alterations associated with the injury, and cellular and molecular mechanisms by which these alterations are induced.
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Affiliation(s)
- Karolina Janik
- Shriners Hospitals Pediatric Research Center, Center for Neural Repair and Rehabilitation, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, United States
| | - Meredith A Manire
- Department of Obstetrics and Gynecology, West Penn Hospital, Allegheny Health Network, Pittsburgh, PA, United States
| | - George M Smith
- Shriners Hospitals Pediatric Research Center, Center for Neural Repair and Rehabilitation, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, United States
| | - Barbara Krynska
- Shriners Hospitals Pediatric Research Center, Center for Neural Repair and Rehabilitation, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, United States
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15
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Muñoz Montoya JE, Jara MA, Vargas Osorio MP, Franco FR. Dermal Sinus Tract associated with Type I and Type II Split Cord Malformation. Asian J Neurosurg 2020; 15:172-175. [PMID: 32181196 PMCID: PMC7057908 DOI: 10.4103/ajns.ajns_287_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 12/11/2019] [Indexed: 11/18/2022] Open
Abstract
The dermal sinus tract of the spine is associated with other occult spinal dysraphisms, such as the split cord malformation (diastematomyelia) in a 40% of the cases and embryologically is not clearly defined if the dermal sinus and split cord malformation have origin in gastrulation or late primary neurulation, but the most accepted theory of the dermal sinus tract consists in early incomplete disjunction, which explains the relation with other spinal dysraphisms. Here, we present two cases, with a dermal sinus tract of the spine associated with Type I and Type II split cord malformation.
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Affiliation(s)
- Juan Esteban Muñoz Montoya
- Departaments of Neurosurgery and Neurosciences, Hospital Militar Central, Universidad Militar Nueva Granada, Bogotá, Colombia
| | - Marcial Anaya Jara
- Departament of Pediatric Neurosurgery, Instituto Nacional de Pediatría, Bogotá, Colombia
| | - María Paula Vargas Osorio
- Departaments of Neurosurgery and Neurosciences, Hospital Militar Central, Universidad Militar Nueva Granada, Bogotá, Colombia
| | - Fernando Rueda Franco
- Departament of Pediatric Neurosurgery, Chief of the Surgery Division, Instituto Nacional de Pediatría, Mexico City, Mexico
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16
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Effects of Erythrosine on Neural Tube Development in Early Chicken Embryos. World Neurosurg 2019; 134:e822-e825. [PMID: 31715407 DOI: 10.1016/j.wneu.2019.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 11/03/2019] [Accepted: 11/04/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Erythrosine (E127), a synthetic food dye containing iodine and sodium, has often been used inside packaged foods and beverages in Turkey and many other countries. We evaluated the effects of erythrosine on neural tube development in early-stage chicken embryos. METHODS The study included 4 groups, with a total of 80 embryos: a control group, a normal saline group, a half-dose group, and a high-dose group. After 30 hours of incubation, saline and erythrosine solution was injected under the embryonic discs. At the end of 72 hours, the embryos were excised and evaluated macroscopically and histopathologically. RESULTS Neural tube defects were detected in the erythrosine-administered groups with statistically significant differences. In contrast, the embryos in the control and saline groups displayed normal development. CONCLUSIONS Erythrosine increased the risk of neural tube defects in early-stage chicken embryos, even at half of the approved dose.
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Alonso JDM, Filho PTH, Ávila AR, Machado VMV, Hataka A, Bueno LMC, Alves ALG, Hussni CA, Rodrigues CA, Watanabe MJ. Surgical Repair of an Occipital Meningocele in a Foal. J Equine Vet Sci 2019; 81:102771. [PMID: 31668304 DOI: 10.1016/j.jevs.2019.06.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 06/20/2019] [Accepted: 06/20/2019] [Indexed: 11/17/2022]
Abstract
There are no previous reports of cranial meningocele in horses. In this report, we present the case of a 1-day-old male Quarter Horse that was born with a mass in the occipital region. The newborn was brought to the veterinary hospital, and a meningocele was diagnosed. The patient then underwent surgical closure of the defect. After an initial favorable response, the patient displayed signs of infection. The antibiotic therapy was changed, and the patient's condition improved. On the 13th postoperative day, the patient exhibited ataxia, difficulty standing, and limb hypertonia. Hydrocephalus was suspected, and a cerebrospinal puncture was performed. Because of the lack of improvement after the puncture and the high turbidity of the obtained fluid, bacterial encephalitis was suspected and antibiotic therapy restarted. The patient was euthanized on the 14th postoperative day when no response to therapy was observed. Postmortem tomography and magnetic resonance imaging showed dilation of the encephalic ventricles with the presence of gas. On necropsy, bacterial encephalitis was confirmed, and multidrug-resistant Escherichia coli was isolated. This case suggests that surgical treatment of meningocele in horses is feasible; however, infectious complications may limit the long-term therapeutic success.
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Affiliation(s)
- Juliana de M Alonso
- Department of Veterinary Surgery and Anesthesiology, Large Animals Surgery, School of Veterinary Medicine and Animal Science, Universidade Estadual Paulista (UNESP), Botucatu, São Paulo, Brazil
| | - Pedro T H Filho
- Department of Neurology, Psychology and Psychiatry, Neurosurgery, Medical School of Botucatu (FMB), Universidade Estadual Paulista (UNESP), Botucatu, São Paulo, Brazil
| | - Alice R Ávila
- Department of Veterinary Surgery and Anesthesiology, Large Animals Surgery, School of Veterinary Medicine and Animal Science, Universidade Estadual Paulista (UNESP), Botucatu, São Paulo, Brazil
| | - Vânia M V Machado
- Department of Animal Reproduction and Veterinary Radiology, Diagnostic Imaging, School of Veterinary Medicine and Animal Science, Universidade Estadual Paulista (UNESP), Botucatu, São Paulo, Brazil
| | - Alessandre Hataka
- Department of Veterinary Clinic, Veterinary Pathology, School of Veterinary Medicine and Animal Science, Universidade Estadual Paulista (UNESP), Botucatu, São Paulo, Brazil
| | - Lais M C Bueno
- Department of Animal Reproduction and Veterinary Radiology, Diagnostic Imaging, School of Veterinary Medicine and Animal Science, Universidade Estadual Paulista (UNESP), Botucatu, São Paulo, Brazil
| | - Ana Liz G Alves
- Department of Veterinary Surgery and Anesthesiology, Large Animals Surgery, School of Veterinary Medicine and Animal Science, Universidade Estadual Paulista (UNESP), Botucatu, São Paulo, Brazil
| | - Carlos A Hussni
- Department of Veterinary Surgery and Anesthesiology, Large Animals Surgery, School of Veterinary Medicine and Animal Science, Universidade Estadual Paulista (UNESP), Botucatu, São Paulo, Brazil
| | - Celso A Rodrigues
- Department of Veterinary Surgery and Anesthesiology, Large Animals Surgery, School of Veterinary Medicine and Animal Science, Universidade Estadual Paulista (UNESP), Botucatu, São Paulo, Brazil
| | - Marcos J Watanabe
- Department of Veterinary Surgery and Anesthesiology, Large Animals Surgery, School of Veterinary Medicine and Animal Science, Universidade Estadual Paulista (UNESP), Botucatu, São Paulo, Brazil.
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Shields LBE, Mutchnick IS, Peppas DS, Rosenberg E. Importance of Physical Examination and Imaging in the Detection of Tethered Cord Syndrome. Glob Pediatr Health 2019; 6:2333794X19851419. [PMID: 31218244 PMCID: PMC6563391 DOI: 10.1177/2333794x19851419] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 04/23/2019] [Accepted: 04/23/2019] [Indexed: 01/15/2023] Open
Abstract
Tethered cord syndrome (TCS) is a type of occult spinal dysraphism that may lead to permanent neurologic and orthopedic deficits. Infants with TCS may have lumbosacral cutaneous malformations (LsCMs). We studied 67 infants referred to a single pediatric urology practice for a urological concern unrelated to occult spinal dysraphism with no prior diagnosis of LsCM between March 1, 2015 and September 30, 2018. Each infant underwent a spinal ultrasound. If an abnormality was detected, they were referred to a pediatric neurosurgeon. The most common cutaneous manifestations were duplicated or bifurcated (46%) gluteal folds and gluteal asymmetry (16%). Fourteen (21%) of the 67 patients had an abnormal spinal ultrasound; 5 of the 14 infants underwent a lumbar magnetic resonance imaging. One infant had urodynamics studies and a tethered cord release. Pediatricians should be familiar with TCS and perform lumbar physical examinations for LsCMs suggestive of TCS to ensure prompt diagnosis and management and avoid potentially devastating complications.
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Salama ER, El Amrousy D. GlideScope ® cobalt video laryngoscope versus direct Miller laryngoscope for lateral position-tracheal intubation in neonates with myelodysplasia: A prospective randomized study. Saudi J Anaesth 2019. [PMID: 30692885 DOI: 10.4103%20/sja.sja_460_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Background and Objective Anesthesiologists encounter difficulties during laryngoscopy and tracheal intubation of neonates with myelodysplasia. Tracheal intubation in lateral position in such cases deemed profitable but not easy because of the compromised laryngeal view. We compared GlideScope video laryngoscope (GVL) versus conventional Miller direct laryngoscope (DL) for tracheal intubation in laterally positioned neonates with myelodysplasia. Materials and Methods Sixty neonates scheduled for elective surgical repair of meningeocele or meningeomyelocele under general anesthesia were allocated randomly for endotracheal intubation using GVL or DL. Percentage of glottis opening (POGO) scores, time to best glottis view (TBGV), endotracheal tube passage time (TPT), intubation time (IT), intubation attempts, and overall success rate of intubation were recorded. Results TBGV was significantly shorter in GVL group (median = 6.8 s, range = 3.5-28.2 s) in comparison with DL group (median = 8.4 s, range = 4.8-32.7 s) (P = 0.01); however, TPT and IT were comparable. POGO scores were significantly higher with GVL group than DL group (median = 93.8, range = 45-100 and median = 82.4, range 10-100, respectively) (P = 0.001). Overall success of intubation was the same; however, three patients in GVL group required a second attempt for intubation in comparison with five patients in DL group. One patient in DL group required a third attempt. Conclusion In laterally positioned neonates, GVL is easier than DL with a similar intubation time, comparable time required for tube passage, better views of the glottis, shorter times to obtain the best glottic view, and high success rate as compared with DL. GlideScope seems to be an effective approach for endotracheal intubation of laterally positioned neonates with myelodysplasia.
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Affiliation(s)
- Eman Ramadan Salama
- Department of Anesthesia and Surgical ICU, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Doaa El Amrousy
- Department of Pediatrics, Faculty of Medicine, Tanta University, Tanta, Egypt
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20
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Salama ER, El Amrousy D. GlideScope ® cobalt video laryngoscope versus direct Miller laryngoscope for lateral position-tracheal intubation in neonates with myelodysplasia: A prospective randomized study. Saudi J Anaesth 2019; 13:28-34. [PMID: 30692885 PMCID: PMC6329240 DOI: 10.4103/sja.sja_460_18] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Anesthesiologists encounter difficulties during laryngoscopy and tracheal intubation of neonates with myelodysplasia. Tracheal intubation in lateral position in such cases deemed profitable but not easy because of the compromised laryngeal view. We compared GlideScope video laryngoscope (GVL) versus conventional Miller direct laryngoscope (DL) for tracheal intubation in laterally positioned neonates with myelodysplasia. MATERIALS AND METHODS Sixty neonates scheduled for elective surgical repair of meningeocele or meningeomyelocele under general anesthesia were allocated randomly for endotracheal intubation using GVL or DL. Percentage of glottis opening (POGO) scores, time to best glottis view (TBGV), endotracheal tube passage time (TPT), intubation time (IT), intubation attempts, and overall success rate of intubation were recorded. RESULTS TBGV was significantly shorter in GVL group (median = 6.8 s, range = 3.5-28.2 s) in comparison with DL group (median = 8.4 s, range = 4.8-32.7 s) (P = 0.01); however, TPT and IT were comparable. POGO scores were significantly higher with GVL group than DL group (median = 93.8, range = 45-100 and median = 82.4, range 10-100, respectively) (P = 0.001). Overall success of intubation was the same; however, three patients in GVL group required a second attempt for intubation in comparison with five patients in DL group. One patient in DL group required a third attempt. CONCLUSION In laterally positioned neonates, GVL is easier than DL with a similar intubation time, comparable time required for tube passage, better views of the glottis, shorter times to obtain the best glottic view, and high success rate as compared with DL. GlideScope seems to be an effective approach for endotracheal intubation of laterally positioned neonates with myelodysplasia.
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Affiliation(s)
- Eman Ramadan Salama
- Department of Anesthesia and Surgical ICU, Faculty of Medicine, Tanta University, Tanta, Egypt
- Address for correspondence: Dr. Eman Ramadan Salama, Department of Anesthesia and Surgical ICU, Faculty of Medicine, Tanta University, Tanta, Egypt. E-mail:
| | - Doaa El Amrousy
- Department of Pediatrics, Faculty of Medicine, Tanta University, Tanta, Egypt
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Zieba J, Walczak M, Gordiienko O, Gerstenhaber JA, Smith GM, Krynska B. Altered Amniotic Fluid Levels of Hyaluronic Acid in Fetal Rats with Myelomeningocele: Understanding Spinal Cord Injury. J Neurotrauma 2018; 36:1965-1973. [PMID: 30284959 DOI: 10.1089/neu.2018.5894] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Myelomeningocele (MMC) is a devastating congenital neural tube defect that results in the exposure of spinal cord to the intrauterine environment, leading to secondary spinal cord injury and severe impairment. Although the mechanisms underlying the secondary pathogenesis are clinically relevant, the exact cause of in utero-acquired spinal cord damage remains unclear. The objective of this study was to determine whether the hyaluronic acid (HA) concentration in amniotic fluid (AF) in the retinoic acid-induced model of MMC is different from that in normal controls and whether these differences could have an impact on the viscosity of AF. Our data shows that the concentration of HA in AF samples from fetuses with MMC (MMC-AF) and normal control samples (Norm-AF) were not significantly different at embryonic day 18 (E18) and E20. Thereafter, the HA concentration significantly increased in Norm-AF but not in MMC-AF. Compared with Norm-AF, the concentration of HA in MMC-AF and the viscosity of MMC-AF were significantly lower at E21. Agarose gel electrophoresis confirmed a significant reduction in the HA level of MMC-AF compared with Norm-AF at E21. No HA-degrading activity was detected in MMC-AF. In summary, we identified a deficiency in the AF level of HA and the viscosity of AF in fetal rats with MMC. These data are discussed in relation to a potential role the reduction in the AF viscosity due to the low level of HA may play in the exacerbating effects of mechanical trauma on spinal cord damage at the MMC lesion site.
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Affiliation(s)
- Jolanta Zieba
- 1 Shriners Hospitals Pediatric Research Center, Center for Neural Repair and Rehabilitation, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Maciej Walczak
- 1 Shriners Hospitals Pediatric Research Center, Center for Neural Repair and Rehabilitation, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Oleg Gordiienko
- 1 Shriners Hospitals Pediatric Research Center, Center for Neural Repair and Rehabilitation, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Jonathan A Gerstenhaber
- 2 Department of Bioengineering, College of Engineering, Temple University, Philadelphia, Pennsylvania
| | - George M Smith
- 1 Shriners Hospitals Pediatric Research Center, Center for Neural Repair and Rehabilitation, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Barbara Krynska
- 1 Shriners Hospitals Pediatric Research Center, Center for Neural Repair and Rehabilitation, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
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Peyronnet B, Brochard C, Jezequel M, Hascoet J, Alimi Q, Senal N, Carsin-Nicole B, Riffaud L, Le Reste PJ, Bonan I, Olivari-Philiponnet C, Siproudhis L, Kerdraon J, Game X, Manunta A. Comparison of neurogenic lower urinary tract dysfunctions in open versus closed spinal dysraphism: A prospective cross-sectional study of 318 patients. Neurourol Urodyn 2018; 37:2818-2826. [DOI: 10.1002/nau.23782] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 07/09/2018] [Indexed: 12/16/2022]
Affiliation(s)
- Benoit Peyronnet
- Service d'urologie; CHU Rennes; Rennes France
- Centre de référence spina bifida; CHU Rennes; Rennes France
- Equipe thématique INPHY CIC 1414 et INSERM UMR 991; CHU Rennes; Rennes France
| | - Charlène Brochard
- Centre de référence spina bifida; CHU Rennes; Rennes France
- Equipe thématique INPHY CIC 1414 et INSERM UMR 991; CHU Rennes; Rennes France
- Service de Gastro-Entérologie; CHU Rennes; Rennes France
| | | | - Juliette Hascoet
- Service d'urologie; CHU Rennes; Rennes France
- Centre de référence spina bifida; CHU Rennes; Rennes France
- Equipe thématique INPHY CIC 1414 et INSERM UMR 991; CHU Rennes; Rennes France
| | - Quentin Alimi
- Service d'urologie; CHU Rennes; Rennes France
- Centre de référence spina bifida; CHU Rennes; Rennes France
- Equipe thématique INPHY CIC 1414 et INSERM UMR 991; CHU Rennes; Rennes France
| | - Nelly Senal
- Centre de référence spina bifida; CHU Rennes; Rennes France
- Service de Médecine Physique et Réadaptation; CHU Rennes; Rennes France
| | - Béatrice Carsin-Nicole
- Centre de référence spina bifida; CHU Rennes; Rennes France
- Service de Neuro-Radiologie; CHU Rennes; Rennes France
| | - Laurent Riffaud
- Centre de référence spina bifida; CHU Rennes; Rennes France
- Service de Neurochirurgie; CHU Rennes; Rennes France
| | - Pierre-Jean Le Reste
- Centre de référence spina bifida; CHU Rennes; Rennes France
- Service de Neurochirurgie; CHU Rennes; Rennes France
| | - Isabelle Bonan
- Centre de référence spina bifida; CHU Rennes; Rennes France
- Service de Médecine Physique et Réadaptation; CHU Rennes; Rennes France
| | - Camille Olivari-Philiponnet
- Centre de référence spina bifida; CHU Rennes; Rennes France
- Service de Médecine Physique et Réadaptation; CHU Rennes; Rennes France
| | - Laurent Siproudhis
- Centre de référence spina bifida; CHU Rennes; Rennes France
- Equipe thématique INPHY CIC 1414 et INSERM UMR 991; CHU Rennes; Rennes France
- Service de Gastro-Entérologie; CHU Rennes; Rennes France
| | - Jacques Kerdraon
- Centre de référence spina bifida; CHU Rennes; Rennes France
- Centre de rééducation de Kerpape; Ploemeur France
| | - Xavier Game
- Département d'Urologie; Transplantation Rénale et Andrologie; CHU Rangueil; Toulouse France
| | - Andrea Manunta
- Service d'urologie; CHU Rennes; Rennes France
- Centre de référence spina bifida; CHU Rennes; Rennes France
- Equipe thématique INPHY CIC 1414 et INSERM UMR 991; CHU Rennes; Rennes France
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Affiliation(s)
- Rose Schrott
- University Program in Environmental Health, Duke Nicholas School of the Environment, and Division of Reproductive Sciences, Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC
| | - Susan K Murphy
- University Program in Environmental Health, Duke Nicholas School of the Environment, and Division of Reproductive Sciences, Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC,Address correspondence to SKM (e-mail: )
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24
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Ben-Sira L, Ponger P, Constantini S. Evaluation of Dorsal Midline Discolorations with Physical Examination and Ultrasound. J Pediatr 2017; 190:246-250. [PMID: 29144251 DOI: 10.1016/j.jpeds.2017.07.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 06/17/2017] [Accepted: 07/12/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess the association between dorsal midline skin discolorations, tethering of the spinal cord, and the role of ultrasound screening of these stigmata, focusing specifically on vascular lesions. STUDY DESIGN We conducted a prospective observational study of infants <6 months of age with suspicious dorsal midline skin stigmata. All were evaluated by physical examination and ultrasound scan. A subset also had a magnetic resonance imaging examination. We examined the association between small, red-shaded discolorations and their respective imaging findings. RESULTS Among 100 cases with discolorations of vascular types, either isolated or combined with low-risk simple dimples or deviated gluteal folds, none had clinically significant pathologic findings requiring surgical intervention. CONCLUSIONS Midline lumbar discolorations are more benign than previously thought. Despite the very low association of this group of stigmata with surgical implications, we still recommend the routine use of ultrasound scanning.
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Affiliation(s)
- Liat Ben-Sira
- Department of Radiology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv Israel.
| | - Penina Ponger
- Neurology Department, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv Israel
| | - Shlomi Constantini
- Department of Pediatric Neurosurgery and Department of Neurosurgery, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv Israel
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25
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Canaz H, Canaz G, Dogan I, Alatas I. Health-related quality of life in non-paraplegic (ambulatory) children with myelomeningocele. Childs Nerv Syst 2017; 33:1997-2002. [PMID: 28656385 DOI: 10.1007/s00381-017-3494-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 06/13/2017] [Indexed: 11/24/2022]
Abstract
PURPOSE Evaluation of the effects of ventriculoperitoenal shunt and incontinence presence on health-related quality of life of ambulatory myelomeningocele patients. METHODS The study group included 35 myelomeningocele patients, between 5 and 18 years old (mean age = 9.6), who were neonatally operated. All patients were ambulatory. The Child Edition of the Child Health and Illness Profile (CHIP-CE) used to evaluate the patient group. Seventeen patients were using clean intermittent catheterization and nine patients had ventriculoperitoneal shunt. RESULTS The CHIP-CE has five domains, and in satisfaction, resilience and achievement domains, significant lower scores were obtained from our study group. In terms of clean intermittent catheterization use, we got significantly lower scores on satisfaction, resilience and achievement domains (p < 0.05). According to the presence of ventriculoperitoneal shunt, we found lower scores in satisfaction, resilience, risk avoidance and achievement domains but the differences were not significant (p > 0.05). No significant difference was spotted according to gender and age. CONCLUSIONS Continence problems have important effects on life quality of myelomeningocele patients. Incontinency should always be considered as a major variable in health-related quality of life evaluations.
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Affiliation(s)
- Huseyin Canaz
- Department of Neurosurgery, Florence Nightingale Hospital, Istanbul Bilim University, Istanbul, Turkey
| | - Gokhan Canaz
- Department of Neurosurgery, Bakirkoy Research and Training Hospital for Neurology, Neurosurgery and Psychiatry, 34147, Istanbul, Turkey.
| | - Irem Dogan
- Faculty of Medicine, Istanbul Bilim University, Istanbul, Turkey
| | - Ibrahim Alatas
- Department of Neurosurgery, Florence Nightingale Hospital, Istanbul Bilim University, Istanbul, Turkey
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Sepulveda W, Wong AE, Sepulveda F, Alcalde JL, Devoto JC, Otayza F. Prenatal diagnosis of spina bifida: from intracranial translucency to intrauterine surgery. Childs Nerv Syst 2017; 33:1083-1099. [PMID: 28593553 DOI: 10.1007/s00381-017-3445-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 04/28/2017] [Indexed: 12/11/2022]
Abstract
Accurate and timely prenatal diagnosis of spina bifida (SB) is a major goal of modern antenatal care. Prenatal screening for open SB should be first performed at the time of routine first-trimester ultrasound by examining the posterior fossa for obliteration or non-visualization of the fourth ventricle ("intracranial translucency") and cisterna magna. The second step of screening is the second-trimester anatomy scan, at which time the features of the Chiari type II malformation should be looked for, including ventriculomegaly, scalloping of the frontal bones ("lemon" sign), and backward and caudal displacement of the cerebellar vermis with obliteration of the cisterna magna ("banana" sign). In cases with positive findings, evaluation must include a focused examination of the spine for defects. In cases of closed SB and SB occulta, the cranial and posterior fossa features will not be present as they are not associated with leaking of spinal fluid and resultant hindbrain herniation, highlighting the fact that the spine should be examined thoroughly whenever possible during the second-trimester scan. In tertiary fetal medicine centers, two-dimensional and three-dimensional ultrasound allows an accurate determination of the location, type, extent, and upper level of the spinal defect as well as the presence of associated anomalies. Fetal magnetic resonance imaging should be restricted to candidates for intrauterine surgery as part of the preoperative protocol.
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Affiliation(s)
- Waldo Sepulveda
- FETALMED - Maternal-Fetal Diagnostic Center, Fetal Imaging Unit, Estoril 50, Suites 203 & 515, Las Condes, 7591047, Santiago, Chile.
| | - Amy E Wong
- Department of Maternal-Fetal Medicine, Palo Alto Medical Foundation, Mountain View, CA, 94040, USA
| | - Francisco Sepulveda
- FETALMED - Maternal-Fetal Diagnostic Center, Fetal Imaging Unit, Estoril 50, Suites 203 & 515, Las Condes, 7591047, Santiago, Chile
| | - Juan L Alcalde
- Department of Obstetrics and Gynecology, Clinica Las Condes, Santiago, Chile
| | - Juan C Devoto
- Department of Anesthesiology, Clinica Las Condes, Santiago, Chile
| | - Felipe Otayza
- Department of Neurosurgery, Clinica Las Condes, Santiago, Chile
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Zieba J, Miller A, Gordiienko O, Smith GM, Krynska B. Clusters of amniotic fluid cells and their associated early neuroepithelial markers in experimental myelomeningocele: Correlation with astrogliosis. PLoS One 2017; 12:e0174625. [PMID: 28358903 PMCID: PMC5373583 DOI: 10.1371/journal.pone.0174625] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 03/13/2017] [Indexed: 01/20/2023] Open
Abstract
Myelomeningocele (MMC) is the most common and severe disabling type of spina bifida resulting in the exposure of vulnerable spinal cord to the hostile intrauterine environment. In this study, we sought to examine the cellular content of fetal amniotic fluid (AF) in MMC and explore a correlation between these cells and pathological development of MMC. MMC was induced in fetal rats by exposing pregnant mothers to all-trans retinoic acid and AF samples were collected before term. Cells were isolated from AF samples and morphologically and phenotypically characterized in short-term cultures. In addition, the spinal cord injury in MMC fetuses was assessed by immunohistochemical examination of astrogliosis. We identified a population of cells from the AF of MMC fetuses (MMC-AF) that formed adherent clusters of tightly packed cells, which were absent from the AF of normal control fetuses (norm-AF). MMC-AF clusters contained cells co-expressing adherens junction associated proteins (ZO-1), N-cadherin and F-actin at sites of cell-cell contacts. In addition, they expressed markers of early neuroepithelial cells such as SOX-1 and Pax-6 along with other stem/progenitor cell markers such as SOX-2 and nestin. Subpopulations of cells in MMC-AF clusters also expressed more advanced differentiation markers such as doublecortin and GFAP. We found that the appearance of cluster forming cells in cultures from MMC-AF correlated with activation of astrogliosis associated with the spinal cord injury in MMC fetuses. In summary, we identified a neuroepithelial cell population in the AF of MMC fetuses that formed adherent clusters in culture and we characterized cellular markers of these cells. Our data suggests that the phase of the disease is a crucial factor in the emergence of these cells into the AF and that these cells may provide a new and important platform for studying the progression of MMC and development of improved strategies for the repair and diagnosis of MMC prenatally.
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Affiliation(s)
- Jolanta Zieba
- Shriners Hospitals Pediatric Research Center, Center for Neural Repair and Rehabilitation, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, United States of America
| | - Amanda Miller
- Shriners Hospitals Pediatric Research Center, Center for Neural Repair and Rehabilitation, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, United States of America
| | - Oleg Gordiienko
- Shriners Hospitals Pediatric Research Center, Center for Neural Repair and Rehabilitation, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, United States of America
| | - George M. Smith
- Shriners Hospitals Pediatric Research Center, Center for Neural Repair and Rehabilitation, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, United States of America
| | - Barbara Krynska
- Shriners Hospitals Pediatric Research Center, Center for Neural Repair and Rehabilitation, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, United States of America
- * E-mail:
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Laharwal MA, Sarmast AH, Ramzan AU, Wani AA, Malik NK, Arif SH, Rizvi M. Epidemiology of the neural tube defects in Kashmir Valley. J Pediatr Neurosci 2016; 11:213-218. [PMID: 27857789 PMCID: PMC5108123 DOI: 10.4103/1817-1745.193368] [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] [Indexed: 12/02/2022] Open
Abstract
Introduction/Background: Neural tube defects (NTD) are the most common congenital malformations affecting the brain and spinal cord and have a multifactorial etiology. Genetic and environmental factors have been found to cause these defects, both individually and in combination. Aims and Objectives: The aim of this study was to determine the incidence, types, demographics, risk factors, and other associated anomalies relevant to NTDs in Kashmir Valley. Materials and Methods: A 2-year hospital-based prospective study was carried out from November 2013 to October 2015. A detailed history of the mother was taken along with detailed clinical examination of neonate including measurement of head circumference and checking the status of fontanella, whether - lax/full/bulging/or tense, type of NTD. Investigations that were done included were X-ray skull: Anteroposterior (AP) and lateral, X-ray spine: AP and lateral, ultrasonography abdomen, magnetic resonance imaging: Spine and brain. Results: The total number of babies with NTD's was 125 with an overall incidence of 0.503. District Kupwara was having the highest incidence (1.047) and district Srinagar the lowest incidence of NTD's (0.197). The majority of NTD's (116 cases, 92.8%) were found in the rural areas. Among the different types of NTD's, spina bifida had an incidence of 0.342 (85 cases, 68%), and anencephaly had an incidence of 0.113 (28 cases, 22.4%). There was a slight preponderance of females over males with NTD's. There were70 females (56%) and 55 males (44%) respectively with a male:female ratio of 0.8:1. Conclusions: The incidence rates of NTDs are very high for Kashmir Valley. Geographical distribution of NTDs at this place confirms a relationship between the socioeconomic status, educational status, maternal age and environmental factors for the development of an NTD. The results of this study point to the importance establishing a health policy to prevent NTDs in Kashmir Valley.
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Affiliation(s)
- Masood Ahmed Laharwal
- Department of Neurosurgery, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Arif Hussain Sarmast
- Department of Neurosurgery, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Altaf Umer Ramzan
- Department of Neurosurgery, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Abrar Ahad Wani
- Department of Neurosurgery, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Nayil Khursheed Malik
- Department of Neurosurgery, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Sajad Hussain Arif
- Department of Neurosurgery, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Masooma Rizvi
- Department of Obstetrics and Gynaecology, Lalded Womens Obstetrical/Gynaecological Hospital, Srinagar, Jammu and Kashmir, India
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The transgenerational inheritance of autism-like phenotypes in mice exposed to valproic acid during pregnancy. Sci Rep 2016; 6:36250. [PMID: 27819277 PMCID: PMC5098241 DOI: 10.1038/srep36250] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 10/12/2016] [Indexed: 11/29/2022] Open
Abstract
Autism spectrum disorder (ASD) is a heterogeneously pervasive developmental disorder in which various genetic and environmental factors are believed to underlie its development. Recently, epigenetics has been suggested as a novel concept for ASD aetiology with a proposition that epigenetic marks can be transgenerationally inherited. Based on this assumption of epigenetics, we investigated the transgenerational inheritance of ASD-like behaviours and their related synaptic changes in the VPA animal model of ASD. The first generation (F1) VPA-exposed offspring exhibited autistic-like impaired sociability and increased marble burying. They also showed increased seizure susceptibility, hyperactivity and decreased anxiety. We mated the VPA-exposed F1 male offspring with naïve females to produce the second generation (F2), and then similarly mated the F2 to deliver the third generation (F3). Remarkably, the autism-like behavioural phenotypes found in F1 persisted to the F2 and F3. Additionally, the frontal cortices of F1 and F3 showed some imbalanced expressions of excitatory/inhibitory synaptic markers, suggesting a transgenerational epigenetic inheritance. These results open the idea that E/I imbalance and ASD-like behavioural changes induced by environmental insults in mice can be epigenetically transmitted, at least, to the third generation. This study could help explain the unprecedented increase in ASD prevalence.
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30
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Doğan H, Sahinoglu S. Fetuses with Neural Tube Defects: ethical approaches and the role of health care professionals in Turkish health care institutions. Nurs Ethics 2016; 12:59-78. [PMID: 15685968 DOI: 10.1191/0969733005ne758oa] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Neural tube defects (NTDs) are very serious malformations for the fetus, causing either low life expectancy or a chance of survival only with costly and difficult surgical interventions. In western countries the average prevalence is 1/1000-2000 and in Turkey it is 4/1000. The aim of the study was to characterize ethical approaches at institutional level to the fetus with an NTD and the mother, and the role of health care professionals in four major centers in Turkey. The authors chose perinatology units of four university hospitals and prepared questionnaires for the responsible professionals concerning their own and their institution’s ethical approaches to the fetus with an NTD and the mother. The investigation revealed that there were no institutional ethical frameworks or ethics committees available to professional teams in the units. The roles of the health care professionals and their individual decisions and approaches based on ethical principles are described. The ethical decision-making process concerning fetuses with NTDs, examples of institutional approaches to the topic and institutional frameworks, and the role of nurses and other health care professionals are all discussed, based on a literature review. The authors suggest that institutional ethical frameworks, ethics committees, professionals’ ethics education and multidisciplinary teamwork should be established for critical situations such as fetuses with an NTD.
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31
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Laharwal MA, Sarmast AH, Ramzan AU, Wani AA, Malik NK, Arif SH, Rizvi M. Epidemiology of the neural tube defects in Kashmir Valley. Surg Neurol Int 2016; 7:35. [PMID: 27127700 PMCID: PMC4838921 DOI: 10.4103/2152-7806.180088] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 02/24/2016] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Neural tube defects (NTDs) are the most common congenital malformations affecting the brain and spinal cord and have a multifactorial etiology. Genetic and environmental factors have been found to cause these defects, both individually and in combination. METHODS A 2-year hospital-based prospective study was carried out from November 2013 to October 2015 to determine the incidence, types, demographics, risk factors, and other associated anamolies relevant to NTDs in Kashmir Valley. A detailed history of the mother was taken along with detailed clinical examination of neonate including measurement of head circumference and checking the status of fontanella, whether lax/full/bulging/or tense, type of NTD. Investigations that were done included were X-ray skull: Anterior-posterior (AP) and lateral, X-ray spine: AP and lateral, ultrasonography abdomen, magnetic resonance imaging: Spine and brain. RESULTS The total number of babies with NTD's was 125 with an overall incidence of 0.503. Kupwara district was having the highest incidence (1.047) and Srinagar district the lowest incidence of NTD's (0.197). Majority of NTD's (116 cases, 92.8%) were found in the rural areas. Among the different types of NTD's, spina bifida had an incidence of 0.342 (85 cases, 68%) and anencephaly had an incidence of 0.113 (28 cases, 22.4%). There was a slight preponderance of females over males with NTD's. There were 70 females (56%) and 55 males (44%), respectively, with a male: female ratio of 0.8:1. CONCLUSIONS The incidence rates of NTDs is very high for Kashmir Valley. Geographical distribution of NTDs at this place confirms a relationship between the socioeconomic status, educational status, maternal too young or advanced age, and environmental factors for the development of a NTD. The results of this study point to the importance establishing a health policy to prevent NTD in Kashmir Valley.
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Affiliation(s)
- Masood Ahmed Laharwal
- Department of Neurosurgery, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Arif Hussain Sarmast
- Department of Neurosurgery, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Altaf Umer Ramzan
- Department of Neurosurgery, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Abrar Ahad Wani
- Department of Neurosurgery, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Nayil Khursheed Malik
- Department of Neurosurgery, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Sajad Hussain Arif
- Department of Neurosurgery, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Masooma Rizvi
- Department of Obstetrics and Gynaecology, Government Lalla Ded Hospital, Srinagar, Jammu and Kashmir, India
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32
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Singh I, Rohilla S, Kumar P, Sharma S. Spinal dorsal dermal sinus tract: An experience of 21 cases. Surg Neurol Int 2015; 6:S429-34. [PMID: 26539316 PMCID: PMC4604646 DOI: 10.4103/2152-7806.166752] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 06/16/2015] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Spinal dorsal dermal sinus is a rare entity, which usually comes to clinical attention by cutaneous abnormalities, neurologic deficit, and/or infection. The present study was undertaken to know the clinical profile of these patients, to study associated anomalies and to assess the results of surgical intervention. METHODS Medical records of 21 patients treated for spinal dorsal dermal sinus from September 2007 to December 2013 were reviewed. RESULTS We had 21 patients with male: female ratio of 13:8. Only 2 patients were below 1-year of age, and most cases (15) were between 2 and 15 years (mean age = 8.2 years). Lumbar region (11 cases) was most frequently involved, followed by thoracic (4 cases), lumbosacral, and cervical region in 3 patients each. All of our patients presented with neurological deficits. Three patients were admitted with acute meningitis with acute onset paraplegia and had intraspinal abscess. The motor, sensory, and autonomic deficits were seen in 14, 6, and 8 patients, respectively. Scoliosis and congenital talipes equinovarus were the common associated anomalies. All patients underwent surgical exploration and repair of dysraphic state and excision of the sinus. Overall, 20 patients improved or neurological status stabilized and only 1 patient deteriorated. Postoperative wound infection was seen in 2 cases. CONCLUSIONS All patients with spinal dorsal dermal sinuses should be offered aggressive surgical treatment in the form of total excision of sinus tract and correction of spinal malformation, as soon as diagnosed.
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Affiliation(s)
- Ishwar Singh
- Department of Neurosurgery, Pt. B.D. Sharma University of Health Sciences, Rohtak, Haryana, India
| | - Seema Rohilla
- Department of Radiodiagnosis, Pt. B.D. Sharma University of Health Sciences, Rohtak, Haryana, India
| | - Prashant Kumar
- Department of Anaesthesiology and Critical Care, Pt. B.D. Sharma University of Health Sciences, Rohtak, Haryana, India
| | - Saurabh Sharma
- Department of Neurosurgery, Pt. B.D. Sharma University of Health Sciences, Rohtak, Haryana, India
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Ceccarelli G, Pozzo E, Scorletti F, Benedetti L, Cusella G, Ronzoni FL, Sahakyan V, Zambaiti E, Mimmi MC, Calcaterra V, Deprest J, Sampaolesi M, Pelizzo G. Molecular signature of amniotic fluid derived stem cells in the fetal sheep model of myelomeningocele. J Pediatr Surg 2015; 50:1521-7. [PMID: 26026346 DOI: 10.1016/j.jpedsurg.2015.04.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Revised: 02/23/2015] [Accepted: 04/15/2015] [Indexed: 02/01/2023]
Abstract
Abnormal cord development results in spinal cord damage responsible for myelomeningocele (MMC). Amniotic fluid-derived stem cells (AFSCs) have emerged as a potential candidate for applications in regenerative medicine. However, their differentiation potential is largely unknown as well as the molecular signaling orchestrating the accurate spinal cord development. Fetal lambs underwent surgical creation of neural tube defect and its subsequent repair. AFSCs were isolated, cultured and characterized at the 12th (induction of MMC), 16th (repair of malformation), and 20th week of gestation (delivery). After performing open hysterectomy, AF collections on fetuses with sham procedures at the same time points as the MMC creation group have been used as controls. Cytological analyses with the colony forming unit assay, XTT and alkaline-phosphatase staining, qRT-PCR gene expression analyses (normalized with aged match controls) and NMR metabolomics profiling were performed. Here we show for the first time the metabolomics and molecular signature variation in AFSCs isolated in the sheep model of MMC, which may be used as diagnostic tools for the in utero identification of the neural tube damage. Intriguingly, PAX3 gene involved in the murine model for spina bifida is modulated in AFSCs reaching the peak of expression at 16 weeks of gestation, 4 weeks after the intervention. Our data strongly suggest that AFSCs reorganize their differentiation commitment in order to generate PAX3-expressing progenitors to counteract the MMC induced in the sheep model. The gene expression signature of AFSCs highlights the plasticity of these cells reflecting possible alterations of embryonic development.
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Affiliation(s)
- Gabriele Ceccarelli
- Department of Public Health, Experimental and Forensic Medicine, Division of Human Anatomy, University of Pavia, Pavia, Italy
| | - Enrico Pozzo
- Department of Public Health, Experimental and Forensic Medicine, Division of Human Anatomy, University of Pavia, Pavia, Italy; Department of Development and Reproduction, Stem Cell Institute, Translational Cardiomyology Laboratory, KU Leuven, Leuven, Belgium
| | - Federico Scorletti
- Department of Maternal and Children's Health, Paediatric Surgery Unit, Fondazione IRCCS Policlinico San Matteo and University of Pavia, Pavia, Italy
| | - Laura Benedetti
- Department of Public Health, Experimental and Forensic Medicine, Division of Human Anatomy, University of Pavia, Pavia, Italy
| | - Gabriella Cusella
- Department of Public Health, Experimental and Forensic Medicine, Division of Human Anatomy, University of Pavia, Pavia, Italy
| | - Flavio Lorenzo Ronzoni
- Department of Pathology and Immunology, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Vardine Sahakyan
- Department of Development and Reproduction, Stem Cell Institute, Translational Cardiomyology Laboratory, KU Leuven, Leuven, Belgium
| | - Elisa Zambaiti
- Department of Maternal and Children's Health, Paediatric Surgery Unit, Fondazione IRCCS Policlinico San Matteo and University of Pavia, Pavia, Italy
| | - Maria Chiara Mimmi
- Department of Medical and Biological Sciences, University of Udine, Udine, Italy
| | - Valeria Calcaterra
- Department of Internal Medicine, University of Pavia and Department of Maternal and Children's Health, Paediatric Endocrinology and Diabetes Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Jan Deprest
- Department Development and Regeneration, Organ System Cluster and Stem Cell Institute, Group Biomedical Sciences and Division Woman and Child, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Maurilio Sampaolesi
- Department of Public Health, Experimental and Forensic Medicine, Division of Human Anatomy, University of Pavia, Pavia, Italy; Department of Development and Reproduction, Stem Cell Institute, Translational Cardiomyology Laboratory, KU Leuven, Leuven, Belgium.
| | - Gloria Pelizzo
- Department of Maternal and Children's Health, Paediatric Surgery Unit, Fondazione IRCCS Policlinico San Matteo and University of Pavia, Pavia, Italy
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Abstract
Myelomeningocele has been recognized since ancient times although written descriptions began not before the 17th century. Among all serious congenital malformations, myelomeningocele is unique that is has a steady and considerable prevalence while being compatible with life. It has a dismal prognosis when left untreated where virtually all die within the first year while aggressive treatment have a profound effect on survival and quality of life. Effective surgical treatment became possible parallel to the treatment of hydrocephalus in the late 1950s. Advent of the shunt systems undoubtedly changed the morbidity and mortality rates due to associated hydrocephalus. Aggressive and effective treatment improved survival rates but also those suffering physical and mental disabilities have increased as well. Ethical and socioeconomic concerns have led to proposal for selective treatment criteria which have raised arguments on medical and ethico-legal rounds. After the swing of the pendulum between early treatment in all affected children and selective treatment of those who fulfilled the criteria for good prognosis, early myelomeningocele repair is practiced widely unless the infant is critically ill.Incidence of myelomeningocele has been decreasing especially in the Western world, partly due to prenatal diagnosis and elective terminations, dietary folate supplementation. Still, it is the most common central nervous system malformation and one of the leading causes of paraplegia, worldwide. Unfortunately, gains in the management of myelomeningocele have been mainly on antenatal diagnosis and prevention while efforts on understanding its cause, mechanisms involved are still tentative. Concerning the surgical management, no revolutionary modification improving outcome has been introduced unlike other fields of neurosurgery.Medical management of a child with myelomeningocele requires a lifelong effort of several disciplines including urology, orthopedics physical and social therapy besides neurosurgery. The initial and probably the most crucial step begin with proper repair of the lesion. The aim of surgery, with its simplest definition should be towards maintaining the medical condition of the newborn. In other words, consequences of an open spinal cord segment with associated malformations have to be avoided with appropriate measures. Comparable to the surgical treatment of any congenital malformation, myelomeningocele repair consist of reversing the failed steps of normal neural tube closure. This requires a thorough understanding of the normal and abnormal embryological sequence of events in formation of the spinal cord. Although the purpose of this chapter is to describe the basic concepts and technique of myelomeningocele repair, contemporary information and progress on epidemiology, and etiology and embryology is presented with discussion of controversial issues regarding the selection process, optimal time for surgery and technical modifications.
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Sewell MJ, Chiu YE, Drolet BA. Neural tube dysraphism: review of cutaneous markers and imaging. Pediatr Dermatol 2015; 32:161-70. [PMID: 25557454 DOI: 10.1111/pde.12485] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Neural tube dysraphisms are congenital anomalies resulting from impaired formation of structures along the craniospinal axis during central nervous system development. When these malformations are large or lack a skin covering, they are easily recognized, whereas smaller or skin-covered malformations may not be readily apparent. Due to the intimate embryologic origin of the skin and nervous system, these occult malformations are often heralded by associated cutaneous abnormalities. In this article, the common clinical presentations and cutaneous markers of craniospinal dysraphism are reviewed, along with the recommended imaging modalities.
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Affiliation(s)
- Matthew J Sewell
- Department of Dermatology, Virginia Commonwealth University, Richmond, Virginia
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Papaevangelou G, Tsitsopoulos PP, Flaris N, Iliadis C, Tsonidis C. Dermal Sinus Tract of the Thoracic Spine Presenting with Intramedullary Abscess and Cranial Nerve Deficits. Pediatr Neurosurg 2015; 50:339-43. [PMID: 26458220 DOI: 10.1159/000439539] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 08/17/2015] [Indexed: 11/19/2022]
Abstract
Congenital dermal sinus tract of the spine is an unusual developmental defect which represents a failure of the surface ectoderm and dermal elements to separate from the neuroectoderm. A 15-month-old female presented with high fever, severe right hemiparesis, difficulty breathing and cranial nerve deficits. Magnetic resonance imaging (MRI) of the spine revealed a congenital dermal sinus tract at the Th6 level, an intramedullary collection extending up to the brainstem and a probable intramedullary cystic lesion. The child was operated acutely with ligation of the sinus tract, drainage of the abscess and partial removal of the intramedullary lesion. Due to abscess recurrence, she was reoperated with complete excision of the dermal sinus tract, abscess redrainage and subtotal excision of the dermoid cyst (retaining a part of its capsule). Pus culture isolated Corynebacterium species and Peptococcus species and histology of the lesion showed a dermoid cyst. Postoperatively, after an initial neurologic deterioration, she progressively improved. An MRI scan at 15 months neither showed recurrence of the collection nor regrowth of the lesion. Spinal dermal sinus tracts that remain unnoticed or untreated can result in serious complications and should be operated as soon as possible to prevent undesirable sequelae.
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Lee SH. A Case of Dermal Sinus Tract with Recurrent Meningitis in a 3-Month-Old Infant. NEONATAL MEDICINE 2015. [DOI: 10.5385/nm.2015.22.3.177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Seung Hyun Lee
- Department of Pediatrics, Wonkwang University School of Medicine, Iksan, Korea
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Gavriliu S, Vlad C, Georgescu I, Burnei G. Diastematomyelia in congenital scoliosis: a report of two cases. 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 2014; 23 Suppl 2:262-6. [PMID: 24535633 DOI: 10.1007/s00586-014-3218-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Revised: 01/23/2014] [Accepted: 01/25/2014] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Even if diastematomyelia is a rare condition, it always has to be identified in case of diagnosing and treating a case of congenital scoliosis. The consequence of missing the diagnosis of such a malformation may be devastating to the involved patient. This paper wants once again to make aware the physicians of the eventual presence of a spinal dysraphic malformation when dealing with a congenital spinal malformation. METHODS The presence of diastematomyelia was noticed in two of our cases, one with congenital scoliosis and another with congenital kyphoscoliosis. First of all in these cases, we performed the resection of the bony septum, followed by spinal fusion in a single-stage surgical procedure. We noticed no complications during and after surgery related to the resection of the bony septum. RESULTS In both patients, we obtained partial correction and stabilization of the congenital spinal malformation after a safe excision of the bony septum. CONCLUSIONS Diastematomyelia is a rare condition. It has to be taken into consideration when dealing with a congenital scoliosis. The first step in the surgical procedure has to be the resection of the diastematomyelic septum. In case of a scoliosis ranging up to 30° and not presenting a progressive potential, the expectative-evaluation attitude is a correct one.
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Affiliation(s)
- Stefan Gavriliu
- Clinical Emergency Hospital for Children "Maria Sklodowska Curie", 20 C-tin Brancoveanu, Bucharest, Romania,
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Health-related quality of life in children and adolescents with spinal dysraphism: results from a Taiwanese sample. Childs Nerv Syst 2013; 29:1671-9. [PMID: 24013337 DOI: 10.1007/s00381-013-2117-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2013] [Accepted: 04/15/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE This study was designed to investigate health-related quality of life (HRQL) in children and adolescents with spinal dysraphism and to determine the differences between the myelomeningocele (MMC) and lipomyelomeningocele (LMMC) groups. METHODS Thirty-two patients (mean age, 13.2 years) with MMC and 28 patients (mean age, 11.3 years) with LMMC participated in this study. HRQL was measured using the Child Health Questionnaire-Parent Form 50 (CHQ-PF50). The CHQ-PF50 scores for the study participants were compared with those of a reference sample of healthy Taiwanese children. Outcomes for children with MMC were compared with those for children with LMMC. We also explored the relationships of the lesion level and associated medical problems with HRQL in these subjects. RESULTS Patients with MMC had significantly lower scores on the physical and psychosocial aspects of CHQ-PF50 than did healthy children. Patients with LMMC had lower scores on some domains but had comparable psychosocial summary scores. Significant differences were noted between the MMC and LMMC groups for all subscales and both summary scores. Children with a higher lesion level had poor physical health (r = -0.52, P < 0.001) but not poor psychosocial health. The number of associated medical problems, indicating their severity, was related to both physical (r = -0.77, P < 0.001) and psychosocial health (r = -0.57, P < 0.001). CONCLUSIONS Children and adolescents with MMC have reduced HRQL compared with those with LMMC. Children and adolescents with more associated medical problems have the greatest risk of diminished physical and psychosocial well-being.
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Prevention of myelomeningocele: African perspectives. Childs Nerv Syst 2013; 29:1533-40. [PMID: 24013323 DOI: 10.1007/s00381-013-2126-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Accepted: 04/19/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND The prevention of neural tube defects (NTDs) is now an issue of major public health concern. Myelomeningocele, the most common NTD, often results in severe disabilities and may be life threatening. In Africa, there is little awareness of the NTDs, and most African countries lag behind in the global efforts at preventing them. PURPOSE Following a review of global literature, we discuss the burden of myelomeningocele on the society and the current state of its prevention with an emphasis on Africa within the global context. The realization that folate supplementation reduces the occurrence of NTDs by as much as 85 % offers an opportunity to promote global reduction in the incidence of NTDs through (1) effective folate supplementation strategies combined with (2) secondary prevention using prenatal detection and termination of NTD pregnancies within respective national legal frameworks. We call attention to the poor state of understanding of NTDs in Africa and the alarming rarity of policies to prevent the condition in the continent. CONCLUSIONS The understanding of the contributions of folate deficiency to the causation of NTDs has enabled appropriate, though still inadequate, preventive measures to be taken in several countries. We call on African governments and the international community to rapidly promote policies aimed at making fortification of wheat (and or other substitute staple foods) with folic acid universally available.
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Abstract
Diabetes mellitus is responsible for nearly 10% of fetal anomalies in diabetic pregnancies. Although aggressive perinatal care and glycemic control are available in developed countries, the birth defect rate in diabetic pregnancies remains higher than that in the general population. Major cellular activities (ie, proliferation and apoptosis) and intracellular metabolic conditions (ie, nitrosative, oxidative, and endoplasmic reticulum stress) have been shown to be associated with diabetic embryopathy using animal models. Translating advances made in animal studies into clinical applications in humans requires collaborative efforts across the basic research, preclinical, and clinical communities.
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Affiliation(s)
- Zhiyong Zhao
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
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Manuela Pérez M, Karla Moënne B, Felipe Otayza M, Marcelo Gálvez M. Caso clinico radiologico marcadores cutáneos y disrafia espinal: A propósito de un caso. REVISTA MÉDICA CLÍNICA LAS CONDES 2011. [DOI: 10.1016/s0716-8640(11)70498-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Radmanesh F, Nejat F, El Khashab M. Infection in myelomeningocele after VP shunt placement. Childs Nerv Syst 2011; 27:341-2; author reply 343-4. [PMID: 21210126 DOI: 10.1007/s00381-010-1376-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2010] [Accepted: 12/15/2010] [Indexed: 11/26/2022]
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Abdollahi Z, Elmadfa I, Djazayery A, Golalipour M, Sadighi J, Salehi F, Sadeghian Sharif S. Efficacy of Flour Fortification with Folic Acid in Women of Childbearing Age in Iran. ANNALS OF NUTRITION AND METABOLISM 2011; 58:188-96. [DOI: 10.1159/000329726] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2010] [Accepted: 05/30/2011] [Indexed: 12/12/2022]
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International survey on the management of skin stigmata and suspected tethered cord. Childs Nerv Syst 2010; 26:1719-25. [PMID: 20563728 DOI: 10.1007/s00381-010-1184-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2010] [Accepted: 05/11/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVES We designed a survey to investigate current international management trends of neonates with lumbar midline skin stigmata suspicious of tethered cord, among pediatric neurosurgeons, focusing on the lower risk stigmata, simple dimples, deviated gluteal folds, and discolorations. Our findings will enable physicians to assess their current diagnosis routine and aid in clarifying management controversies. STUDY DESIGN A questionnaire on the proposed diagnostic evaluation of seven case reports, each accompanied by relevant imaging, was distributed by e-mail to members of the International Society for Pediatric Neurosurgery, the European Society for Pediatric Neurosurgery, and via the PEDS server list between March and August 2008. RESULTS Sixty-two questionnaires, completed by experienced professionals with a rather uniform distribution of experience levels, were analyzed. Forty-eight percent do not recommend any imaging of simple dimples, 30% recommend US screening and 22% recommend MR. Seventy-nine percent recommend imaging of deviated gluteal fold with 30% recommending MR. Ninety-two percent recommend imaging infants with hemangiomas with 74% recommending MR. MR for sinus tracts is recommended by 90% if sacral and by 98% if lumber. Eighty-four percent recommend MR for filar cyst. CONCLUSIONS Our survey demonstrates that management of low-risk skin stigmata, simple dimple, deviated gluteal fold, and discolorations lacks consensus. In addition, a significant sector of the professional community proposes a work-up of simple dimples, sacral tracts, and filar cysts that contradicts established recommendations. A simple classification system is needed to attain a better approach, enabling correct diagnosis of tethered cord without exposing neonates to unnecessary examinations.
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Cornegé-Blokland E, Jansen HE, de Jong-de Vos van Steenwijk CCE, Poenaru D. Quality of life of children with spina bifida in Kenya is not related to the degree of the spinal defects. Trop Med Int Health 2010; 16:30-6. [DOI: 10.1111/j.1365-3156.2010.02680.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Guardiola A, Koltermann V, Aguiar PM, Grossi SP, Fleck V, Pereira EC, Pellanda L. Neurological congenital malformations in a tertiary hospital in south Brazil. ARQUIVOS DE NEURO-PSIQUIATRIA 2010; 67:807-11. [PMID: 19838508 DOI: 10.1590/s0004-282x2009000500005] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 02/26/2009] [Accepted: 08/13/2009] [Indexed: 11/22/2022]
Abstract
BACKGROUND Congenital anomalies are one of the main causes of morbidity and mortality among infants. The involvement of the central nervous system (CNS) occurs in 21% of cases. OBJECTIVE To identify incidence of CNS malformations and associated factors in newborns at a Terciary Hospital of Porto Alegre. METHOD Case-control study conducted between 2000 and 2005 based on the Latin American Collaborative Study of Congenital Malformations database. RESULTS Among 26,588 births registered in this period, 3.67% presented with malformations (IC=95%; 3.44-3.9), being 0.36% of the CNS (IC=95%,(0.29-0.43)). The most common CNS malformation was meningomielocele (10.4%). Young maternal age (p=0.005); low birth weight (p=0.015); large cephalic perimeter (p=0.003); post term birth (p=0.000) and low APGAR indexes at the 1st and 5th minutes were associated with CNS malformations. CONCLUSION We found an incidence of CNS malformations similar as compared to literature.
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Affiliation(s)
- Ana Guardiola
- Federal University Foundation of Porto Alegre, Porto Alegre, RS, Brazil.
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Uz E, Alanay Y, Aktas D, Vargel I, Gucer S, Tuncbilek G, von Eggeling F, Yilmaz E, Deren O, Posorski N, Ozdag H, Liehr T, Balci S, Alikasifoglu M, Wollnik B, Akarsu NA. Disruption of ALX1 causes extreme microphthalmia and severe facial clefting: expanding the spectrum of autosomal-recessive ALX-related frontonasal dysplasia. Am J Hum Genet 2010; 86:789-96. [PMID: 20451171 DOI: 10.1016/j.ajhg.2010.04.002] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2010] [Revised: 04/05/2010] [Accepted: 04/09/2010] [Indexed: 01/01/2023] Open
Abstract
We present an autosomal-recessive frontonasal dysplasia (FND) characterized by bilateral extreme microphthalmia, bilateral oblique facial cleft, complete cleft palate, hypertelorism, wide nasal bridge with hypoplasia of the ala nasi, and low-set, posteriorly rotated ears in two distinct families. Using Affymetrix 250K SNP array genotyping and homozygosity mapping, we mapped this clinical entity to chromosome 12q21. In one of the families, three siblings were affected, and CNV analysis of the critical region showed a homozygous 3.7 Mb deletion containing the ALX1 (CART1) gene, which encodes the aristaless-like homeobox 1 transcription factor. In the second family we identified a homozygous donor-splice-site mutation (c.531+1G > A) in the ALX1 gene, providing evidence that complete loss of function of ALX1 protein causes severe disruption of early craniofacial development. Unlike loss of its murine ortholog, loss of human ALX1 does not result in neural-tube defects; however, it does severely affect the orchestrated fusion between frontonasal, nasomedial, nasolateral, and maxillary processes during early-stage embryogenesis. This study further expands the spectrum of the recently recognized autosomal-recessive ALX-related FND phenotype in humans.
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Affiliation(s)
- Elif Uz
- Gene Mapping Laboratory, Department of Medical Genetics, Hacettepe University Medical Faculty, Sihhiye, Ankara, Turkey
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Anesthetic concerns and perioperative complications in repair of myelomeningocele: a retrospective review of 135 cases. J Neurosurg Anesthesiol 2010; 22:11-5. [PMID: 19779365 DOI: 10.1097/ana.0b013e3181bb44a9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Myelomeningocele (MMC) a complex congenital spinal anomaly, results from neural tube defect during first 4 weeks of gestation. Medical records of 135 children who underwent excision and repair of MMC from January 2003 to December 2006 were analyzed, retrospectively. Data on associated illnesses, anesthetic management, perioperative complications, and outcome were recorded. The patient population consisted of older infants with unrepaired MMC. The average age of presentation was 1 year and 8 months. The commonest site of presentation was lumbar (39.3%). Leaking MMC was present in 19.3% of cases, most had associated electrolyte imbalance. Hydrocephalus was the commonest association (67.4%) followed by Chiari-II malformation (58.4%). Renal abnormality was present in 9% of cases and 24.4% of children had scoliosis. Two infants (1.5%) presented with inspiratory stridor. Intraoperative cardiac and respiratory problems were observed in 15.6% and 11.1%, of cases, respectively. Two children (1.5%) suffered cardiac arrest; both had associated Chiari-II malformation and hydrocephalus. Postoperative ventilation was required in 8.9% of children, primarily due to inadequate reversal from neuromuscular blockade. Infection, cerebrospinal fluid leak, and pseudomeningocele were common surgical complications. Improvement of motor, sensory, and sphincteric function was observed in 30.5%, 22.9%, and 14.1%, respectively. To conclude, surgical repair of MMC may at times pose life-threatening complications mostly because of associated anomalies. Children with associated Chiari malformation and/or hydrocephalus need special attention during perioperative period.
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Abstract
OBJECTIVE Spinal dermal sinus tract (DST) is a rare entity which usually comes to clinical attention by cutaneous abnormalities, neurologic deficit, and/or infection. We performed this study to assess presentation patterns, associated anomalies, radiologic, urologic, and surgical findings in children afflicted with spinal DST. METHODS Medical records of 35 children treated for spinal DST in Children's Medical Center from January 2001 to December 2008 were reviewed. RESULTS Patients' age ranged from 3 days to 8.44 years. Dermal sinuses were located most frequently in the lumbar and lumbosacral regions. The most common causes for referral were abnormal skin findings (57.1%) and infection (31.4%). Notably eight patients presented with meningitis. The overall rate of neurologic abnormalities was 37.1%, four of whom presented acutely with rapidly progressive paraplegia and meningitis. The most common magnetic resonance imaging finding was tethered cord (63%). At least one urological evaluation was performed in 30 patients, which revealed abnormal results in 77% of them. All patients underwent complete resection of the tract and repair of associated abnormalities. Most tracts terminated within the intradural space. Fifteen patients (42.8%) had inclusion tumor with the dermoid tumor being the most common. None of the patients demonstrated neurological deterioration postoperatively. CONCLUSION Dermal sinus tract is an innocuous-appearing spinal dysraphism that may contribute to devastating morbidities if not timely addressed. In order to prevent complications, timely surgical intervention including complete resection of sinus tract with intradural exploration and correction of associated abnormalities is of utmost importance.
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Affiliation(s)
- Farid Radmanesh
- Department of Neurosurgery, Children's Hospital Medical Center, Tehran University of Medical Sciences, Tehran, 14155-7854, Iran
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