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Deo RC, Acharya A, Mahapatra AK, Panigrahi S. Thoracic bony human tail in a newborn baby: a rare case and review of literature. Childs Nerv Syst 2023; 39:3317-3321. [PMID: 37289286 DOI: 10.1007/s00381-023-06013-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 05/28/2023] [Indexed: 06/09/2023]
Abstract
BACKGROUND The dorsal cutaneous appendage or so-called human tail is considered to be a cutaneous marker of underlying occult dysraphism. CASE PRESENTATION We are presenting an unusual case of spinal dysraphism with a bony human tail at midthoracic region occurring in a newborn baby with tethered cord (conus at L4). Physical examination was unremarkable except for a thoracic appendage and a dermal sinus over coccyx region. Magnetic resonance imaging (MRI) scan of spine revealed bony outgrowth arising from D7 posterior element with multiple butterfly-shaped vertebrae found at D2 D4 D8 D9 D10 with low-lying conus at L4-L5 level. Surgical excision of the tail and untethering of the spinal cord along with excision of dermal sinus were performed. The infant had an uneventful postoperative period and was unchanged neurologically. CONCLUSION To our knowledge, no similar case has been reported in English literature till date. DISCUSSION The specific features of this rare case of human tail treated surgically are discussed in light of the available literature.
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Affiliation(s)
- Rama Chandra Deo
- Department of Neurosurgery, IMS and SUM Hospital, Kalinga Nagar, Bhubaneswar, Odisha, India.
| | - Abhijit Acharya
- Department of Neurosurgery, IMS and SUM Hospital, Kalinga Nagar, Bhubaneswar, Odisha, India
| | - A K Mahapatra
- Department of Neurosurgery, IMS and SUM Hospital, Kalinga Nagar, Bhubaneswar, Odisha, India
| | - Souvagya Panigrahi
- Department of Neurosurgery, IMS and SUM Hospital, Kalinga Nagar, Bhubaneswar, Odisha, India
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Tojima S, Yamada S. Classification of the "human tail": Correlation between position, associated anomalies, and causes. Clin Anat 2020; 33:929-942. [PMID: 32319695 DOI: 10.1002/ca.23609] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 04/15/2020] [Accepted: 04/18/2020] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Numerous case reports have indicated that the "human tail" is not always a harmless protrusion but can be associated with anomalies such as occult dysraphic malformations. However, the definition and classification of this anomaly have not been discussed. A prevailing hypothesis is that the "human tail" is a residual embryonic tail. Herein, we attempted to classify and define the human tail and investigate the frequency of this anomaly. MATERIALS AND METHODS We first defined the human tail as a protrusion on the dorsal side of the lumbar, sacrococcygeal, and para-anal regions identified after birth. We collected case reports written in English, Japanese, French, German, and Italian that were published from the 1880s to the present. RESULTS We discovered two important findings: (a) the cause of this anomaly may differ even though the "tails" resemble each other closely in appearance and (b) its position tends to be correlated with the type of anomaly and its associated cause. We propose a new classification of the human tail based on these findings. CONCLUSION Our classification may facilitate more accurate treatment and precise case descriptions of the human tail.
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Affiliation(s)
- Sayaka Tojima
- Department of Anatomy and Cell Biology, Graduate School of Medicine, Osaka City University, Abeno-ku, Osaka, Japan
| | - Shigehito Yamada
- Congenital Anomaly Research Center, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Human Health Science, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Proposed caudal appendage classification system; spinal cord tethering associated with sacrococcygeal eversion. Childs Nerv Syst 2017; 33:69-89. [PMID: 27497702 DOI: 10.1007/s00381-016-3208-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 07/26/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The most commonly used classification system for caudal appendages (aka human tails) dates from the 1980s and classifies appendages (tails) as either true tails or pseudotails. Advances in neuroimaging since the 1980s, however, as well as an ever-increasing number of reported cases, have made this system outdated. Sacrococcygeal eversion is a condition in which the distal sacral and coccygeal vertebrae are curved in a retroverted rather than anteverted direction. It can give rise to one type of caudal appendage. Sacrococcygeal eversion has never been associated with spinal cord tethering in any previously published reports. METHODS We reviewed all cases of caudal appendage encountered by pediatric neurosurgeons at Children's Hospital Colorado since 2000 in which the appendage would be classified as a true tail by the most commonly used system mentioned above. We also reviewed cases of sacrococcygeal eversion encountered since 2000 by the same group of pediatric neurosurgeons. We searched the hospital electronic medical record system for additional appendages using the terms "caudal appendage" and "persistent human tail." RESULTS We found 9 "true" tails (as classified by the most commonly used system). All 9 were associated with tethering or possible tethering of the spinal cord and 6 were associated with a low-lying conus medullaris. There were 8 cases of sacrococcygeal eversion, including 2 associated with Apert or Pfeiffer syndrome and fibroblast growth factor receptor 2 (FGFR2) mutations; these have previously been reported. There was a single case of sacrococcygeal eversion associated with Goldenhar or Turner syndrome; the former was associated with a potentially tethering lesion. Four cases of sacrococcygeal eversion not associated with any known syndrome were also found; two of these were associated with tethering or potentially tethering lesions. CONCLUSIONS Most so-called true tails are likely cutaneous markers for spinal dysraphism and spinal cord tethering and are not remnants of the embryonic human tail. Sacrococcygeal eversion can be associated with spinal cord tethering. Based on our cases, and on review of the literature, we devised a five-category classification system for caudal appendages: (1) soft-tissue caudal appendages, (2) bony caudal appendages, (3) bony caudal prominences, (4) true tails, and (5) "other" caudal appendages.
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Abstract
Human tail refers to a congenital cutaneous appendix protruding from the lumbosacral region. It is usually associated with an underlying spina bifida occulta, a form of spinal dysraphism. A contiguous fibrolipoma can sometimes be seen extending from the subcutaneous portion of the tail into the inferior spinal cord, resulting in tethered cord syndrome. Management of such lesions includes complete neurologic examination and magnetic resonance imaging. Early diagnosis and microsurgical intervention can prevent development or progression of severe neurologic defects in later life.
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Affiliation(s)
- Dipti Kumar
- Kapoor Newborn and Childcare Center, New Delhi, India.
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Pang D, Zovickian J, Moes GS. Retained medullary cord in humans: late arrest of secondary neurulation. Neurosurgery 2011; 68:1500-19; discussion 1519. [PMID: 21336222 DOI: 10.1227/neu.0b013e31820ee282] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Formation of the caudal spinal cord in vertebrates is by secondary neurulation, which begins with mesenchyme-epithelium transformation within a pluripotential blastema called the tail bud or caudal cell mass, from thence initiating an event sequence proceeding from the condensation of mesenchyme into a solid medullary cord, intrachordal lumen formation, to eventual partial degeneration of the cavitatory medullary cord until, in human and tailless mammals, only the conus and filum remain. OBJECTIVE We describe a secondary neurulation malformation probably representing an undegenerated medullary cord that causes tethered cord symptoms. METHOD We present 7 patients with a robust elongated neural structure continuous from the conus and extending to the dural cul-de-sac, complete with issuing nerve roots, which, except in 2 infants, produced neurological deficits by tethering. RESULTS Intraoperative motor root and direct cord stimulation indicated that a large portion of this stout neural structure was "redundant" nonfunctional spinal cord below the true conus. Histopathology of the redundant cord resected at surgery showed a glioneuronal core with ependyma-lined lumen, nerve roots, and dorsal root ganglia, corroborating the picture of a blighted spinal cord. CONCLUSION We propose that these redundant spinal cords are portions of the medullary cord normally destined to regress but are here retained because of late arrest of secondary neurulation before the degenerative phase. Because programmed cell death almost certainly plays a central role during degeneration, defective apoptosis may be the underlying mechanism.
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Affiliation(s)
- Dachling Pang
- Department of Pediatric Neurosurgery, University of California, Davis, Davis, California, USA.
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Pettorini BL, Massimi L, Cianfoni A, Paternoster G, Tamburini G, Di Rocco C. Thoracic lipomeningocele associated with diastematomyelia, tethered spinal cord, and hydrocephalus. J Neurosurg Pediatr 2007; 106:394-7. [PMID: 17566209 DOI: 10.3171/ped.2007.106.5.394] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Accessory human tails are uncommon malformations consisting of meningeal and neural structures and possibly occult spinal dysraphism (pseudotails). The thoracic location of a lipomeningocele constituting a pseudotail is very rare. The authors report the case of a young boy harboring a thoracic dorsal appendage consisting of a lipomeningocele and a dermoid cyst that was complicated by the presence of diastematomyelia, tethered spinal cord, syringomyelia, and mild hydrocephalus. The preoperative moderate ventricular dilation was decompressed by the surgical repair of the spinal malformation and required a specific treatment. The authors discuss the rare association of these clinical entities and conclude that complete spine and brain neuroimaging studies are necessary for the correct surgical planning of this kind of malformation.
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Lin PJ, Chang YT, Tseng HI, Lin JY, Huang YS. Human tail and myelomeningocele. Pediatr Neurosurg 2007; 43:334-7. [PMID: 17627154 DOI: 10.1159/000103318] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2005] [Accepted: 07/19/2006] [Indexed: 11/19/2022]
Abstract
The human tail is rarely reported and is usually associated with underlying spina bifida occulta. A male newborn presenting a caudal appendage (human tail) with skin-covered myelomeningocele and tethered cord is described. Surgical excision of the human tail and repair of the myelomeningocele were performed 3 days after birth. After the operation, the patient had an uneventful convalescence and received follow-up at our outpatient clinic without any neurological sequelae. To our knowledge, no similar case report exists in the literature. Like other skin-related lesions in the lumbosacral area, the present case of caudal appendage with myelomeningocele is only a cutaneous sign of underlying spinal dysraphism since the skin and nerve system are related by their similar ectodermal origin. After excision of the tail and repair of an underlying lesion, long-term follow-up of the neurological status is warranted.
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Affiliation(s)
- Pei-Jung Lin
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
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Abstract
STUDY DESIGN Human tails continue to elicit curiosity till the present times. A unique case of human cervical dysraphism is described. OBJECTIVES In addition to the cosmetic stigma, these cutaneous markers provide a lead to reach the underlying spinal dysraphic states. SETTING Plains of North India. METHODS A case of human tail at the neck region is presented, whose cutaneous deformity lead the clinicians to his underlying spinal dysraphic state. RESULTS The final outcome of the patient was favorable. CONCLUSION Such markers should always be looked upon with a caution. The present report describes a unique case of a human neck tail, a causing cervical cord tethering.
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Affiliation(s)
- S Mohindra
- 1Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Amirjamshidi A, Abbassioun K, Shirani Bidabadi M. Skin-covered midline spinal anomalies: a report of four rare cases with a discussion on their genesis and milestones in surgical management. Childs Nerv Syst 2006; 22:460-5. [PMID: 16450132 DOI: 10.1007/s00381-005-0014-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND The differential diagnosis for a dorsal midline mass presenting in a newborn encompasses a wide range of pathological conditions, including spinal dysraphisms, tumoral overgrowths including teratoma and hamartoma, disturbances in regression of fetal tail, and pseudotail formation. OBJECTIVES To present (a) three rare cases of human tails and one case of tethered cord due to a midline anomaly resembling part of a human limb, (b) to discuss different kinds of clinical and pathological conditions which may be encountered in such newborns, (c) to hypothesize a theory about genesis of these congenital lesions, and (d) to remind drawbacks in preoperative evaluations and surgical management of these newborns. MATERIALS AND METHODS Four newborns with dorsal midline malformations initially diagnosed as heterotopias are presented. Appropriate preoperative investigations and proper surgical interventions leading to resection of the lesions were performed. All four were skin-covered lesions containing well-differentiated cellular elements of fat, vascular, muscular, bony, and cartilaginous origin. Midline spinal dysraphism was detectable both pre- and intraoperatively only in one case in which cord untethering was also performed along with the first surgical intervention. In the other three "tailed cases," midline bone defect could not be detected in the available X-ray films; consequently, simple excision of the tail-like lesions was done. The first patient had to be explored for repeat untethering of the cord after 4 years, but the others have not yet developed any sign of tethering during an average period of 12 years follow-up. CONCLUSION Morphological diagnosis of these lesions is not easy, and the attending pediatrician and neurosurgeon should be familiar with the differential diagnosis of such lesions and be prepared for possible time-consuming operation mandatory to achieve total resection of the lesion in a newborn under general anesthesia. Reviewing the possible theories regarding the genesis of such anomalies, it is hypothesized and suggested that all similar cases could have been of hamartomatous origin rather than defects of embryogenesis.
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Affiliation(s)
- A Amirjamshidi
- Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.
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Park SH, Huh JS, Cho KH, Shin YS, Kim SH, Ahn YH, Cho KG, Yoon SH. Teratoma in human tail lipoma. Pediatr Neurosurg 2005; 41:158-61. [PMID: 15995336 DOI: 10.1159/000085876] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2004] [Accepted: 01/10/2005] [Indexed: 11/19/2022]
Abstract
We report a case of a rare congenital teratoma that developed in a lipoma attached to a remnant human tail. A male newborn baby presented with a large, 3-cm mass with an open margin, which pedunculated from a tail attached to the midline skin of the coccygeal area. Magnetic resonance images demonstrated multiple sacral spinal bifida without cord tethering, and also showed neural roots and a lipoma and teratoma with peripheral homogeneous high density and internal low density on T(2)-weighted images. Intraoperatively, we found and dissected two nerve roots from the filum terminale which extended into the mass. Pathologic examination of the mass revealed abnormal differentiation of respiratory epithelium and squamous cell metaplasia along the open margin of the mass, and mainly lipoma in the rest of the mass. We suggest that this case could support the hypothesis of transient teratomatous cells in the pathogenesis of the spina bifida with lumbosacral lipoma.
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Affiliation(s)
- Se-Hyuck Park
- Department of Neurosurgery, Kandong Sacred Heart Hospital, Hallym University, Seoul, Korea
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Donovan DJ, Pedersen RC. Human tail with noncontiguous intraspinal lipoma and spinal cord tethering: case report and embryologic discussion. Pediatr Neurosurg 2005; 41:35-40. [PMID: 15886511 DOI: 10.1159/000084863] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2004] [Accepted: 11/07/2004] [Indexed: 11/19/2022]
Abstract
Children born with a tail-like appendage have a rare malformation that is frequently associated with abnormalities of the spine and spinal cord. A contiguous fibrolipoma is usually seen extending from the subcutaneous portion of the tail into the inferior spinal cord, resulting in tethered cord syndrome. We present the case of a child born with a tail and intraspinal lipoma that were not contiguous with each other, and were separated by an intact layer of lumbosacral fascia. The tail and lipoma were removed and the spinal cord untethered, and the child is neurologically normal 2 years after surgery. The absence of a contiguous lipoma from the tail to the spinal cord suggests that this condition may be principally caused by a disorder of secondary neurulation and/or regression of the normal embryonic tail bud. The embryology of the lower spine is reviewed and possible etiologies discussed.
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Affiliation(s)
- Daniel J Donovan
- Neurosurgery Service, Department of Surgery, Tripler Army Medical Center, Honolulu, Hawaii, USA. daniel.
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Ishikawa E, Matsumura A, Enomoto T, Tsurubuchi T, Nose T. Ectopic fingerlike structure in the thoracic region. Case report. J Neurosurg 2001; 95:250-2. [PMID: 11599847 DOI: 10.3171/spi.2001.95.2.0250] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The authors present a case of a rare cutaneous lesion resembling a human finger that protruded from the posterior thoracic region of a 7-month-old girl who was examined after the fingerlike protrusion was noted at birth. The protrusion measured 3 cm in length and 1 cm in diameter. It was located at the level of T-12 and was surrounded by angiomatous and lipomatous tissue. A computerized tomography scan demonstrated three bones in the protrusion. including deformities of the T-9 and T-10 and T-11 dysraphism. Magnetic resonance imaging revealed a hyperintense signal on the T1-weighted sequence and a hypointense signal on the T2-weighted sequence, which was visualized at the attachment to the spinal cord from T9-11. After removal of the fingerlike structure and subcutaneous mass, a T10-11 laminectomy and removal of the intradural mass were performed. Histological examination showed that the appendage was composed of nail, three bones, cartilage, and normal skin. This appendage can be recognized not only as a variant type of caudal appendage but as an ectopic finger and fingernail. The authors discuss the developmental differences among the protrusion in the present case and ordinary caudal appendages.
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Affiliation(s)
- E Ishikawa
- Department of Neurosurgery, Institute of Clinical Medicine, University of Tsukuba, Ibaraki, Japan
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Abstract
The human tail is a congenital anomaly with a protruding lesion from the lumbosacrococcygeal region. A newborn with a tail-like structure over the coccygeal area observed since birth is presented. Lipoma accompanied by tethered spinal cord were found. In reviewing the literature from 1960 to 1997, 59 cases were described. Higher incidences of spinal dysraphism (49.15%) and tethered spinal cord (20.34%) compared with previous reports were evident. This fact plays an important role in understanding the disturbance of development and regression of human tails. A new classification according to whether the anomaly appears in combination with spinal dysraphism is proposed for clinical usage. Preoperative detailed image studies are needed to clarify the possibility of tethered spinal cord syndrome developing in the future and thus prevent it. Magnetic resonance imaging is the modality of choice if available. Long-term follow-up for possible sequelae after operation, especially in cases with spinal dysraphism, is necessary.
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Affiliation(s)
- F L Lu
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Republic of China
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Abstract
Human true tail is a rarely reported anomaly that may have a marked psychologic impact on the patient's family and may be associated with other congenital anomalies. A true tail in a newborn girl is reported, and findings from a review of the literature are summarized. The clinical and pathologic differential diagnoses are discussed, as they might affect the management and prognosis of this congenital malformation.
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Affiliation(s)
- M Alashari
- Department of Pathology, Children's Hospital, Buffalo, New York 14222, USA
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Abstract
We describe a 4-year-old Hispanic boy with a dermal pit and an overlying macular vascular malformation in the lumbosacral area. Magnetic resonance imaging of the region revealed an intraspinal lesion at L1-L2. A fibrous tract was excised. A benign lipoma intrinsic to the roots of the cauda equina was noted at surgery. The cutaneous stigmata of occult spinal dysraphisms are reviewed.
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Affiliation(s)
- D A Davis
- Department of Medicine, University of Colorado Medical School, Denver
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Chakrabortty S, Oi S, Yoshida Y, Yamada H, Yamaguchi M, Tamaki N, Matsumoto S. Myelomeningocele and thick filum terminale with tethered cord appearing as a human tail. Case report. J Neurosurg 1993; 78:966-9. [PMID: 8487080 DOI: 10.3171/jns.1993.78.6.0966] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Tail-like caudal appendages may be associated with spinal dysraphism, particularly with spinal lipomas or lipomyelomeningoceles. An unusual case is presented of a patient with a myelomeningocele and a thick filum terminale with tethered spinal cord, which presented with the external appearance of a human tail. A review of the literature reveals that human tails may be associated with dysraphic conditions. Extensive neuroradiological examinations should be performed for all such cases of apparent tails.
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Affiliation(s)
- S Chakrabortty
- Department of Neurosurgery, Kobe University School of Medicine, Japan
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Baruchin AM, Mahler D, Hauben DJ, Rosenberg L. The human caudal appendage (human tail). BRITISH JOURNAL OF PLASTIC SURGERY 1983; 36:120-3. [PMID: 6821717 DOI: 10.1016/0007-1226(83)90028-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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