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Ren F, Bressler L, Pruitt L, Wang H, Liu L, Elston DM. Midline cutaneous anomalies of the craniospinal axis. J Am Acad Dermatol 2023; 89:1238-1244. [PMID: 37598328 DOI: 10.1016/j.jaad.2023.06.062] [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: 02/15/2022] [Revised: 05/28/2023] [Accepted: 06/26/2023] [Indexed: 08/21/2023]
Abstract
Patients with midline cutaneous anomalies of the craniospinal axis can be indicative of underlying embryonic defects, such as neural tube defects. Lack of familiarity with these midline aberrant skin findings may lead to misdiagnosis and delayed treatment. In this review, midline cutaneous anomalies of the craniospinal axis including aplasia cutis congenita, cranial and spinal dysraphism, and other developmental anomalies are explored in detail with emphasis on cutaneous clues to the diagnosis and appropriate workup.
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Affiliation(s)
- Faliang Ren
- Department of Dermatology, Children's Hospital of Chongqing Medical University, Chongqing, China; Department of Dermatology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
| | - Lindsey Bressler
- Department of Dermatology & Dermatological Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Laura Pruitt
- Department of Dermatology & Dermatological Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Hua Wang
- Department of Dermatology, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Li Liu
- Department of Dermatology, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Dirk M Elston
- Department of Dermatology & Dermatological Surgery, Medical University of South Carolina, Charleston, South Carolina
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2
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Macaskill L, Gowda H. Can You Look at This Perianal Skin Tag? J Pediatr 2023; 262:113591. [PMID: 37399921 DOI: 10.1016/j.jpeds.2023.113591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 06/25/2023] [Accepted: 06/26/2023] [Indexed: 07/05/2023]
Affiliation(s)
- Laura Macaskill
- Neonatal Unit, Birmingham Heartlands Hospital, Birmingham, United Kingdom
| | - Harsha Gowda
- Neonatal Unit, Birmingham Heartlands Hospital, Birmingham, United Kingdom
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3
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Ashebo L, Anari JB, Cahill PJ. Update on the Diagnosis and Management of Early-onset Scoliosis. Curr Rev Musculoskelet Med 2023; 16:447-456. [PMID: 37615932 PMCID: PMC10497459 DOI: 10.1007/s12178-023-09848-w] [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] [Accepted: 05/30/2023] [Indexed: 08/25/2023]
Abstract
PURPOSE OF REVIEW In this article, we review the most recent advancements in the approaches to EOS diagnosis and assessment, surgical indications and options, and basic science innovation in the space of early-onset scoliosis research. RECENT FINDINGS Early-onset scoliosis (EOS) covers a diverse, heterogeneous range of spinal and chest wall deformities that affect children under 10 years old. Recent efforts have sought to examine the validity and reliability of a recently developed classification system to better standardize the presentation of EOS. There has also been focused attention on developing safer, informative, and readily available imaging and clinical assessment tools, from reduced micro-dose radiographs, quantitative dynamic MRIs, and pulmonary function tests. Basic science innovation in EOS has centered on developing large animal models capable of replicating scoliotic deformity to better evaluate corrective technologies. And given the increased variety in approaches to managing EOS in recent years, there exist few clear guidelines around surgical indications across EOS etiologies. Despite this, over the past two decades, there has been a considerable shift in the spinal implant landscape toward growth-friendly instrumentation, particularly the utilization of MCGR implants. With the advent of new biological and basic science treatments and therapies extending survivorship for disease etiologies associated with EOS, the treatment for EOS has steadily evolved in recent years. With this has come a rising volume and variation in management options for EOS, as well as the need for multidisciplinary and creative approaches to treating patients with these complex and heterogeneous disorders.
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Affiliation(s)
- Leta Ashebo
- Division of Orthopaedics, Children's Hospital of Philadelphia, 3500 Civic Center Blvd, Philadelphia, PA, 19142, USA
| | - Jason B Anari
- Division of Orthopaedics, Children's Hospital of Philadelphia, 3500 Civic Center Blvd, Philadelphia, PA, 19142, USA
| | - Patrick J Cahill
- Division of Orthopaedics, Children's Hospital of Philadelphia, 3500 Civic Center Blvd, Philadelphia, PA, 19142, USA.
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4
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Rojas-Sepúlveda CM, Buitrago-Orjuela L. Differential diagnosis for two 'holes in the head' of a child from 982 to 904 BP in northern South America. INTERNATIONAL JOURNAL OF PALEOPATHOLOGY 2023; 41:117-122. [PMID: 37192561 DOI: 10.1016/j.ijpp.2023.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 04/03/2023] [Accepted: 04/30/2023] [Indexed: 05/18/2023]
Abstract
OBJECTIVE To present paleopathological evidence of a congenital anomaly with photographic support and a review that will help scholars to diagnose the condition. MATERIALS Well-preserved skeletal remains of a child from central Colombia, dated 968-1046 CE. METHODS Macroscopic examination and computerized axial tomography. RESULTS Two holes were observed in the skull. CONCLUSIONS The pathology is consistent with a neural tube defect or an inclusion cyst. SIGNIFICANCE Neural tube defects and inclusion cysts, in paleopathology, are rarely reported in children. The preservation and origin of the individual make this case valuable. The photographic support and the review is useful for other scholars in the field. LIMITATIONS It was not possible to determine a single cause. SUGGESTIONS FOR FUTURE RESEARCH Review cases in identified osteological collections.
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Affiliation(s)
- Claudia M Rojas-Sepúlveda
- Department of Anthropology, Universidad Nacional de Colombia-Sede Bogotá, Carrera 45 #26-85, Bogotá D.C., Colombia.
| | - L Buitrago-Orjuela
- Concesión Alto Magdalena, Calle 106 # 57 - 23 oficina 408 Edificio 106, Bogotá, Colombia
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5
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Advances in Fetal Surgical Repair of Open Spina Bifida. Obstet Gynecol 2023; 141:505-521. [PMID: 36735401 DOI: 10.1097/aog.0000000000005074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 10/03/2022] [Indexed: 02/04/2023]
Abstract
Spina bifida remains a common congenital anomaly of the central nervous system despite national fortification of foods with folic acid, with a prevalence of 2-4 per 10,000 live births. Prenatal screening for the early detection of this condition provides patients with the opportunity to consider various management options during pregnancy. Prenatal repair of open spina bifida, traditionally performed by the open maternal-fetal surgical approach through hysterotomy, has been shown to improve outcomes for the child, including decreased need for cerebrospinal fluid diversion surgery and improved lower neuromotor function. However, the open maternal-fetal surgical approach is associated with relatively increased risk for the patient and the overall pregnancy, as well as future pregnancies. Recent advances in minimally invasive prenatal repair of open spina bifida through fetoscopy have shown similar benefits for the child but relatively improved outcomes for the pregnant patient and future childbearing.
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6
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The diagnosis of the middle interhemispheric variant of holoprosencephaly with fetal MRI. RADIOLOGIA 2022; 64:375-378. [DOI: 10.1016/j.rxeng.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 07/05/2021] [Indexed: 11/17/2022]
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7
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Sacral Spina Bifida Occulta: A Frequency Analysis of Secular Change. ANTHROPOLOGICAL REVIEW 2022. [DOI: 10.18778/1898-6773.85.2.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Substantial relaxation of natural selection beginning around 1900 changed the mutation/selection balance of modern genetic material, producing an increase in variable anatomical structures. While multiple structures have been affected, the temporal increase in variations of the sacrum, specifically, ‘Sacral Spina Bifida Occulta,’ have been reliably demonstrated on a localised scale. Calculation of largescale frequency has been hindered by the localised nature of these publications, the morphological variability of this variation, and potential pathological associations, which have produced divergent classifications, and conflicting reported rates of occurrence. A systematic review of the reported literature was conducted to provide an objective analysis of Sacral Spina Bifida Occulta frequency from 2500 BCE to the present. This review was designed to compensate for observed inconsistencies in reporting and to ascertain, for the first time, the temporal trajectory of this secular trend. A systematic review of Sacral Spina Bifida Occulta literature was conducted through the strict use of clinical meta-analysis criteria. Publications were retrieved from four databases: PubMed, Embase, the Adelaide University Library database, and Google Scholar. Data were separated into three historical groups, (1 = <1900, 2 = 1900 to 1980 and 3 = >1980), and frequency outcomes compared, to determine temporal rates of occurrence.
A total of 39/409 publications were included in the final analysis, representing data for 16,167 sacra, spanning a period of 4,500 years. Statistically significant results were obtained, with total open S1 frequency increasing from 2.34%, (79 to 1900CE), to 4.80%, (1900 to 1980CE) and to 5.43% (>1980CE). These increases were significant at p<0.0001, with Chi-squared analysis. A clear secular increase in the global frequency of Sacral Spina Bifida Occulta has been demonstrated from 1900 to the present. This research provides a novel and adaptable framework for the future assessment of variation distribution, with important implications for the fields of biological anthropology and bioarchaeology.
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Isaković J, Šimunić I, Jagečić D, Hribljan V, Mitrečić D. Overview of Neural Tube Defects: Gene–Environment Interactions, Preventative Approaches and Future Perspectives. Biomedicines 2022; 10:biomedicines10050965. [PMID: 35625701 PMCID: PMC9138472 DOI: 10.3390/biomedicines10050965] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 04/13/2022] [Accepted: 04/19/2022] [Indexed: 11/16/2022] Open
Abstract
Neural tube defects (NTDs) are the second most common congenital malformations of humans, characterized by impaired development of the central nervous system. Even though the etiology of most birth defects remains undetermined, genetic and environmental risk factors in the background of NTDs have been identified and extensively reported. On top of genetic and nutritional risks which include mutations in both coding and non-coding regions and maternal folate status, respectively, recent years have seen a rise in the identification of a variety of teratogens that could be implicated in NTD development. These include polycyclic aromatic hydrocarbons, arsenic, pesticides, maternal hyperthermia and antibiotics as well as pain and seizure medication. With an increase in understanding of teratogens leading to NTD formation, preventative and treatment approaches have witnessed great advances throughout the years. While the most common preventative approach includes folic acid food fortification as well as suggested inositol supplementation, treatment and management approaches differ greatly depending on the developmental stage and the site of the lesion and include prenatal surgery, stem cell transplantation and postnatal surgery. Because NTDs still represent a large health and financial burden for the patient and society as a whole, it is crucial to investigate potential risk factors and develop novel approaches in order to fully prevent this category of disorders.
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Affiliation(s)
- Jasmina Isaković
- Omnion Research International Ltd., Heinzelova 4, 10000 Zagreb, Croatia
- Department of Histology and Embryology, University of Zagreb School of Medicine, 10000 Zagreb, Croatia; (D.J.); (V.H.); (D.M.)
- Correspondence:
| | - Iva Šimunić
- Laboratory for Stem Cells, Croatian Institute for Brain Research, University of Zagreb School of Medicine, 10000 Zagreb, Croatia;
| | - Denis Jagečić
- Department of Histology and Embryology, University of Zagreb School of Medicine, 10000 Zagreb, Croatia; (D.J.); (V.H.); (D.M.)
- Laboratory for Stem Cells, Croatian Institute for Brain Research, University of Zagreb School of Medicine, 10000 Zagreb, Croatia;
| | - Valentina Hribljan
- Department of Histology and Embryology, University of Zagreb School of Medicine, 10000 Zagreb, Croatia; (D.J.); (V.H.); (D.M.)
- Laboratory for Stem Cells, Croatian Institute for Brain Research, University of Zagreb School of Medicine, 10000 Zagreb, Croatia;
| | - Dinko Mitrečić
- Department of Histology and Embryology, University of Zagreb School of Medicine, 10000 Zagreb, Croatia; (D.J.); (V.H.); (D.M.)
- Laboratory for Stem Cells, Croatian Institute for Brain Research, University of Zagreb School of Medicine, 10000 Zagreb, Croatia;
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9
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Garrido Márquez I, Fernández Navarro L, Moya Sánchez E. The diagnosis of the middle interhemispheric variant of holoprosencephaly with fetal MRI. RADIOLOGIA 2021; 64:S0033-8338(21)00121-1. [PMID: 34399977 DOI: 10.1016/j.rx.2021.07.002] [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: 02/02/2021] [Revised: 06/29/2021] [Accepted: 07/05/2021] [Indexed: 10/20/2022]
Abstract
Congenital anomalies of the central nervous system comprise a wide spectrum of malformations associated with a wide variety of genetic syndromes and chromosomal anomalies, and they are among the principal causes of morbidity and mortality in infants. Among these anomalies, holoprosencephaly arises from the complete or partial failure of the brain to divide into the cerebral hemispheres. Imaging tests are fundamental for the prenatal diagnosis of holoprosencephaly; the diagnostic process usually starts with sonography and then the findings are refined with fetal MRI. Radiologists need to be familiar with the possible findings because the prognosis varies.
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Affiliation(s)
- I Garrido Márquez
- Servicio de Radiodiagnóstico, Hospital Universitario Clínico San Cecilio, Granada, España.
| | - L Fernández Navarro
- Servicio de Radiodiagnóstico, Hospital Universitario Clínico San Cecilio, Granada, España
| | - E Moya Sánchez
- Servicio de Radiodiagnóstico, Hospital Universitario Clínico San Cecilio, Granada, España
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10
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Maurya VP, Singh Y, Srivastava AK, Das KK, Bhaisora KS, Sardhara J, Behari S. Spinal Dermoid and Epidermoid Cyst: An Institutional Experience and Clinical Insight into the Neural Tube Closure Models. J Neurosci Rural Pract 2021; 12:495-503. [PMID: 34295103 PMCID: PMC8289537 DOI: 10.1055/s-0041-1724229] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objectives
The spinal dermoid and epidermoid cysts (SDECs) are rare entities comprising less than 1% of pediatric intraspinal tumors. The present study aims to extrapolate the clinicoradiological data, in order to identify the most plausible neural tube closure model in human and provide a retrospective representation from our clinical experience.
Materials and Methods
We collected the details of all histologically proven, newly diagnosed primary SDECs who underwent excision over the past 20 years. Secondary or recurrent lesions and other spinal cord tumors were excluded. Surgical and follow-up details of these patients as well as those with associated spinal dysraphism were reviewed. Clinical and radiological follow-up revealed the recurrence in these inborn spinal cord disorders.
Results
A total of 73 patients were included retrospectively, having a mean age of 22.4 ± 13.3 years, and 41 (56.2%) cases fell in the first two decades of life. Twenty-four (32.9%) dermoid and 49 (67.1%) epidermoid cysts comprised the study population and 20 of them had associated spinal dysraphism. The distribution of SDECs was the most common in lumbosacral region (
n
= 30) which was 10 times more common than in the sacral region (
n
= 3). Bladder dysfunction 50 (68.5%) and pain 48 (65.7%) were the most common presenting complaints. During follow-up visits, 40/48 (83.3%) cases showed sensory improvement while 11/16 (68.7%) regained normal bowel function. There was no surgical mortality with recurrence seen in eight till the last follow-up.
Conclusions
The protracted clinical course of the spinal inclusion cysts mandates a long-term follow-up. The results of our study support the multisite closure model and attempt to provide a retrospective reflection of neural tube closure model in humans by using SDECs as the surrogate marker of neural tube closure defect.
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Affiliation(s)
- Ved P Maurya
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Yashveer Singh
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Arun K Srivastava
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Kuntal K Das
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Kamlesh S Bhaisora
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Jayesh Sardhara
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Sanjay Behari
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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11
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Coulthard LG, Vonhoff CR, Badran AM, Robertson TE, Wood MJ. Growth of Intramedullary Spinal Cord Dermoid Cyst from a Congenital Thoracic Dermal Sinus Tract after Negative Screening Ultrasound Imaging. Pediatr Neurosurg 2021; 56:79-84. [PMID: 33503616 DOI: 10.1159/000512580] [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: 06/01/2020] [Accepted: 10/27/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Intramedullary thoracic dermoid cysts are rare lesions that are associated with dermal sinus tracts (DSTs). Current recommendations advocate for imaging-based screening of suspected DSTs shortly after birth to exclude associated inclusion lesions. CASE PRESENTATION A 6-year-old male child presented with a 2-week history of progressive ataxia, lower limb weakness, and hyperreflexia. He was suspected to have a thoracic DST at birth, though initial screening ultrasound was negative for an inclusion lesion or intradural tract. On representation, MRI demonstrated a 3.9-cm intramedullary thoracic dermoid cyst causing significant spinal cord compression. Intraoperatively, a DST extending intradurally was found. The associated dermoid cyst was removed via intracapsular resection. CONCLUSIONS Whilst dermoid cysts are presumed to progressively develop from DSTs, to our knowledge, this is the first case in English literature documenting a thoracic spinal cord intramedullary dermoid cyst following a negative screening ultrasound for a suspected DST. We use this case to highlight the false-negative rates associated with postnatal screening and advocate for early neurosurgical referral of suspected DSTs, regardless of imaging findings.
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Affiliation(s)
- Liam G Coulthard
- Queensland Children's Hospital, South Brisbane, Queensland, Australia, .,School of Medicine, University of Queensland, Herston, Queensland, Australia,
| | | | - Ahmad M Badran
- Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Thomas E Robertson
- School of Medicine, University of Queensland, Herston, Queensland, Australia.,Pathology Queensland, Royal Brisbane & Women's Hospital, Herston, Queensland, Australia
| | - Martin J Wood
- Queensland Children's Hospital, South Brisbane, Queensland, Australia.,Brisbane Clinical Neuroscience Centre, Mater Hospital, South Brisbane, Queensland, Australia
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13
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Otto JP, Molina JG, Chahín A. ESCOLIOSIS IDIOPÁTICA DEL ADOLESCENTE DE BAJO GRADO. REVISTA MÉDICA CLÍNICA LAS CONDES 2020. [DOI: 10.1016/j.rmclc.2020.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Choi SJ, Yoon HM, Hwang JS, Suh CH, Jung AY, Cho YA, Lee JS. Incidence of Occult Spinal Dysraphism Among Infants With Cutaneous Stigmata and Proportion Managed With Neurosurgery: A Systematic Review and Meta-analysis. JAMA Netw Open 2020; 3:e207221. [PMID: 32614421 PMCID: PMC7333023 DOI: 10.1001/jamanetworkopen.2020.7221] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
IMPORTANCE Occult spinal dysraphism (OSD) is the most common congenital spinal anomaly. Cutaneous anomalies such as skin dimples or deviated gluteal folds are well known as stigmata of OSD and are indicators for further evaluation; however, the association between cutaneous anomalies and OSD has not been systemically evaluated. OBJECTIVE To evaluate the incidence of OSD and the proportion of OSD cases managed with a neurosurgical intervention among neonates or infants with various cutaneous stigmata. DATA SOURCES PubMed and Embase databases were searched for studies published up to July 25, 2018, that evaluated the proportion of OSD cases in neonates or infants with cutaneous stigmata. Search terms included ultrasound, dysraphism, dimple, and infant or neonate. The search was limited to English-language publications. STUDY SELECTION Two reviewers selected the studies evaluating the incidence of OSD among neonates or infants with cutaneous stigmata. DATA EXTRACTION AND SYNTHESIS The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines for data extraction were followed. Pooled proportions of OSD cases and OSD cases that were managed with a neurosurgical intervention were obtained using the generalized linear mixed model and maximum likelihood method. MAIN OUTCOME AND MEASURES The pooled incidence of OSD and OSD cases managed with neurological surgery among patients with cutaneous stigmata was the primary outcome. This outcome was also evaluated in each subgroup, and heterogeneity was explored using subgroup analysis. RESULTS A total of 15 studies, involving 6558 neonate or infant patients with various cutaneous stigmata, were included. The pooled proportion of OSD cases among the patients with cutaneous stigmata was 2.8% (95% CI, 2.1%-3.8%; I2 = 51.6%), and the proportion managed with neurological surgery was 0.6% (95% CI, 0.3%-1.3%; I2 = 66.4%). Cases with combined stigmata showed a significantly higher association with OSD than those with a single stigma (10.5% [95% CI, 6.9%-15.8%] vs 2.3% [%, 95% CI, 1.5%-3.5%]; P < .001). The pooled proportion of OSD cases among patients with an atypical dimple was significantly higher than among those with simple dimple (8.8% [95% CI, 4.5%-16.6%] vs 0.6% [95% CI of 1.4%-2.1%]; P = .001). CONCLUSIONS AND RELEVANCE The proportion of OSD in healthy, asymptomatic patients with midline cutaneous stigmata was low, and the proportion of patients who underwent a neurosurgical intervention was even lower. However, a careful evaluation as well as potential spinal magnetic resonance imaging is recommended for neonates or infants with combined stigmata or an atypical dimple for possible high-risk lesions.
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Affiliation(s)
- Se Jin Choi
- Research Institute of Radiology, Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Hee Mang Yoon
- Research Institute of Radiology, Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Ji Sun Hwang
- Department of Radiology, Hallym University Medical Center, Dongtan Sacred Heart Hospital, Hwaseong, South Korea
| | - Chong Hyun Suh
- Research Institute of Radiology, Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Ah Young Jung
- Research Institute of Radiology, Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Young Ah Cho
- Research Institute of Radiology, Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jin Seong Lee
- Research Institute of Radiology, Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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15
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Amelot A, Cretolle C, de Saint Denis T, Sarnacki S, Catala M, Zerah M. Spinal dysraphism as a new entity in V.A.C.TE.R.L syndrome, resulting in a novel acronym V.A.C.TE.R.L.S. Eur J Pediatr 2020; 179:1121-1129. [PMID: 32055959 DOI: 10.1007/s00431-020-03609-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 01/09/2020] [Accepted: 02/06/2020] [Indexed: 10/25/2022]
Abstract
Anorectal malformation (ARM) is the most common symptom in VACTERL syndrome (vertebral, anal, cardiac, tracheo-esophageal fistula, renal, and limb anomalies). The association of ARM and spinal dysraphisms (DYS) is well documented. We aim to better evaluate children with VACTERL association and ARM, considering the presence or not of DYS. Between 2000 and 2015, 279 children with VACTERL associations were identified in Necker Children's Hospital, Paris. We identified 61 VACTERL children (22%) with ARM. A total of 52 VACTERL children with ARM were included. DYS were identified in 36/52 of cases (69.2%). A total of 33 (63.5%) VACTERL children presented with sphincterial dysfunction. We constated that 28/33 (84.8%) of them had DYS + (p < 0.0001). More children in ARM (DYS +) subgroup are presenting with initial urinary sphincter dysfunction (58 vs 19%, p < 0.009) than ARM (DYS -). We identified 29 lipoma filum in our series, which were not statistically associated with urinary disorders (p = 0.143).Conclusion: We propose to refine the definition of VACTERL association, by adding S as Spinal defect to include it as an integral part of this syndrome, resulting in a novel acronym V.A.C.TE.R.L.S.What is Known:• The VACTERL association: congenital anomalies of the bony vertebral column (V), anorectal malformation (A), congenital cardiopathy (C), tracheo-esophageal defects (TE), renal and urinary tract anomalies (R), and limb malformations (L).• VACTERL children needs a complete appraisal, as early as possible, to adopt the most appropriate therapeutic management.What is New:• Include spine dysraphism (DYS) as a part of this syndrome, resulting in a novel acronym V.A.C.TE.R.L.S.• The significant correlation between VACTERL/DYS and urinary dysfunction requires to investigate the spine cord prenatally.
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Affiliation(s)
- Aymeric Amelot
- Department of Pediatric Neurosurgery, Necker-EM Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris-Descartes, Paris, France.
| | - Célia Cretolle
- Department of Visceral Pediatric surgery, Necker-EM Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris-Descartes, Paris, France.,Reference center for AnoRectal and rare Pelvic anomalies MAREP, Necker-EM Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris-Descartes, Paris, France
| | - Timothée de Saint Denis
- Department of Pediatric Neurosurgery, Necker-EM Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris-Descartes, Paris, France
| | - Sabine Sarnacki
- Department of Visceral Pediatric surgery, Necker-EM Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris-Descartes, Paris, France.,Reference center for AnoRectal and rare Pelvic anomalies MAREP, Necker-EM Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris-Descartes, Paris, France
| | - Martin Catala
- cUMR7622 UPMC et CNRS, Paris cedex 05, France; dFédération de Neurologie, Groupe Hospitalier Pitié-Salpêtrière 47-83 boulevard de l'Hôpital, Paris Cedex 13, France
| | - Michel Zerah
- Department of Pediatric Neurosurgery, Necker-EM Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris-Descartes, Paris, France.,Reference center for Chiari and Malformations of the Spine and the Spinal Cord C-MAVEM and Institute for Genetic Diseases IMAGINE , Necker-EM Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris-Descartes, Paris, France
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16
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Aby J, Kim J, Lai L, Flaherman V, Loyal J. Variation in Management of Cutaneous Lumbosacral Findings in Newborns. Hosp Pediatr 2020; 10:496-501. [PMID: 32404330 DOI: 10.1542/hpeds.2019-0264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Cutaneous lumbosacral findings in neonates are common in the newborn nursery but may also be associated with occult spinal dysraphism. Variation in management of lumbosacral findings by neonatal clinicians has not been previously described. METHODS Clinicians in the Better Outcomes through Research for Newborns (BORN) Network were invited to participate in an electronic survey. Participants reviewed 18 photographs of lumbosacral findings in asymptomatic neonates and selected 1 or more initial management step(s): routine care, watchful waiting, imaging, and/or subspecialty consultation. Additional data collected include ease of access to imaging and subspecialty consultants and characteristics of respondents. RESULTS Of 407 BORN Network clinicians, 206 (51%) completed the survey. Respondents were in >90% agreement in initial management approach of 8 of 18 cases. The most common initial actions were spinal ultrasound (53%), neurosurgery evaluation (18%), and MRI (13%). Anomalies of the gluteal crease had the lowest proportion of agreement. In 2 cases, there were differences in respondents' choice to image or consult a subspecialist depending on their percent clinical full time equivalent spent taking care of neonates <1 month of age: (1) coccygeal hair (P = .02) and (2) deviated gluteal crease (P = .02). CONCLUSIONS Variation in initial management of neonatal lumbosacral findings by clinicians in the BORN Network was seen most often for deviations of the gluteal crease, flat vascular macules, and coccygeal hair.
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Affiliation(s)
- Janelle Aby
- Department of Pediatrics, Stanford University, Stanford, California;
| | - Juliann Kim
- Palo Alto Medical Foundation, Palo Alto, California
| | - Lillian Lai
- Departments of Pediatrics and Epidemiology and Biostatistics, University of San Francisco, San Francisco, California; and
| | - Valerie Flaherman
- Departments of Pediatrics and Epidemiology and Biostatistics, University of San Francisco, San Francisco, California; and
| | - Jaspreet Loyal
- Department of Pediatrics, Yale University, New Haven, Connecticut
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17
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Bessis D. [Cutaneous signs of occult cranial and spinal dysraphism]. Ann Dermatol Venereol 2020; 147:504-519. [PMID: 32340727 DOI: 10.1016/j.annder.2020.02.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 10/21/2019] [Accepted: 02/21/2020] [Indexed: 01/06/2023]
Abstract
Dysraphism refers to neural tube closure abnormalities and midline closure abnormalities of the skin, paravertebral muscles, vertebrae and meninges. Cranial dysraphism (CD) and occult spinal dysraphism (OSD) may be discovered via evocative skin signs present at birth or appearing later in childhood or even in adulthood. This review describes the various types of skin signs associated with CD and OSD. All congenital midline skin lesions, particularly on the frontonasal area, the vertex or the occipitocervical and low back regions, should prompt suspicion of underlying dysraphism. The main evocative midline skin abnormalities are: (i) for underlying DCEO: a nodule, swelling, skin openings and hair collar sign or hair tuft; (ii) for underlying DSO, localized hypertrichosis, an atypical or complex lower back dimple, a dermoid fistula, infantile haemangioma, caudal appendage and lipoma. In the event of suspected DCEO or DSO, spinal or medullary MRI constitutes the reference examination.
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Affiliation(s)
- D Bessis
- Département de dermatologie, hôpital Saint-Éloi, CHRU de Montpellier, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France; Université Montpellier, 163, rue Auguste-Broussonnet, 34090 Montpellier, France; Inserm 1058, 60, rue de Navacelles, 34394 Montpellier cedex 5, France.
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- Département de dermatologie, hôpital Saint-Éloi, CHRU de Montpellier, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France; Université Montpellier, 163, rue Auguste-Broussonnet, 34090 Montpellier, France; Inserm 1058, 60, rue de Navacelles, 34394 Montpellier cedex 5, France
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18
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Karim Ahmed A, Howell EP, Harward S, Sankey EW, Ehresman J, Schilling A, Wang T, Pennington Z, Gray L, Sciubba DM, Goodwin CR. Split cord malformation in adults: Literature review and classification. Clin Neurol Neurosurg 2020; 193:105733. [PMID: 32146230 DOI: 10.1016/j.clineuro.2020.105733] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 01/27/2020] [Accepted: 02/07/2020] [Indexed: 11/16/2022]
Abstract
The objective of this study was to summarize the available literature describing the presentation, diagnostic evaluation, and management for adults with Type 1 and Type 2 split spinal cord malformations. A review of the literature was performed using the CINAHL, PubMed, Embase, and Web of Science database, alongside all associated bibliographies, to include studies describing Type 1 and Type 2 split cord malformations diagnosed in patients above the age of 18. All relevant studies of split cord malformations were included, regardless of the year published and terminology used to describe the dysraphism. Clinical case series (≥ 2 patients), cohort studies, and review articles comprising adult patients with radiographically diagnosed diastematomyelia, diplomyelia, or dimyelia were included (Class of Evidence I-IV). A total of 17 unique articles, describing 146 unique adult spinal cord malformation subjects, were included. The most common associated condition was tethered cord syndrome (59.8 %). Operative management for symptomatic split cord malformation was performed in 72.3 % of cases. For those with preoperative neurologic deficits, operative management resulted in symptomatic improvement in 96.6 %, compared to 0 % conservative management (p < 0.05). For those with pain alone, operative management resulted in improvement of 91.1 %, compared to 12.5 % conservative management (p < 0.05). To date, this is the only literature review to include all split cord malformations (SCM Types I and II) presenting in adulthood, with clinical characteristics, associated conditions, and long-term treatment outcomes.
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Affiliation(s)
- A Karim Ahmed
- Department of Neurosurgery. The Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Elizabeth P Howell
- Department of Neurosurgery. Duke University Medical Center, Durham, NC, USA
| | - Stephen Harward
- Department of Neurosurgery. Duke University Medical Center, Durham, NC, USA
| | - Eric W Sankey
- Department of Neurosurgery. Duke University Medical Center, Durham, NC, USA
| | - Jeffrey Ehresman
- Department of Neurosurgery. The Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Andrew Schilling
- Department of Neurosurgery. The Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Timothy Wang
- Department of Neurosurgery. Duke University Medical Center, Durham, NC, USA
| | - Zachary Pennington
- Department of Neurosurgery. The Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Linda Gray
- Department of Radiology. Duke University Medical Center, Durham, NC, USA
| | - Daniel M Sciubba
- Department of Neurosurgery. The Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - C Rory Goodwin
- Department of Neurosurgery. Duke University Medical Center, Durham, NC, USA.
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19
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Asaad SK, Jensen ASC, Bjarkam CR. Spinal dysraphism in a 63-year-old multipara faun-tailed woman. Br J Neurosurg 2020; 34:110-111. [DOI: 10.1080/02688697.2018.1424322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Sofia Kamakh Asaad
- Department of Neurosurgery, Clinical Institute of Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - Anne-Sofie Caroline Jensen
- Department of Neurosurgery, Clinical Institute of Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - Carsten Reidies Bjarkam
- Department of Neurosurgery, Clinical Institute of Medicine, Aalborg University Hospital, Aalborg, Denmark
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20
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Rodríguez Bandera AI, Sebaratnam DF, Feito Rodríguez M, de Lucas Laguna R. Cutaneous ultrasound and its utility in Pediatric Dermatology: Part II-Developmental anomalies and vascular lesions. Pediatr Dermatol 2020; 37:40-51. [PMID: 31742750 DOI: 10.1111/pde.13897] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
High-frequency ultrasonography represents a promising tool for pediatric dermatologists. It is a noninvasive and harmless diagnostic technique that is especially appealing when working with children. It can be easily performed at the patient's bedside, avoiding diagnostic delays, sedation, or multiple visits. It represents a useful adjunct to clinical examination and aids our understanding of cutaneous pathology. In this second part, we describe the ultrasonographic findings of developmental anomalies and vascular lesions.
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Affiliation(s)
| | - Deshan Frank Sebaratnam
- Sydney Children's Hospitals' Network, Sydney, New South Wales, Australia.,University of New South Wales, Sydney, New South Wales, Australia
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21
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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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22
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Rossi A. Imaging in Spine and Spinal Cord Developmental Malformations. Clin Neuroradiol 2019. [DOI: 10.1007/978-3-319-61423-6_32-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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23
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Rossi A. Imaging in Spine and Spinal Cord Developmental Malformations. Clin Neuroradiol 2019. [DOI: 10.1007/978-3-319-68536-6_32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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24
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Spinal cord ultrasonography of the newborn. J Ultrasound 2018; 22:113-119. [PMID: 30535560 DOI: 10.1007/s40477-018-0345-y] [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: 09/13/2018] [Accepted: 11/30/2018] [Indexed: 10/27/2022] Open
Abstract
Ultrasound represents the first-line survey for the assessment of spinal cord development abnormalities. In fact, within 6 months of life, the non-ossification of neuronal arcs provides an excellent acoustic window that allows a detailed depiction of the spinal canal, its content and of the surrounding soft tissues. Nevertheless, an accurate ultrasound examination requires a complete knowledge of the anatomy, the condition of normality, the frequent anatomical variants and the main pathologies involved. This review is intended to briefly summarize the US technique, the main clinical indication and the key notions that could help to properly perform this type of ultrasound examination.
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25
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Avagliano L, Massa V, George TM, Qureshy S, Bulfamante GP, Finnell RH. Overview on neural tube defects: From development to physical characteristics. Birth Defects Res 2018; 111:1455-1467. [PMID: 30421543 DOI: 10.1002/bdr2.1380] [Citation(s) in RCA: 93] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 07/29/2018] [Indexed: 12/18/2022]
Abstract
Neural tube defects (NTDs) are the second most common congenital malformations in humans affecting the development of the central nervous system. Although NTD pathogenesis has not yet been fully elucidated, many risk factors, both genetic and environmental, have been extensively reported. Classically divided in two main sub-groups (open and closed defects) NTDs present extremely variable prognosis mainly depending on the site of the lesion. Herein, we review the literature on the histological and pathological features, epidemiology, prenatal diagnosis, and prognosis, based on the type of defect, with the aim of providing important information based on NTDs classification for clinicians and scientists.
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Affiliation(s)
- Laura Avagliano
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy
| | - Valentina Massa
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy
| | - Timothy M George
- Pediatric Neurosurgery, Dell Children's Medical Center, Department of Neurosurgery, The University of Texas at Austin Dell Medical School, Austin, Texas
| | - Sarah Qureshy
- Department of Pediatrics, The University of Texas at Austin Dell Medical School, Austin, Texas
| | | | - Richard H Finnell
- Department of Pediatrics, The University of Texas at Austin Dell Medical School, Austin, Texas.,Center for Precision Environmental Health, Department of Molecular and Cellular Biology and Medicine, Baylor College of Medicine, Houston, Texas
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26
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Sung HJ, Lee HS. Dorsal midline cutaneous stigmata associated with occult spinal dysraphism in pediatric patients. KOREAN JOURNAL OF PEDIATRICS 2018; 62:68-74. [PMID: 30304899 PMCID: PMC6382965 DOI: 10.3345/kjp.2018.06744] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 10/01/2018] [Indexed: 11/27/2022]
Abstract
PURPOSE To investigate the prevalence of occult spinal dysraphism (OSD) and subsequent neurosurgery in pediatric patients with isolated or combined dorsal midline cutaneous stigmata with or without other congenital malformations. METHODS We carried out a retrospective review of patients who underwent sonography or magnetic resonance imaging (MRI) for OSD because of suspicion of dorsal midline cutaneous stigmata (presumed to be a marker for OSD) between January 2012 and June 2017. Information about patient characteristics, physical examination findings, spinal ultrasound and MRI results, neurosurgical notes, and accompanying congenital anomalies was collected. RESULTS Totally 250 patients (249 ultrasound and one MRI screening) were enrolled for analysis. Eleven patients underwent secondary MRI examinations. The prevalence of OSD confirmed by an MRI was 2.4% (6 patients including one MRI screening). Five patients (2%) had tethered cord and underwent prophylactic neurosurgery, 3 of whom had a sacrococcygeal dimple and a fibrofatty mass. Prevalence of tethered cord increased as markers associated with a sacrococcygeal dimple increased (0.5% of the isolated marker group, 8.1% of the 2-marker group, and 50% of the 3-marker group). Incidence of OSD with surgical detethering in 17 other congenital anomaly patients was 11.8%, which was higher than the 1.3% in 233 patients without other congenital anomalies. CONCLUSION Our results suggest that the presence of dorsal midline cutaneous stigmata, particularly fibrofatty masses, along with a sacrococcygeal dimple is associated with OSD or cord tethering requiring surgery. OSD should be suspected in patients with concurrent occurrence of other congenital anomalies.
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Affiliation(s)
- Hyun Jung Sung
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyun-Seung Lee
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
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27
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Abstract
The skin and the nervous system share common embryologic origins. Cutaneous stigmata may be early clues to underlying occult spinal dysraphism. The delayed manifestations of spinal dysraphism may also involve the skin. We report a case of a 4-year-old child in whom acro-osteolysis and cutaneous trophic changes on the right foot were the presenting features of occult dysraphism.
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Affiliation(s)
- Hima Gopinath
- Department of Dermatology, Venereology and Leprosy, Sri Manakula Vinayagar Medical College and Hospital, Pondicherry University, Pondicherry, India
| | - Meghana Valeti
- Department of Dermatology, Venereology and Leprosy, Sri Manakula Vinayagar Medical College and Hospital, Pondicherry University, Pondicherry, India
| | - Kaliaperumal Karthikeyan
- Department of Dermatology, Venereology and Leprosy, Sri Manakula Vinayagar Medical College and Hospital, Pondicherry University, Pondicherry, India
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28
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Aby J, Kim JL. A Cross-Sectional Assessment of Cutaneous Lumbosacral and Coccygeal Physical Examination Findings in a Healthy Newborn Population. Glob Pediatr Health 2018; 5:2333794X18756133. [PMID: 29450217 PMCID: PMC5808970 DOI: 10.1177/2333794x18756133] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective. The purpose of this study is to describe the range and frequency of cutaneous lumbosacral and coccygeal findings encountered during the newborn examination in a population of apparently healthy babies, to determine if the prevalence of these findings is associated with race/ethnicity, and to report the frequency of co-occurrence of low-risk cutaneous findings. Methods. Lumbosacral physical findings of 1121 infants were documented on well newborns at least 35 weeks or greater gestational age under the authors’ care. The overall frequency of each physical finding was tabulated in addition to determining whether frequencies varied by race/ethnicity. Co-occurrence of the most common physical findings was also examined. Results. Of 1096 infants included in the study, 24.8% had deviated or duplicated gluteal creases, 15.6% had dimples, and 24.7% had lumbosacral and/or coccygeal hairiness. All racial/ethnic groups had double to quadruple the risk of lumbosacral hair when compared with Caucasians. A total of 44.1% of study infants had lumbosacral/coccygeal slate-grey patches, which were least common in Caucasians. Seven infants had coccygeal skin tags, and 14 infants had lumbosacral vascular macules. Thirty-one percent had more than 1 cutaneous lumbosacral finding present, 24.8% had 2 findings, and 6.2% had 3 or more findings. Conclusion. Coccygeal dimples, increased lumbosacral and/or coccygeal hair, deviations and/or duplications of the gluteal crease, and lumbosacral slate-grey patches are common in healthy newborns and vary by race/ethnicity. Eleven percent of study infants had 2 or more low-risk cutaneous findings excluding slate-grey patches. Distinction between low-risk and common versus high-risk findings is important when deciding which patients need further evaluation.
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29
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Ausili E, Maresca G, Massimi L, Morgante L, Romagnoli C, Rendeli C. Occult spinal dysraphisms in newborns with skin markers: role of ultrasonography and magnetic resonance imaging. Childs Nerv Syst 2018; 34:285-291. [PMID: 29075839 DOI: 10.1007/s00381-017-3638-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 10/17/2017] [Indexed: 11/30/2022]
Abstract
PURPOSE The purpose of this paper is to investigate occult spinal dysraphisms (OSD) using lumbar ultrasonography (LUS) in newborns presenting with specific skin markers or sacrococcygeal dimple. METHOD From 2012 to 2015, we performed LUS in newborns with cutaneous stigmata and/or sacroccygeal dimple. Magnetic resonance imaging (MRI) was performed in all patients with abnormal ultrasound or features of neurological involvement in order to detect spinal lesions. RESULTS We prospectively evaluated 475 newborns who presented cutaneous stigmata performing LUS during their 4 weeks of life though 439 completed the study. All patients had a follow-up of almost 12 months. Of these, 39 presented abnormal ultrasonography and underwent MRI. In this group, spinal dysraphism was confirmed in 12 patients. When considering skin markers, dermal sinus correlated with higher risk of spinal cord lesions, on the other hand the presence of simple sacral dimple alone denoted a very low risk of occult spinal dysraphism. The simultaneous presence of more skin markers and/or the presence of lumbar ultrasonography abnormality regarding the level of the conus, pulsatility, and the position of the cord, thickness of the filum terminale, or the presence of an intratecal mass, lipoma, or dermal sinus tract indicated the necessity to perform MRI in order to detect spinal cord abnormalities because of higher risk of spinal lesions. CONCLUSION LUS in newborns with specific skin markers is a valid method to select patients in which MRI can be performed to detect OSD. The presence of a simple sacral dimple alone is a negligible marker for occult neural pathology while the presence of isolated dermal sinus or more than one cutaneous marker could be considered indicative of higher risk of spinal dysraphism.
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Affiliation(s)
- E Ausili
- Spina Bifida Center, Women's and Infant Health Sciences, A. Gemelli Policlinic, Catholic University of Sacred Heart, Largo A. Gemelli 8, 00168, Rome, Italy.
| | - G Maresca
- Spina Bifida Center, Women's and Infant Health Sciences, A. Gemelli Policlinic, Catholic University of Sacred Heart, Largo A. Gemelli 8, 00168, Rome, Italy
| | - L Massimi
- Neurosurgery Department, Catholic University of Sacred Heart, Largo A. Gemelli 8, 00168, Rome, Italy
| | - L Morgante
- Spina Bifida Center, Women's and Infant Health Sciences, A. Gemelli Policlinic, Catholic University of Sacred Heart, Largo A. Gemelli 8, 00168, Rome, Italy
| | - C Romagnoli
- Spina Bifida Center, Women's and Infant Health Sciences, A. Gemelli Policlinic, Catholic University of Sacred Heart, Largo A. Gemelli 8, 00168, Rome, Italy
| | - C Rendeli
- Spina Bifida Center, Women's and Infant Health Sciences, A. Gemelli Policlinic, Catholic University of Sacred Heart, Largo A. Gemelli 8, 00168, Rome, Italy
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30
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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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31
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Campion A, Lee C, Bao N, Lazareff J. A parental perspective concerning barriers to care for neural tube defects in China. Surg Neurol Int 2017; 8:195. [PMID: 28904822 PMCID: PMC5590351 DOI: 10.4103/sni.sni_384_16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 02/28/2017] [Indexed: 11/20/2022] Open
Abstract
Background: The People's Republic of China (PRC) has the highest incidence of neural tube defects (NTDs) in the world. NTDs remain a significant contributor to the global burden of disease amendable to surgical care; however, no studies to date have evaluated the patients’ perspective regarding perceived barriers to care. Methods: The study was conducted at the Shanghai Children's Medical Center (SCMC) between 6/11/2014 and 7/17/2014. Surveys were administered to families presenting to the clinic of the SCMC director for Pediatric Neurosurgery. Additionally, orphaned patients under the care of the Baobei Foundation were surveyed for comparison. Participants were allowed to mark as many barriers on the survey as they deemed relevant to their experience. Results: A total of 69 patients were surveyed. The most frequently chosen barrier to care, with a P value < 10-5, was that the referring physician did not know enough about the child's condition. As compared to the Baobei Foundation orphans, surveyed patients presented at an older age for initial treatment (7 months versus 1 month, P value = 0.001), and visited more hospitals before reaching SCMC (3.14 versus 1.0, P value < 10-5). Conclusions: The results of this study highlight the referring physician as a primary barrier to care. The younger age at time of treatment for Baobei orphans born with NTDs supports this finding, as they essentially bypassed the referral process. An elaboration on reasons for this real or perceived barrier may provide insight into a means for expedited diagnosis and treatment of NTDs within the PRC.
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Affiliation(s)
- Andrew Campion
- David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Clement Lee
- David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Nan Bao
- Department of Neurosurgery, Shanghai Children's Medical Center, Shanghai, China
| | - Jorge Lazareff
- David Geffen School of Medicine at UCLA, Los Angeles, California, USA.,UCLA Center for World Health at the David Geffen School of Medicine, Los Angeles, California, USA
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32
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Yu J, Maheshwari M, Foy AB, Calkins CM, Drolet BA. Neonatal Lumbosacral Ulceration Masking Lumbosacral and Intraspinal Hemangiomas Associated with Occult Spinal Dysraphism. J Pediatr 2016; 175:211-5. [PMID: 27215780 DOI: 10.1016/j.jpeds.2016.04.069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2015] [Revised: 03/30/2016] [Accepted: 04/20/2016] [Indexed: 11/25/2022]
Affiliation(s)
- JiaDe Yu
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, WI.
| | - Mohit Maheshwari
- Division of Neuroradiology, Children's Hospital of Wisconsin, Milwaukee, WI
| | - Andrew B Foy
- Division of Neurosurgery, Children's Hospital of Wisconsin, Milwaukee, WI
| | - Casey M Calkins
- Department of Pediatric, General and Thoracic Surgery, Children's Hospital of Wisconsin, Milwaukee, WI
| | - Beth A Drolet
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, WI
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Rodríguez Bandera AI, de Lucas Laguna R. Utilidad de la ecografía en la consulta de dermatología infantil. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.piel.2015.09.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Shankar P, Zamora C, Castillo M. Congenital malformations of the brain and spine. HANDBOOK OF CLINICAL NEUROLOGY 2016; 136:1121-1137. [PMID: 27430461 DOI: 10.1016/b978-0-444-53486-6.00058-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
In this chapter we briefly address the most common congenital brain and spinal anomalies as well as their most salient imaging, especially magnetic resonance, findings. Some of them, such as Chiari II, and open spinal defects, have become relatively rare due to their detection in utero and repair of the spinal malformation. Regardless of the type of brain anomaly, the most common clinical symptoms are mental retardation, hydrocephalus, and seizure; the latter two may need to be surgically and medically addressed. The most commonly found spinal congenital anomalies include the filum terminale lipoma which is generally asymptomatic and incidental and the caudal regression syndrome for which no primary treatment exists. Any spinal congenital anomaly may present in adulthood as a consequence of spinal cord tethering and/or development of syringomyelia.
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Affiliation(s)
- Prashant Shankar
- Division of Neuroradiology, Department of Radiology, University of North Carolina, Chapel Hill, NC, USA
| | - Carlos Zamora
- Division of Neuroradiology, Department of Radiology, University of North Carolina, Chapel Hill, NC, USA
| | - Mauricio Castillo
- Division of Neuroradiology, Department of Radiology, University of North Carolina, Chapel Hill, NC, USA.
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