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Zoghi S, Feili M, Mosayebi MA, Ansari A, Feili A, Masoudi MS, Taheri R. Surgical outcomes of myelomeningocele repair: A 20-year experience from a single center in a middle-income country. Clin Neurol Neurosurg 2024; 239:108214. [PMID: 38503112 DOI: 10.1016/j.clineuro.2024.108214] [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: 08/12/2023] [Revised: 02/23/2024] [Accepted: 02/27/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND AND PURPOSE Spina bifida is the second major cause of congenital disorders and the most common central nervous system congenital malformation compatible with life primarily. Herein, we describe the short-term outcome of post-natal Myelomeningocele (MMC) surgical management and predictors of its postoperative complications and mortality. METHODS This retrospective chart review studies the children who underwent post-natal surgical management for MMC in Namazi hospital, a tertiary referral center, in southern Iran from May 2001 to September 2020. RESULTS 248 patients were included in this study. The mean age at the operation was 8.47 ± 8.69 days. The most common site of involvement of MMC was Lumbosacral (86%, n = 204). At the evaluation conducted prior to the operation, cerebrospinal fluid leak was observed in 7% (n=16) of the patients. Postoperatively, 5.7% of the patients expired in the 30-day follow-up after the operation (n = 14), while 24% needed readmission (n = 47). The most common complications leading to readmission were wound dehiscence (n = 10, 42%) and wound purulence (n = 6, 25%). Only the site of the lesion (p-value = 0.035) was associated with postoperative complication. After controlling for potential confounders, the site of the lesion (adjusted odds ratio = 0.146, 95% confidence interval = 0.035-0.610, p-value = 0.008) and age at surgery (adjusted odds ratio = 1.048, 95% confidence interval = 1.002-1.096, p-value = 0.041) were significantly associated with mortality CONCLUSIONS: The age of the patients at the surgery and the site of the lesion are the two factors that were associated with mortality. However, further investigations into preoperative interventions and risk factors to mitigate the risk of complications and mortality are highly encouraged.
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Affiliation(s)
- Sina Zoghi
- Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran; Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Feili
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Ali Ansari
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Afrooz Feili
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Reza Taheri
- Shiraz Neuroscience Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; School of Medicine, Fasa University of Medical Sciences, Fasa, Iran.
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Hebbar K C, Reddy A, Luthra A, Chauhan R, Meena SC, Tripathi M. Comparison of the efficacy of intranasal atomised dexmedetomidine versus intranasal atomised ketamine as a premedication for sedation and anxiolysis in children undergoing spinal dysraphism surgery: A randomized controlled trial. Eur J Anaesthesiol 2024; 41:288-295. [PMID: 38095481 DOI: 10.1097/eja.0000000000001936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
BACKGROUND Preoperative anxiety leads to adverse clinical outcomes and long-term maladaptive behavioural changes. The role of intranasal atomised dexmedetomidine and atomised ketamine as premedication to produce sedation and anxiolysis in paediatric neurosurgical patients has not been extensively studied. OBJECTIVE To study the efficacy of intranasal atomised dexmedetomidine and intranasal atomised ketamine as premedication in producing sedation and facilitating smooth induction in children undergoing spinal dysraphism surgery. DESIGN A prospective randomised double-blind trial. SETTING A tertiary teaching hospital. PATIENTS Sixty-four children aged 1 to 10 years undergoing spinal dysraphism surgery. METHODS Children were randomised to receive intranasal atomised dexmedetomidine 2.5 μg kg -1 (Group D, n = 32) and intranasal atomised ketamine 5 mg kg -1 (Group K, n = 32) 30 min before surgery. OUTCOMES MEASURED The primary outcome was to compare the level of sedation in both groups using the University of Michigan Sedation Score (UMSS). The secondary outcomes included an assessment of the ease of parental separation, intravenous cannulation and satisfactory mask acceptance along with perioperative vitals (heart rate, blood pressure and oxygen saturation). The incidence of emergence agitation and time to discharge were also noted. RESULTS The degree of sedation was significantly better in Group D as compared to Group K at 20 min (UMSS, 1.55 ± 0.51 versus 1.13 ± 0.34, difference, -0.406; 95% CI, -0.621 to -0.191; P = 0.0001) and 30 min (2.32 ± 0.6 versus 1.94 ± 0.50, difference, -0.374; 95% CI, -0.650 to -0.100; P = 0.007). The ease of parental separation, venous cannulation and mask acceptance ( P = 0.83, 0.418 and 0.100 respectively) were comparable in both groups. The heart rate was lower in group D at 10, 20 and 30 min post-drug administration but was clinically insignificant. The incidence of emergence agitation and time to discharge was also similar with no adverse events reported. CONCLUSION Intranasal atomised dexmedetomidine produces greater sedation as compared to intranasal atomised ketamine with comparable ease of parental separation, venous cannulation and mask acceptance with no adverse effects.
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Affiliation(s)
- Chethan Hebbar K
- From the Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India (CHK, AR, AL, RC, SCM), Department of Neurosurgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India (MT)
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Sakti YM, Lanodiyu ZA, Sakadewa GP, Cein CR, Baskara AANN, Rahayu BFP. Spina bifida occulta at the lumbar spine level manifested as chronic low back pain and unpredictable neurologic deficit: A case report. Int J Surg Case Rep 2024; 116:109320. [PMID: 38325108 PMCID: PMC10859287 DOI: 10.1016/j.ijscr.2024.109320] [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: 12/05/2023] [Revised: 01/24/2024] [Accepted: 01/26/2024] [Indexed: 02/09/2024] Open
Abstract
INTRODUCTION Spina bifida occulta has a variety of symptoms that may hinder the diagnosis and subsequently delay appropriate treatment, causing a decrease in the patient's quality of life. This study aims to shed light on spina bifida occulta, with chronic low back pain as the predominant symptom, and the treatment applied in this case. PRESENTATION OF CASE A 46-year-old male was diagnosed with spina bifida occulta at the 5th lumbar spine after 2 years of having chronic low back pain that radiated to the left leg. He was initially diagnosed with chronic low back pain and was treated with epidural steroid injections which yielded a suboptimal outcome. Through an MRI examination, a spina bifida occulta at the 5th lumbar spine was identified and the patient was then referred to a tertiary hospital for further spinal decompressive treatments. The decompression level was obtained intraoperatively with the aid of intraoperative neurophysiological monitoring. Following the procedure, pain had almost completely subsided, and the patient regained full function for his daily activities without any pain or restrictions. DISCUSSION Non-specific clinical symptoms hindered the prompt diagnose of occult spinal dysraphism. MRI examinations of the spine is required and recommended for the characterization of intraspinal and perispinal abnormalities. Using intraoperative neurophysiological monitoring, we observed an improvement of nerve function at the L3-L5 level following decompression at the L3 level. CONCLUSION The diagnosis of spina bifida can be challenging when patients are presented with non-specific clinical symptoms, in this case as pain. We recommend spinal MRI examinations in cases of chronic lower back pain that fail to improve following expected pain management and therapy. Intraoperative neurophysiological monitoring can be used to assist in the identification of the level for decompression, as well as the resolution of pain.
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Affiliation(s)
- Yudha Mathan Sakti
- Staff of Orthopaedic and Traumatology Division, Department of Surgery, Dr. Sardjito General Hospital, Faculty of Medicine, Public Health and Nursing Universitas Gadjah Mada, Yogyakarta, Indonesia.
| | - Zikrina Abyanti Lanodiyu
- Staff of Orthopaedic and Traumatology Division, Department of Surgery, Dr. Sardjito General Hospital, Faculty of Medicine, Public Health and Nursing Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Galih Prasetya Sakadewa
- Resident of Orthopaedic and Traumatology Division, Department of Surgery, Dr. Sardjito General Hospital, Faculty of Medicine, Public Health and Nursing Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Caesarean Rayhan Cein
- Resident of Orthopaedic and Traumatology Division, Department of Surgery, Dr. Sardjito General Hospital, Faculty of Medicine, Public Health and Nursing Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Anak Agung Ngurah Nata Baskara
- Resident of Orthopaedic and Traumatology Division, Department of Surgery, Dr. Sardjito General Hospital, Faculty of Medicine, Public Health and Nursing Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Bernadeta Fuad Paramita Rahayu
- Resident of Orthopaedic and Traumatology Division, Department of Surgery, Dr. Sardjito General Hospital, Faculty of Medicine, Public Health and Nursing Universitas Gadjah Mada, Yogyakarta, Indonesia
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Apte A, Fauser T, Carson Q, Liechty KW, Simpson LN, Avellino AM. In utero Diagnosis of Spinal Dermal Sinus. Fetal Diagn Ther 2024; 51:235-242. [PMID: 38402872 DOI: 10.1159/000536404] [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: 09/25/2023] [Accepted: 01/14/2024] [Indexed: 02/27/2024]
Abstract
INTRODUCTION Congenital dermal sinus (CDS) is an open neural tube defect (NTD) that occurs in 1 in 2,500 births a year and often goes undetected until patients present with complications like infection and neurological deficits. Early diagnosis and repair of CDS may prevent formation of these complications. In utero diagnosis of these lesions may improve long-term outcomes by enabling referral to specialty services and planned postnatal repair; however, only 2 such cases have been reported in the literature. We present a third case of in utero diagnosis of CDS with a description and discussion of findings from surgical exploration and pathology. CASE PRESENTATION Routine prenatal ultrasound scan detected a tethered cystic structure arising from the back of the fetus at 20 weeks of gestation. Dedicated fetal ultrasound confirmed the presence of a cystic lesion protruding through a lamina defect, while fetal magnetic resonance imaging showed an intact spinal cord and meninges, suggesting a diagnosis of CDS. Neurosurgery followed along closely and took the child for surgical exploration on day 2 of life. A fibrous stalk with an intradural component and associated cord tethering was excised. Histology showed fibrous tissue without an epithelial-lined lumen. CONCLUSION CDS is a form of NTD that occurs from nondisjunction of the cutaneous ectoderm and neuroectoderm during formation of the neural tube. Slight differences in how this error occurs can explain variations seen in this spectrum of disease, including CDS without an epithelial-lined lumen as seen in this case. Newborns with CDS can go undiagnosed for years and present with long-term complications. Fetal imaging can assist in early recognition and surgical excision of CDS in newborns.
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Affiliation(s)
- Anisha Apte
- Department of Surgery, University of Arizona Tucson College of Medicine, Banner Children's at Diamond Children's Medical Center, Tucson, Arizona, USA
| | - Tobias Fauser
- Department of Surgery, University of Arizona Tucson College of Medicine, Banner Children's at Diamond Children's Medical Center, Tucson, Arizona, USA
| | - Quinlan Carson
- Department of Pathology, University of Arizona Tucson College of Medicine, Banner Children's at Diamond Children's Medical Center, Tucson, Arizona, USA
| | - Kenneth W Liechty
- Department of Surgery, University of Arizona Tucson College of Medicine, Banner Children's at Diamond Children's Medical Center, Tucson, Arizona, USA
| | - Lauren N Simpson
- Department of Neurosurgery, University of Arizona Tucson College of Medicine, Banner Children's at Diamond Children's Medical Center, Tucson, Arizona, USA
| | - Anthony M Avellino
- Department of Neurosurgery, University of Arizona Tucson College of Medicine, Banner Children's at Diamond Children's Medical Center, Tucson, Arizona, USA
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Balani A, Sidpra J, Sudhakar S, Biswas A, Öztekin Ö, Capra V, Catala M, Copp AJ, Kumar N, Johal N, Tahir MZ, Thompson D, Pang D, Mirsky DM, Ho ML, Huisman TAGM, Rossi A, Mankad K. International Consensus Statement on the Radiological Evaluation of Dysraphic Malformations of the Spine and Spinal Cord. AJNR Am J Neuroradiol 2024:ajnr.A8117. [PMID: 38360788 DOI: 10.3174/ajnr.a8117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 11/13/2023] [Indexed: 02/17/2024]
Abstract
Dysraphic malformations of the spine and spinal cord (DMSSC) represent a spectrum of common congenital anomalies typically (though not exclusively) affecting the lower spinal segments. These may be responsible for varying degrees of neurologic, orthopedic, and urologic morbidity. With advances in neuroimaging, it is now possible to better diagnose and evaluate these disorders both prenatally and postnatally. Neuroimaging, performed at the right time and with technique optimization, is integral in guiding clinical management. However, the terminology used to describe these lesions has become increasingly confusing, and there is a lack of consensus regarding the essential radiologic features and their clinical weighting. This variability in radiologic practice risks unstructured decision making and increases the likelihood of suboptimal, less informed clinical management. In this manuscript, the first of a series of consensus statements, we outline a standardized international consensus statement for the radiologic evaluation of children with suspected DMSSC derived from a critical review of the literature, and the collective clinical experience of a multinational group of experts. We provide recommendations for plain radiography, sonography, CT, and MR imaging in the evaluation of DMSSC with an emphasis on technique of imaging and imaging protocols.
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Affiliation(s)
- Ankit Balani
- From the Department of Neuroradiology (A. Balani, J.S., S.S., A. Biswas, K.M.), Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Jai Sidpra
- From the Department of Neuroradiology (A. Balani, J.S., S.S., A. Biswas, K.M.), Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- Developmental Biology and Cancer Section (J.S., A.J.C., K.M.), University College London Great Ormond Street Institute of Child Health, London, UK
| | - Sniya Sudhakar
- From the Department of Neuroradiology (A. Balani, J.S., S.S., A. Biswas, K.M.), Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Asthik Biswas
- From the Department of Neuroradiology (A. Balani, J.S., S.S., A. Biswas, K.M.), Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Özgür Öztekin
- Department of Neuroradiology (Ö.Ö.), Izmir Bakircay University, Izmir, Turkey
| | - Valeria Capra
- Medical Genetics Unit (V.C.), IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Martin Catala
- Laboratoire de Biologie du Développement (M.C.), UMR 7622 de Sorbonne Université et du CNRS, ERL 1156 de l'INSERM et Institut de Biologie Paris Seine, Paris, France
| | - Andrew J Copp
- Developmental Biology and Cancer Section (J.S., A.J.C., K.M.), University College London Great Ormond Street Institute of Child Health, London, UK
| | - Neetu Kumar
- Department of Urology (N.K., N.J.), Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Navroop Johal
- Department of Urology (N.K., N.J.), Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - M Zubair Tahir
- Department of Neurosurgery (M.Z.T., D.T., D.P.), Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Dominic Thompson
- Department of Neurosurgery (M.Z.T., D.T., D.P.), Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Dachling Pang
- Department of Neurosurgery (M.Z.T., D.T., D.P.), Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- Department of Paediatric Neurosurgery (D.P.), University of California, Davis, Davis, California
| | - David M Mirsky
- Department of Radiology (D.M.M.), Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
| | - Mai-Lan Ho
- Department of Radiology (M.-L.H.), Nationwide Children's Hospital, Ohio State University, Columbus, Ohio
| | - Thierry A G M Huisman
- Edward B. Singleton Department of Radiology (T.A.G.M.H.), Texas Children's Hospital and Baylor College of Medicine, Houston, Texas
| | - Andrea Rossi
- Neuroradiology Unit (A.R.), IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Department of Health Sciences (A.R.), University of Genoa, Genoa, Italy
| | - Kshitij Mankad
- From the Department of Neuroradiology (A. Balani, J.S., S.S., A. Biswas, K.M.), Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- Developmental Biology and Cancer Section (J.S., A.J.C., K.M.), University College London Great Ormond Street Institute of Child Health, London, UK
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Toms AS, Rai E, John NC, Panwar J. Use of ultrasound to estimate the prevalence of occult spinal dysraphism in children undergoing urogenital and anorectal surgeries: A cross-sectional study. J Anaesthesiol Clin Pharmacol 2024; 40:90-94. [PMID: 38666156 PMCID: PMC11042110 DOI: 10.4103/joacp.joacp_254_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 08/25/2022] [Accepted: 08/26/2022] [Indexed: 04/28/2024] Open
Abstract
Background and Aim The use of ultrasound has immensely increased the safety toward regional blocks and central venous access and has been considered as the standard of care for securing central access. The aim of this study is to estimate the prevalence of occult spinal dysraphism using ultrasound in children less than 2 years of age undergoing elective urogenital or anorectal surgery. Material and Methods The lumbosacral region of 159 American Society of Anesthesiologists (ASA) category I/II patients, posted for elective urogenital and anorectal surgery was scanned with ultrasound, prior to giving caudal block. Results The prevalence of occult spina bifida was 3% in our study. There was no statistically significant association of cutaneous marker with abnormal scan. Conclusion Prevalence of occult spina bifida was ten-times higher in our study than in the general population. Perioperative ultrasound screening of the lower spinal anatomy by anesthesiologist done prior to performing neuraxial block is worthwhile in ruling out occult spinal anomalies in high-risk children of occult spinal dysraphism.
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Affiliation(s)
- Ann Sumin Toms
- Asst. Professor, Department of Anaesthesiology, CMC Vellore, Tamil Nadu, India
| | - Ekta Rai
- Professor and Head, Department of Anaesthesiology, CMC Vellore, Tamil Nadu, India
| | - Novin Chacko John
- Senior Registrar, Department of Anaesthesiology, CMC Vellore, Tamil Nadu, India
| | - Jyoti Panwar
- Professor, Department of Radiology, CMC Vellore, Tamil Nadu, India
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Dineva S, Gaydarski L, Landzhov B. Disorder of sexual development, urinary bladder duplication, pancake kidney and neural tube defect. Radiol Case Rep 2023; 18:2354-2358. [PMID: 37179802 PMCID: PMC10172636 DOI: 10.1016/j.radcr.2023.03.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/17/2023] [Accepted: 03/23/2023] [Indexed: 05/15/2023] Open
Abstract
Congenital malformations of the urogenital system with fully developed duplications, such as urinary bladder, are sporadic. They are often present in the setting of endogenous molecular disbalance, such as steroid metabolism disturbances. Other rare manifestations of hormonal disbalance present as intersex conditions in which the individual has karyotype-specific internal genital organs with opposite-sex signs of the external genitalia, known as ambiguous genitalia. Congenital variations and malformations are often fully recognized and understood during radiological exams. Herein we present a unique case of a 2-month-old baby with female chromosomal sex and ambiguous genitalia together with the manifestation of several anatomical malformations: urinary bladder duplication in the coronal plane, pancake kidney with supernumerary renal arteries, 2 ureters and neural tube defect. Despite their low incidence rate, knowledge of such malformations is paramount for correct diagnosis and treatment in such cases.
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Affiliation(s)
- Svetla Dineva
- Radiology Department, National Cardiology Hospital, “Konyovitsa” 65 Str, Sofia, 1309, Bulgaria
- Corresponding author.
| | - Lyubomir Gaydarski
- Department of Anatomy, Histology and Embryology, Medical University of Sofia, Sofia, Bulgaria
| | - Boycho Landzhov
- Department of Anatomy, Histology and Embryology, Medical University of Sofia, Sofia, Bulgaria
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Chawla A, Patil MC, Reddy SJ, Pillai S, N SSB. Global Differences in Management of Neurogenic Bladder: Indian Perspective. CURRENT BLADDER DYSFUNCTION REPORTS 2023. [DOI: 10.1007/s11884-023-00692-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
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Khalaf Z, Al Hindi S. Sacrococcygeal spindle cell tumour: A case report. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2023. [DOI: 10.1016/j.epsc.2023.102611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
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Jamir I, Biswas R, Gulati R, Kumar P, Radjendirane A. Intra-spinal abscess due to Bacteroides fragilis and Klebsiella pneumoniae co-infection in a child with spinal dysraphism. Anaerobe 2023; 79:102673. [PMID: 36503026 DOI: 10.1016/j.anaerobe.2022.102673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 11/25/2022] [Accepted: 11/27/2022] [Indexed: 12/13/2022]
Abstract
Bacteroides fragilis (B. fragilis) is an uncommon cause of spinal abscess. We present a case of an 18-month-old child, with spinal dysraphism-Spina bifida occulta, who developed intra-spinal abscess infection with B. fragilis and Klebsiella pneumoniae. Magnetic resonance imaging (MRI) of the brain and spine showed multiple abscesses extending through the presacral fistula into the spinal cord. Patient was surgically treated along with administration of antimicrobial agents (ceftriaxone and metronidazole), resulting in an excellent clinical outcome.
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Affiliation(s)
- Imola Jamir
- Department of Microbiology, JIPMER, Puducherry, India
| | - Rakhi Biswas
- Department of Microbiology, JIPMER, Puducherry, India.
| | - Reena Gulati
- Department of Paediatrics, JIPMER, Puducherry, India
| | - Pradeep Kumar
- Department of Microbiology, JIPMER, Puducherry, India
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Rana A, Krishnan V, Jamwal R. “Spinal Dysraphism Spectrum: A Novel Protocol-based Approach for Accurate Diagnosis on Imaging”. JOURNAL OF PEDIATRIC NEUROLOGY 2023. [DOI: 10.1055/s-0043-1761418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
AbstractThe spectrum of spinal dysraphism includes various congenital anomalies of the spinal column and spinal cord. Clinical manifestations are varied and range from paraparesis, gastrointestinal, genitourinary, and musculoskeletal anomalies to asymptomatic cases depending on the level and extent of spinal involvement. Magnetic resonance imaging is the gold standard for assessing these complex spinal anomalies. Even for the experienced radiologist, diagnosis can be challenging in complex cases. It is essential to be aware of the normal embryological developmental stages of the spine for an adequate understanding of the complex anatomy, pathogenesis, and cliniconeuroradiological classification of spinal dysraphism, which is necessary for accurately diagnosing each case as a particular pathological entity. In this pictorial essay, we have depicted the stages and process of spinal embryogenesis, cliniconeuroradiological classification, and the imaging spectrum of spinal dysraphism. As the confusing terminologies and the numerous variants can potentially lead to misdiagnosis, we have proposed a step-wise protocol-based imaging approach to analyze each case and arrive at the correct diagnosis systematically. This would be particularly helpful in confusing and difficult cases, as accurate and early diagnosis is crucial for appropriate patient management.
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Affiliation(s)
- Abhilasha Rana
- Department of Radio-Diagnosis, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Venkatram Krishnan
- Department of Radio-Diagnosis, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Rupie Jamwal
- Department of Radio-Diagnosis, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
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Foo YW, Lim JX, Primalani NK, Ng LP, Seow WT, Low DCY, Low SYY. Tethered cord secondary to focal nondisjunction of the primary neural tube: experience from a Singapore children's hospital. Br J Neurosurg 2022:1-7. [PMID: 36564943 DOI: 10.1080/02688697.2022.2159931] [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: 09/08/2022] [Accepted: 12/13/2022] [Indexed: 12/25/2022]
Abstract
PURPOSE Tethered cord due to focal nondisjunction of primary neuralisation (FNPN) is a rare form of spinal dysraphism. We present our institutional experience in managing children diagnosed with FNPN. MATERIALS AND METHODS This is a single institution, retrospective study approved by the hospital ethics board. Patients below 18 years of age diagnosed with CDS, LDM or their mixed lesions, and subsequently underwent intervention by the Neurosurgical Service, KK Women's and Children's Hospital, are included. RESULTS From 2001 to 2021, 16 FNPN patients (50% males) were recruited. Eight of them had CDS (50.0%), seven had LDM (43.8%), and one patient had a mixed CDS and LDM lesion (6.2%). The average duration of follow up was 5.7 years and the mean age of surgery was 6 months old. Thirteen patients underwent prophylactic intent surgery (81.2%) and three had therapeutic intent surgery (18.8%). All patients did not have new neurological deficit or required repeat surgery for cord retethering. We observed that detethering surgery performed at or less than three months old was associated with having a wound infection (p = .022). CONCLUSIONS Our study reports that early recognition and timely intervention are mainstays of management for FNPN. We advocate a multi-disciplinary approach for good outcomes.
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Affiliation(s)
- Yi Wen Foo
- Neurosurgical Service, KK Women's and Children's Hospital, Singapore
| | - Jia Xu Lim
- Department of Neurosurgery, National Neuroscience Institute, Singapore
| | | | - Lee Ping Ng
- Neurosurgical Service, KK Women's and Children's Hospital, Singapore
| | - Wan Tew Seow
- Neurosurgical Service, KK Women's and Children's Hospital, Singapore
- Department of Neurosurgery, National Neuroscience Institute, Singapore
- Neuroscience Academic Clinical Program, SingHealth Duke-NUS, Singapore
| | - David C Y Low
- Neurosurgical Service, KK Women's and Children's Hospital, Singapore
- Department of Neurosurgery, National Neuroscience Institute, Singapore
- Neuroscience Academic Clinical Program, SingHealth Duke-NUS, Singapore
| | - Sharon Y Y Low
- Neurosurgical Service, KK Women's and Children's Hospital, Singapore
- Department of Neurosurgery, National Neuroscience Institute, Singapore
- Neuroscience Academic Clinical Program, SingHealth Duke-NUS, Singapore
- Paediatrics Academic Clinical Program, SingHealth Duke-NUS, Singapore
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Saekhu M, Susanto E, Handryastuti S, Ashari S, Nugroho S. Spinal dermal sinus coinciding with an infected giant epidermoid cyst in an infant presenting with constipation: a case report. PAEDIATRICA INDONESIANA 2022. [DOI: 10.14238/pi62.5.2022.357-63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Early diagnosis of spinal tumors is a prerequisite for achieving satisfactory neurological recovery. However, rare diseases tend to have a long diagnostic course.1 In addition, the clinical presentation of spinal tumors in most children is not apparent, moreover, spinal tumors may not show clinical symptoms if they are located in the lumbar spine and sized no more than one vertebra.2,3 Clinical presentations caused by tumors in the lumbar spine may include weakness of both limbs, impaired urination, and constipation.
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14
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Safari H, Jahangiri Babadi A, Alizadeh P, Ajudani R, Hamidi S. Huge unrepaired myelocystocele, progressive sac enlargement in later stages of life: a case report. Br J Neurosurg 2022:1-4. [PMID: 36074342 DOI: 10.1080/02688697.2022.2118235] [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: 06/14/2021] [Revised: 03/22/2022] [Accepted: 08/23/2022] [Indexed: 11/02/2022]
Abstract
BACKGROUND Spinal dysraphism is characterized by failure of fusion at dorsal midline structures through the embryonic developmental stages. A terminal myelocystocele consists of a skin-covered lumbosacral spina bifida and meningocele that directly continuous with the spinal subarachnoid space. OBSERVATION A 43-year-old woman who was diagnosed at birth with myelocystocele in the lower segments of the lumbar spine. She was not operated in the early stages of life. At the 43th years of her old, during 9-months, the sac began to progressively increase in size. In our initial examination before surgery, an extremely large skin-covered myelocystocele sac was observed in the thoracolumbar with a diameter of approximately 60 * 70 * 40 cm. patient operated and sac repaired. More than 20 liter of cerebrospinal fluid drainaged from cyst during surgery. LESSONS The mechanism of cyst enlargement is not well understood. Progressive and severe increase in size of unrepaired myelocystocele sac is possible in old ages even without cerebral hydrocephalus.
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Affiliation(s)
- Hosein Safari
- Department of Neurosurgery, Ahvaz Anesthesiology and Pain Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Armin Jahangiri Babadi
- Department of Neurosurgery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Pooyan Alizadeh
- Department of Neurosurgery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Reza Ajudani
- Department of Neurosurgery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Soroor Hamidi
- Department of Neurosurgery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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15
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Yarandi KK, Pour-Rashidi A, Mortazavi A, Shirani M, Mohammadi E, Karimiyarandi H, Amirjamshidi A. Pitfalls in diagnosis of cord tethering in scoliosis: Lessons learned from a series in a single centre. INTERDISCIPLINARY NEUROSURGERY 2022. [DOI: 10.1016/j.inat.2022.101596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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16
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Uy MNAR, Tantengco OAG. Investigating the landscape and trajectory of spina bifida research in Asia: a bibliometric analysis. Childs Nerv Syst 2022; 38:1581-1591. [PMID: 35474541 DOI: 10.1007/s00381-022-05527-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 04/10/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Spina bifida is a type of a neural tube defect which affects 243.14 per 100,000 babies in Asia. Research articles on spina bifida have increased in the recent years. However, no study has focused on the research trends in this field in Asia. METHODS A systematic review of literature on spina bifida in Asia was performed using the Scopus database from inception to 2020. All published studies on spina bifida conducted in or published by authors from Asia were included in our analysis. Bibliometric information was obtained from Scopus and bibliometrics diagrams were created using VOSviewer software. RESULTS A total of 652 articles were obtained in this study. The number of publications showed an upward trend starting 2000s. The country with the greatest number of publications was Japan while All India Institute of Medical Sciences was the most productive institution in spina bifida research in Asia. The current focus of this field in Asia was prevalence of spina bifida, prenatal diagnosis, folic acid supplementation, and complications of spina bifida. Future areas of research in spina bifida include the genetic basis of neural tube defects and the use of stem cell technology as therapies for spina bifida. CONCLUSION This is the first bibliometric analysis on spina bifida in Asia. It showed the trend and future areas of research on spina bifida in Asia. Despite the increase in scientific literature on spina bifida research, more research outputs and collaborations are needed especially in developing countries in Asia.
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Affiliation(s)
| | - Ourlad Alzeus G Tantengco
- College of Medicine, University of the Philippines Manila, Pedro Gil Street, Ermita, Manila, Philippines.
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17
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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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Berchi Kankam S, Ashrafi M, Tayebi Meybodi K, Sotoudeh Anvari M, Habibi Z, Nejat F. Lumbosacral non-terminal myelocystocele associated with teratoma: case report and review of literature. Childs Nerv Syst 2022; 38:1229-1232. [PMID: 34515813 DOI: 10.1007/s00381-021-05361-y] [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: 07/16/2021] [Accepted: 09/05/2021] [Indexed: 10/20/2022]
Abstract
Non-terminal myelocystoceles are commonly found in the cervical or thoracic spinal region. Their sac can rarely be associated with tumor. A rare case of an infant with a lumbosacral non-terminal myelocystocele and accompanying mature teratoma is reported in whom the tumor was attached to the placode not as a part of the sac.
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Affiliation(s)
- S Berchi Kankam
- Department of Pediatric Neurosurgery, Children's Medical Center, Tehran University of Medical Sciences, Tehran, 1419733151, Iran
| | - M Ashrafi
- Department of Pediatric Neurosurgery, Children's Medical Center, Tehran University of Medical Sciences, Tehran, 1419733151, Iran
| | - K Tayebi Meybodi
- Department of Pediatric Neurosurgery, Children's Medical Center, Tehran University of Medical Sciences, Tehran, 1419733151, Iran
| | - M Sotoudeh Anvari
- Department of Pediatric Pathology, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Z Habibi
- Department of Pediatric Neurosurgery, Children's Medical Center, Tehran University of Medical Sciences, Tehran, 1419733151, Iran
| | - F Nejat
- Department of Pediatric Neurosurgery, Children's Medical Center, Tehran University of Medical Sciences, Tehran, 1419733151, Iran.
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Mackay A, Sosland R, Tran K, Stewart J, Boone T, Khavari R. Prospective Evaluation of Intradetrusor Injections of OnabotulinumtoxinA in Adults With Spinal Dysraphism. Urology 2022; 161:146-152. [PMID: 34890686 PMCID: PMC8940632 DOI: 10.1016/j.urology.2021.09.045] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 09/18/2021] [Accepted: 09/27/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To prospectively evaluate the effectiveness of OnabotulinumtoxinA (BTX-A) on neurogenic overactive bladder (nOAB) in adults with congenital spinal dysraphism (CSD). METHODS We conducted a prospective, nonrandomized pilot study of 24 adults with CSD and neurogenic overactive bladder. Patients were evaluated with baseline video-urodynamics (UDS) and validated questionnaires, underwent injection 200U BTX-A, and then underwent repeat evaluation with questionnaires and UDS 1-3 months postinjection. A high-risk subgroup was separately analyzed based on adverse clinical characteristics (ie, decrease bladder compliance, vesicoureteral reflux, hydronephrosis, chronic kidney disease). RESULTS BTX-A injection improved patient recorded outcome measures seen in both I-QOL Score total (67.9 vs 75.5, P = .007) and Neurogenic Bladder Symptom Score total (38.0 vs 29.0, P = .001). On UDS, BTX-A injection significantly improved end filling pressure (16.0 vs 8.8, P = .036) and also improved bladder compliance (mL/cm H2O) (89.38 vs 135.81, P = .445). High-risk patients were found to have similar improvements in most subjective questionnaire scoring, a significant decrease in end filling pressures, and improved bladder compliance on UDS. CONCLUSION BTX-A can be used as an effective treatment in adults with CSD. We found that BTX-A significantly improved quality of life from patient reported outcome measurements as well as improving end filling pressures and bladder compliance. These improvements were seen even within our high-risk subgroup. Further studies are needed to evaluate long-term efficacy and appropriate follow-up of this at-risk population.
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Affiliation(s)
| | - Rachel Sosland
- Department of Urology, Houston Methodist Hospital, Houston TX
| | - Khue Tran
- Department of Urology, Houston Methodist Hospital, Houston TX
| | - Julie Stewart
- Department of Urology, Houston Methodist Hospital, Houston TX
| | - Timothy Boone
- Department of Urology, Houston Methodist Hospital, Houston TX
| | - Rose Khavari
- Department of Urology, Houston Methodist Hospital, Houston TX.
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20
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Sato Y, Watanabe Y, Saito H, Watanabe T, Ikeda H. Meningitis due to Enterobacter aerogenes in the community associated with congenital dermal sinus in a Japanese infant. IDCases 2022; 30:e01619. [PMID: 36187423 PMCID: PMC9519588 DOI: 10.1016/j.idcr.2022.e01619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 09/12/2022] [Accepted: 09/16/2022] [Indexed: 11/19/2022] Open
Abstract
Congenital dermal sinus is associated with meningitis caused by atypical pathogens. Although nosocomial infections with Enterobacter aerogenes in limited settings have been reported, community-acquired infections associated with congenital dermal sinus are rarely observed. We present the first non-neonatal case of a 3-month-old boy with meningitis due to Enterobacter aerogenes associated with congenital dermal sinus. The patient visited our hospital with fever and a skin dimple with lumbosacral hemangioma. He was diagnosed with meningitis based on cerebrospinal fluid (CSF) examination, which showed a cell count of 5717/µL. Subsequently, antimicrobial therapy with meropenem, cefotaxime (CTX), and vancomycin was initiated. His fever subsided, and the number of CSF cells decreased. Magnetic resonance imaging was performed for the dimple of the lumbosacral region, revealing the congenital dermal sinus. Enterobacter aerogenes was isolated from CSF and stool cultures, and treatment was adjusted to CTX alone based on susceptibility testing. However, the CSF culture remained positive. Although CTX was effective, the response to treatment was partial, and a switch to meropenem was required to achieve negative CSF cultures. In conclusion, Enterobacter aerogenes, although atypical, can cause community-acquired meningitis associated with congenital dermal sinus. Consistent with previous reports, in this case, a hemangioma on the back led to the diagnosis of congenital dermal sinus. Hence, systemic examination, including the back, is important. In addition, use of a third-generation cephalosporin (e.g., CTX) may not negate the CSF culture, even if it is effective. Thus, a switch to another drug (e.g., carbapenem) may be required.
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21
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Wishahi M. Lower urinary tract dysfunction in pediatrics progress to kidney disease in adolescents: Toward precision medicine in treatment. World J Nephrol 2021; 10:37-46. [PMID: 34430383 PMCID: PMC8353602 DOI: 10.5527/wjn.v10.i4.37] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 06/16/2021] [Accepted: 07/22/2021] [Indexed: 02/06/2023] Open
Abstract
Newborn infants who had neurogenic bladder dysfunction (NBD) have a normal upper urinary tract at birth. Most of them will develop deterioration of renal function and chronic kidney disease if they do not receive proper management. Children with NBD can develop renal damage at adolescence or earlier, which is due to high detrusor pressures resulted from poor compliance of the bladder, detrusor overactivity against a closed sphincter or detrusor sphincter dyssynergia. To preserve renal function and prevent deterioration of the kidneys, NBD must be treated immediately after being diagnosed. Over the last few years there was great progress in the treatment of children with the NBD. We searched PubMed and the Cochrane Library for peer-reviewed articles published in any language up to March 10, 2021, using the search term “neurogenic bladder children.” Our search excluded diagnosis, pathophysiology, surgical treatment of spinal cord injury and spina bifida. The research identified the effectiveness of treatment regimens targeting prevention of chronic kidney disease and the indications of kidney transplantation. The results of the research showed that NBD in children should be diagnosed early in life, and the child should receive the proper management. The literature search concluded that the management of NBD in children would be personalized for every case and could be changed according to response to treatment, side effects, child compliance, availability of treatment modality and costs of treatment. The objectives of the study are to present the different options of management of NBD in children and the selection of the proper method in a personalized manner.
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Affiliation(s)
- Mohamed Wishahi
- Department of Urology, Theodor Bilharz Research Institute, Cairo 12411, Egypt
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22
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Resmi MR, Thappa DM, Chandrashekar L, Plakkal N, Ramesh A. A Hospital Based Cross Sectional Study of Midline Cutaneous Lesions in Neonates and its Association with Spinal Dysraphism Detected Using Ultrasound. Indian Dermatol Online J 2021; 12:408-411. [PMID: 34211906 PMCID: PMC8202487 DOI: 10.4103/idoj.idoj_748_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 11/26/2020] [Accepted: 01/25/2021] [Indexed: 11/09/2022] Open
Abstract
Background: Spinal dysraphism occurs due to incomplete fusion of the midline mesenchymal, bony, or neural elements of the spine. The defects in the spinal cord can be associated with skin lesion since both have same embryonic origin. Aims and Objectives: This study was conducted to determine the association of midline and paramedian cutaneous lesions with spinal dysraphism by using spinal ultrasonography. Materials and Methods: Two thousand apparently healthy neonates were screened in the postnatal ward of a tertiary care center in South India. Those neonates with cutaneous lesions in the midline and paramedian region were screened for evidence of spinal dysraphism by using spinal ultrasonography. Results: Among 2000 neonates, 120 (6%) had at least one cutaneous lesion, of which 114 (5.7%) were in the midline and 6 (0.3%) were on the paramedian region of dorsal and ventral aspect of the body. Among these neonates, two cases had more than one skin lesions. The most common cutaneous lesion observed was typical dimple (82, 68%) followed by hypertrichosis (12, 10%). Ultrasonography revealed spinal anomaly in six (5%) of them. The cutaneous lesions associated with spinal dysraphism were obvious midline swelling, dermal sinus, and multiple skin lesions. Conclusion: Congenital midline and paramedian skin lesions may be the marker of spinal dysraphism. In the presence of such cutaneous lesions, only 5% of them had associated spinal anomaly in our study.
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Affiliation(s)
- M R Resmi
- Department of Dermatology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - Devinder Mohan Thappa
- Department of Dermatology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - Laxmisha Chandrashekar
- Department of Dermatology and STD, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - Nishad Plakkal
- Department of Neonatology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - A Ramesh
- Department of Radiodiagnosis, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
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Moussa M, Papatsoris AG, Chakra MA, Fares Y, Dabboucy B, Dellis A. Perspectives on urological care in spina bifida patients. Intractable Rare Dis Res 2021; 10:1-10. [PMID: 33614369 PMCID: PMC7882087 DOI: 10.5582/irdr.2020.03077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 10/04/2020] [Accepted: 12/12/2020] [Indexed: 02/05/2023] Open
Abstract
Spina bifida (SB) is a neurogenetic disorder with a complex etiology that involves genetic and environmental factors. SB can occur in two major forms of open SB or SB aperta and closed SB or SB occulta. Myelomeningocele (MMC), the most common neural tube defects (NTDs), occurs in approximately 1 in 1,000 births. Considering non-genetic factors, diminished folate status is the best-known factor influencing NTD risk. The methylenetetrahydrofolate reductase (MTHFR) gene has been implicated as a risk factor for NTDs. The primary disorder in the pathogenesis of MMC is failed neural tube closure in the embryonic spinal region. The clinical manifestation of SB depends on clinical type and severity. SB can be detected in the second trimester using ultrasound which will reveal specific cranial signs. The management of MMC traditionally involves surgery within 48 h of birth. Prenatal repair of MMC is recommended for fetuses who meet maternal and fetal Management of Myelomeningocele Study (MOMS) specified criteria. Urological manifestations of SB include urinary incontinence, urolithiasis, sexual dysfunction, renal dysfunction, and urinary tract infection. Renal failure is among the most severe complications of SB. The most important role of the urologist is the management of neurogenic bladder. Medical management with clean intermittent catheterization and anticholinergic treatment is generally considered the gold standard of therapy. However, when this therapy fails surgical reconstruction become the only remaining option. This review will summarize the pathogenesis, risk factors, genetic contribution, diagnostic test, and management of SB. Lastly, the urologic outcomes and therapies are reviewed.
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Affiliation(s)
- Mohamad Moussa
- Urology Department, Zahraa Hospital, University Medical Center, Lebanese University, Beirut, Lebanon
| | - Athanasios G. Papatsoris
- 2nd Department of Urology, School of Medicine, Sismanoglio Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Mohamad Abou Chakra
- Department of Urology, Faculty of Medicine, Lebanese University, Beirut, Lebanon
| | - Youssef Fares
- Department of Neurosurgery, Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Baraa Dabboucy
- Department of Neurosurgery, Faculty of Medicine, Lebanese University, Beirut, Lebanon
| | - Athanasios Dellis
- Department of Urology/General Surgery, Areteion Hospital, Athens, Greece
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Austin PF, Franco I, Dobremez E, Kroll P, Titanji W, Geib T, Jenkins B, Hoebeke PB. OnabotulinumtoxinA for the treatment of neurogenic detrusor overactivity in children. Neurourol Urodyn 2020; 40:493-501. [PMID: 33305474 PMCID: PMC7839517 DOI: 10.1002/nau.24588] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 10/29/2020] [Accepted: 11/16/2020] [Indexed: 02/06/2023]
Abstract
AIMS This study evaluated whether one (or more) of three doses of onabotulinumtoxinA were safe and effective to treat neurogenic detrusor overactivity (NDO) in children. METHODS This was a 48-week prospective, multicenter, randomized, double-blind study in children (aged 5-17 years) with NDO and urinary incontinence (UI) receiving one onabotulinumtoxinA treatment (50, 100, or 200 U; not to exceed 6 U/kg). Primary endpoint: change from baseline in daytime UI episodes. Secondary endpoints: change from baseline in urine volume at first morning catheterization, urodynamic measures, and positive response on the treatment benefit scale. Safety was also assessed. RESULTS There was a similar reduction in urinary incontinence from baseline to Week 6 for all doses (-1.3 episodes/day). Most patients reported positive responses on the treatment benefit scale (75.0%-80.5%). From baseline to Week 6, increases were observed in urine volume at first morning clean intermittent catheterization (50 U, 21.9 ml; 100 U, 34.9 ml; 200 U, 87.5 ml; p = 0.0055, 200 U vs. 50 U) and in maximum cystometric capacity (range 48.6-63.6 ml) and decreases in maximum detrusor pressure during the storage phase (50 U, -12.9; 100 U, -20.1; 200 U, -27.3 cmH2 O; p = 0.0157, 200 U vs. 50 U). The proportion of patients experiencing involuntary detrusor contractions dropped from baseline (50 U, 94.4%; 100 U, 88.1%; 200 U, 92.6%) to Week 6 (50 U, 61.8%; 100 U, 44.7%; 200 U, 46.4%). Safety was similar across doses; urinary tract infection was most frequent. CONCLUSIONS OnabotulinumtoxinA was well tolerated and effective for the treatment of NDO in children; 200 U showed greater efficacy in reducing bladder pressure and increasing bladder capacity.
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Affiliation(s)
- Paul F Austin
- Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Israel Franco
- Yale New Haven Children's Hospital, New Haven, Connecticut, USA
| | | | - Pawel Kroll
- Neuro-urology Unit, Paediatric Urology Clinic, Poznań, Poland
| | | | - Till Geib
- Allergan, an AbbVie company, Irvine, California, USA
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25
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Mattar MAB, Kassem M, Sabry AM. Complicated congenital dermal sinus: Diagnosis and management. INTERDISCIPLINARY NEUROSURGERY 2020. [DOI: 10.1016/j.inat.2020.100739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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26
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Balani A, Chatur C, Biswas A, Oztekin O, Mankad K. Spinal dysraphisms: highlighting discrepancies in the current literature and emphasizing on the need for a consensus. Quant Imaging Med Surg 2020; 10:549-553. [PMID: 32269916 PMCID: PMC7136728 DOI: 10.21037/qims.2020.02.04] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Accepted: 02/03/2020] [Indexed: 03/29/2024]
Affiliation(s)
- Ankit Balani
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Chinky Chatur
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | | | | | - Kshitij Mankad
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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27
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Kumar I, Sachan A, Aggarwal P, Verma A, Shukla RC. Structured MRI reporting in spinal dysraphism. Acta Radiol 2020; 61:1520-1533. [PMID: 32054289 DOI: 10.1177/0284185120903445] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Magnetic resonance evaluation of spinal dysraphism can be confusing for inexperienced radiologists and a detailed, step-by-step evaluation of the normal and abnormal imaging findings can help garner the diagnosis. The purpose of this article is to review the existing literature and to provide a comprehensive, structured, template checklist-style format for reporting spinal dysraphism that can help inexperienced radiologists to systematically analyze and report all the significant and ancillary findings in cases of spinal dysraphism and efficiently communicate the findings to the treating physician/surgeon.
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Affiliation(s)
- Ishan Kumar
- Department of Radiodiagnosis, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Ankita Sachan
- Department of Radiodiagnosis, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Priyanka Aggarwal
- Department of Pediatrics, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Ashish Verma
- Department of Radiodiagnosis, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Ram C Shukla
- Department of Radiodiagnosis, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
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28
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Unveiling the tale of the tail: an illustration of spinal dysraphisms. Neurosurg Rev 2019; 44:97-114. [PMID: 31811517 DOI: 10.1007/s10143-019-01215-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 10/31/2019] [Accepted: 11/20/2019] [Indexed: 01/15/2023]
Abstract
Spinal dysraphism is an umbrella term describing herniation of meninges or neural elements through defective neural arch. They can be broadly categorized into open and closed types. MRI is the investigation of choice to study neural abnormalities and to assess the severity of hydrocephalus and Chiari malformation. Knowledge of the embryology of these disorders is valuable in correctly identifying the type of dysraphism. The aim of surgery is untethering and dural reconstruction. Accurate depiction of the abnormal anatomy in cases of spinal dysraphism is of utmost importance for surgical management of these patients. MRI makes this possible due to its excellent soft tissue contrast resolution and multiplanar capability, allowing the radiologist to evaluate the intricate details in small pediatric spinal structures. Imaging enlightens the surgeons about the status of spinal cord and other associated abnormalities and helps detect re-tethering in operated cases. Besides, antenatal surgery to repair myelomeningoceles has made detection of open dysraphisms on fetal MRI and antenatal ultrasound critical. The purpose of this review is to describe the development of spine, illustrate the myriad imaging features of open and closed spinal dysraphisms, and enlist the reporting points the operating surgeon seeks from the radiologist.
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Li Z, Chen YA, Chow D, Talbott J, Glastonbury C, Shah V. Practical applications of CISS MRI in spine imaging. Eur J Radiol Open 2019; 6:231-242. [PMID: 31304197 PMCID: PMC6603258 DOI: 10.1016/j.ejro.2019.06.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 05/21/2019] [Accepted: 06/10/2019] [Indexed: 01/09/2023] Open
Abstract
Conventional spin echo imaging is limited by low spatial resolution and CSF pulsation artifact. CISS MRI enables submillimeter spatial resolution and myelographic contrast. Inherent flow compensation of the CISS technique reduces CSF pulsation artifact. CISS improves the delineation of a wide variety of spinal pathologies.
Routine magnetic resonance imaging evaluation of the spine is often limited by low spatial resolution and artifacts resulting from cerebrospinal fluid pulsation. Balanced steady-state free precession sequences can supplement routine spin echo sequences and provide exquisite anatomic detail and high cerebrospinal fluid-to-soft tissue contrast, adding significant diagnostic value to the evaluation of a wide variety of spine disorders.
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Affiliation(s)
- Zhixi Li
- Department of Radiology and Biomedical Imaging, University of California, 505 Parnassus Avenue, M-391, San Francisco, CA 94143-0628, USA
| | - Yingming Amy Chen
- Department of Radiology and Biomedical Imaging, University of California, 505 Parnassus Avenue, M-391, San Francisco, CA 94143-0628, USA
| | - Daniel Chow
- Department of Radiology and Biomedical Imaging, University of California, 505 Parnassus Avenue, M-391, San Francisco, CA 94143-0628, USA
| | - Jason Talbott
- Department of Radiology and Biomedical Imaging, University of California, 505 Parnassus Avenue, M-391, San Francisco, CA 94143-0628, USA
| | - Christine Glastonbury
- Department of Radiology and Biomedical Imaging, University of California, 505 Parnassus Avenue, M-391, San Francisco, CA 94143-0628, USA
| | - Vinil Shah
- Department of Radiology and Biomedical Imaging, University of California, 505 Parnassus Avenue, M-391, San Francisco, CA 94143-0628, USA
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Eid S, Iwanaga J, Loukas M, Jerry Oakes W, Shane Tubbs R. Ventral and dorsal tethering bands of the spinal cord in the same patient: a case report. Childs Nerv Syst 2019; 35:389-391. [PMID: 30338360 DOI: 10.1007/s00381-018-3993-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 10/10/2018] [Indexed: 11/26/2022]
Abstract
Fibrous bands are one of the causes of tethered cord syndrome and these can be located on the dorsal or more rarely, ventral aspect of the dura mater. We report a case of dorsal and ventral tethering bands in the same patient found at surgery for tethered cord syndrome. Such fibrous bands restrict normal movement of the spinal cord and lead to a variety of neurological symptoms. To our knowledge, we report the first case of dorsal and ventral tethering bands of the spinal cord in the same patient. This case report aims to increase awareness of such anatomical variations and emphasize the importance of meticulous surgical dissection in order to identify such bands.
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Affiliation(s)
- Seif Eid
- Department of Anatomical Sciences, St. George's University, St. George's, West Indies, Grenada
| | - Joe Iwanaga
- Seattle Science Foundation, 550 17th Ave, James Tower, Suite 600, Seattle, WA, 98122, USA.
| | - Marios Loukas
- Department of Anatomical Sciences, St. George's University, St. George's, West Indies, Grenada
| | | | - R Shane Tubbs
- Department of Anatomical Sciences, St. George's University, St. George's, West Indies, Grenada
- Seattle Science Foundation, 550 17th Ave, James Tower, Suite 600, Seattle, WA, 98122, USA
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Kurian JJ, Jacob TJK, Mathai J. Encouraging Results of Bowel and Bladder Management in Spina Bifida Aperta in South India with Quality of Life Scores in a Tertiary Care Institution in South India. J Indian Assoc Pediatr Surg 2019; 24:21-26. [PMID: 30686883 PMCID: PMC6322176 DOI: 10.4103/jiaps.jiaps_195_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Context It is often a challenge to counsel parents with children operated for spina bifida aperta in developing countries. Data regarding the efficacy of simple measures and preventive are scarce. Aims The aim of this study is to study such children for the incidence, prevalence of bowel bladder dysfunction, and the quality of life (QOL) in children who are involved with a multidisciplinary team in India. Materials and Methods All children with spina bifida occulta were followed - QOL questionnaires (PIN Q, modified Barthels activities of daily living , and the visual analog score [VAS]) were used. Interventions, such as clean intermittent catheterization (CIC), bowel enemas, and surgical procedures, were studied. Results A total of 68 children were assessed. Twenty-nine of these children over five were evaluated with QOL scores. The prevalence of incontinence of bowel and bladder was studied. The primary outcomes included the QOL scores, and the various surgical options help bowel and bladder management. Hydronephrosis in 17.95% of children <5 years and 65.5% of children over 5 years was noted. Nineteen children were socially independent for their bowel management. The Barthel index and PIN-Q showed a poor QOL in 27.6% and the VAS in 34.5% had the same. This translated to an acceptable QOL for over two-thirds of the children. Conclusions Simple procedures and training for bowel management translate to a significant number of children being able to independently manage bowel care. About 30% of children develop hydronephrosis by 5 years; the decision to teach CIC must be made by then. We believe that positive counseling is given to the parents of children with spina bifida aperta as the children are capable of a reasonable QOL.
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Affiliation(s)
- Jujju Jacob Kurian
- Department of Paediatric Surgery, Christian Medical College, Vellore, Tamil Nadu, India
| | - Tarun John K Jacob
- Department of Paediatric Surgery, Christian Medical College, Vellore, Tamil Nadu, India
| | - John Mathai
- Department of Paediatric Surgery, Christian Medical College, Vellore, Tamil Nadu, India
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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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Díaz Sanhueza C, Pardo Vargas R, Bustos P. Manifestaciones neurológicas asociadas a espina bífida en adultos. Semergen 2018; 44:276-280. [DOI: 10.1016/j.semerg.2017.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 08/17/2017] [Accepted: 09/22/2017] [Indexed: 11/26/2022]
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Mehta DV. Magnetic Resonance Imaging in Paediatric Spinal Dysraphism with Comparative Usefulness of Various Magnetic Resonance Sequences. J Clin Diagn Res 2017; 11:TC17-TC22. [PMID: 28969239 DOI: 10.7860/jcdr/2017/30134.10393] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 07/29/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Spinal dysraphism occurs due to failure of fusion of parts along dorsal aspect of midline structures lying along spinal axis from skin to vertebrae and spinal cord. Congenital spinal anomalies may be minimal and asymptomatic like spinal bifida occulta, or severe with marked neurological deficits like Arnold-Chiari malformation or caudal regression syndrome. Magnetic Resonance Imaging (MRI) is the modality of choice to diagnose mild to severe spinal dysraphism. AIM To diagnose type and extent of clinically suspected spinal anomalies by MRI scan and to compare various sequences for identifying neural tissue and fatty tissue in anomalies. MATERIALS AND METHODS Fifty paediatric patients referred with clinical suspicion of spinal anomalies for MRI scan to radiodiagnosis department and diagnosed as having spinal dysraphism on 1.5 Tesla MRI Scan, were included in this observational analytic study. Various MRI sequences were taken in multiple planes. MRI findings of spinal dysraphism were compared with detailed clinical examination or surgical findings. Osseous anomalies like spina bifida occulta were confirmed by radiographs or CT scan. RESULTS Out of 50 patients, type II Arnold-Chiari Malformation (34%), Spina Bifida Occulta (22%) and Diastematomyelia (18%) were common anomalies. MRI findings were well correlated with surgical findings in 20 operated cases. Nerve roots with/ without neural placode in thecal sac/outpouching were detected in combination of 3D HASTE myelographic sequence with SE/ TSE T1W sequence in 24 cases; which was significantly high as compared to combinations of SE/TSE T1W sequence with TSE T2W, with STIR and with Single Shot Myelographic sequence {p-value 0.002, < 0.001 and 0.008 respectively}. Fatty component was present in dysraphism in five cases, commonly as isolated anomaly; which was detected by combination of STIR and SE/TSE T1W sequences in all five cases. CONCLUSION Paediatric spinal dysraphism and associated malformations are accurately diagnosed on MRI scan. MR myelographic 3D-HASTE and STIR sequences should be a part of protocol to evaluate spinal dysraphism.
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Affiliation(s)
- Deepakkumar Vinodary Mehta
- Professor, Department of Radiodiagnosis, Pramukhswami Medical College and Shree Krishna Hospital, Gokal Nagar, Karamsad, Anand, Gujarat, India
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Kumar J, Afsal M, Garg A. Imaging spectrum of spinal dysraphism on magnetic resonance: A pictorial review. World J Radiol 2017; 9:178-190. [PMID: 28529681 PMCID: PMC5415887 DOI: 10.4329/wjr.v9.i4.178] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 02/15/2017] [Accepted: 03/02/2017] [Indexed: 02/06/2023] Open
Abstract
Congenital malformations of spine and spinal cord are collectively termed as spinal dysraphism. It includes a heterogeneous group of anomalies which result from faulty closure of midline structures during development. Magnetic resonance imaging (MRI) is now considered the imaging modality of choice for diagnosing these conditions. The purpose of this article is to review the normal development of spinal cord and spine and reviewing the MRI features of spinal dysraphism. Although imaging of spinal dysraphism is complicated, a systematic approach and correlation between neuro-radiological, clinical and developmental data helps in making the correct diagnosis.
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Abstract
PURPOSE OF REVIEW Spina bifida is caused by incomplete neural tube closure during the first trimester. This condition may lead to bowel and bladder dysfunction as well as truncal weakness and motor anomalies. Presentations vary between myelomeningoceles and lipomeningoceles and may result in different outcomes. This review seeks to explore our current understanding of the variations in outcomes between individuals with myelomeningocele and lipomeningocele. RECENT FINDINGS Prenatal intervention has become a standard of care for prenatal diagnoses of myelomeningocele and has been shown to reduce shunt placement and improve motor skills. However, urological benefit from early intervention remains to be seen. Early surgical repair, however, may be beneficial for patients with lipomeningocele. Literature on the urological outcomes of patients with myelomeningocele and lipomeningocele is lacking. Further research is needed to better elucidate differences in long-term urological outcomes between these two pathologies.
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Affiliation(s)
- Yvonne Y Chan
- Department of Urology, University of California Davis Children's Hospital, Sacramento, CA, 95817, USA
| | - Samantha K Sandlin
- Department of Urology, University of California Davis Children's Hospital, Sacramento, CA, 95817, USA.,Stem Cell Program, Institute for Regenerative Cures, University of California, Davis Medical Center, 4860 Y Street, Suite 3500, Sacramento, CA, 95817, USA
| | - Eric A Kurzrock
- Department of Urology, University of California Davis Children's Hospital, Sacramento, CA, 95817, USA. .,Stem Cell Program, Institute for Regenerative Cures, University of California, Davis Medical Center, 4860 Y Street, Suite 3500, Sacramento, CA, 95817, USA.
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Mohd-Zin SW, Marwan AI, Abou Chaar MK, Ahmad-Annuar A, Abdul-Aziz NM. Spina Bifida: Pathogenesis, Mechanisms, and Genes in Mice and Humans. SCIENTIFICA 2017; 2017:5364827. [PMID: 28286691 PMCID: PMC5327787 DOI: 10.1155/2017/5364827] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 11/14/2016] [Accepted: 12/01/2016] [Indexed: 05/26/2023]
Abstract
Spina bifida is among the phenotypes of the larger condition known as neural tube defects (NTDs). It is the most common central nervous system malformation compatible with life and the second leading cause of birth defects after congenital heart defects. In this review paper, we define spina bifida and discuss the phenotypes seen in humans as described by both surgeons and embryologists in order to compare and ultimately contrast it to the leading animal model, the mouse. Our understanding of spina bifida is currently limited to the observations we make in mouse models, which reflect complete or targeted knockouts of genes, which perturb the whole gene(s) without taking into account the issue of haploinsufficiency, which is most prominent in the human spina bifida condition. We thus conclude that the need to study spina bifida in all its forms, both aperta and occulta, is more indicative of the spina bifida in surviving humans and that the measure of deterioration arising from caudal neural tube defects, more commonly known as spina bifida, must be determined by the level of the lesion both in mouse and in man.
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Affiliation(s)
- Siti W. Mohd-Zin
- Department of Parasitology, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Ahmed I. Marwan
- Laboratory for Fetal and Regenerative Biology, Colorado Fetal Care Center, Division of Pediatric Surgery, Children's Hospital Colorado, University of Colorado, Anschutz Medical Campus, 12700 E 17th Ave, Aurora, CO 80045, USA
| | | | - Azlina Ahmad-Annuar
- Department of Biomedical Science, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Noraishah M. Abdul-Aziz
- Department of Parasitology, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
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Mishra VV, Nanda S, Aggarwal R, Tanvir. Successful Pregnancy Outcome in an Operated Case of Lipomeningomyocele: A Rare Case. J Clin Diagn Res 2016; 10:QD04-QD05. [PMID: 27790529 PMCID: PMC5072029 DOI: 10.7860/jcdr/2016/18562.8558] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2015] [Accepted: 03/28/2016] [Indexed: 11/24/2022]
Abstract
Lipomeningomyocele is one of the types of occult spinal dysraphism associated with tethered cord syndrome, which is characterised by neurodeficit symptomatology due to stretch- induced functional disorder of the spinal cord with its caudal part attached by an in elastic tissue. There is stretching of conus medullaris and nerve roots due to disproportionate growth between vertebral column and spinal cord, resulting in various neurological deficits. Its incidence is approximately 1 in 4000 births in the USA, with a slightly higher female preponderance, although its true incidence is not known. There are very few studies on pregnancy outcome in these patients and the management dilemma in this group has prompted us to report this case.
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Affiliation(s)
- Vineet Vashistha Mishra
- Head of Department and Professor, Department of Obstetrics and Gynaecology, Institute of Kidney Diseases and Research Centre, Institute of Transplantation Sciences, Ahmedabad, Gujarat, India
| | - Sakshi Nanda
- Fellow, Department of Obstetrics and Gynaecology, Institute of Kidney Diseases and Research Centre, Institute of Transplantation Sciences, Ahmedabad, Gujarat, India
| | - Rohina Aggarwal
- Associate Professor, Department of Obstetrics and Gynaecology, Institute of Kidney Diseases and Research Centre, Institute of Transplantation Sciences, Ahmedabad, Gujarat, India
| | - Tanvir
- Senior Resident, Department of Obstetrics and Gynaecology, Institute of Kidney Diseases and Research Centre, Institute of Transplantation Sciences, Ahmedabad, Gujarat, India
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Dhingani DD, Boruah DK, Dutta HK, Gogoi RK. Ultrasonography and magnetic resonance imaging evaluation of pediatric spinal anomalies. J Pediatr Neurosci 2016; 11:206-212. [PMID: 27857788 PMCID: PMC5108122 DOI: 10.4103/1817-1745.193374] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
CONTEXT Spinal dysraphisms are congenital abnormalities of the spine due to imperfect fusion of midline mesenchymal, bony and neural structures. Imaging plays a vital role in their evaluation as significant portion of patients may present with concurrent anomalies that need to be corrected simultaneously to avoid repeat surgeries. AIMS The aims of the study were to evaluate Spinal dysraphisms using USG and MRI and to correlate imaging findings with operative findings in patients undergoing surgery. SETTINGS AND DESIGN Hospital based observational study conducted over a period of year. MATERIALS AND METHODS 38 cases of both sexes and below 12 years of age with spinal dysraphism were studied. USG was performed in 29 cases where acoustic window was available for proper evaluation. MRI was performed in all cases. USG findings were compared with MRI findings and operative follow up was taken in 23 cases who underwent operative management. STATISTICAL ANALYSIS USED Results were analysed using percentage and arithmetic mean. RESULTS 39.47 % cases were male and 60.53 % cases were female. Neonatal period was the most common presenting age group. Closed spinal dysraphism (63.16%) was more common than open (36.84%). 79.31% cases showed full agreement between spinal USG and MRI examinations and 6 out of 20.69% showed partial agreement. On operative correlation, USG findings were confirmatory in 91.30% cases and MRI findings were confirmatory in 100% cases. CONCLUSIONS USG can be used as the initial modality for evaluation of spinal dysraphism as well as for screening of suspected cases. MRI is indicated to confirm abnormal USG findings, which shows all concurrent abnormalities and also provides additional anatomical details relevant to surgical planning.
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Affiliation(s)
| | - Deb Kumar Boruah
- Department of Radio Diagnosis, Assam Medical College and Hospital, Dibrugarh, Assam, India
| | - Hemonta Kumar Dutta
- Department of Pediatric Surgery, Assam Medical College and Hospital, Dibrugarh, Assam, India
| | - Rudra Kanta Gogoi
- Department of Radio Diagnosis, Assam Medical College and Hospital, Dibrugarh, Assam, India
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Balasubramanian P, Srinivas CR, Arunachalam P, Thirumurthy KS, Rajkumar PR, Manuvidhya H. Lumbar lipomeningomyelocele associated with multiple café au lait spots: a case report. Pediatr Dermatol 2015; 32:e78-81. [PMID: 25786983 DOI: 10.1111/pde.12557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We report on a child with several café au lait spots in association with a lumbar lipomeningomyelocele as an apparently new association. Cutaneous markers, the identification of which plays a crucial role in the early diagnosis and management of spinal malformations, can accompany occult spinal dysraphism. Herein we report a case of lumbar lipomeningomyelocele associated with an overlying café au lait spot that served as a marker of occult spinal dysraphism. The patient also had segmental café au lait spots on the face, making the association unique.
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Affiliation(s)
- Pradeep Balasubramanian
- Department of Dermatology, PSG Institute of Medical Sciences and Research, Coimbatore, India
| | - C R Srinivas
- Department of Dermatology, PSG Institute of Medical Sciences and Research, Coimbatore, India
| | - Pavai Arunachalam
- Department of Paediatric Surgery, PSG Institute of Medical Sciences and Research, Coimbatore, India
| | - K S Thirumurthy
- Department of Neurosurgery, PSG Institute of Medical Sciences and Research, Coimbatore, India
| | - P R Rajkumar
- Department of Neurosurgery, PSG Institute of Medical Sciences and Research, Coimbatore, India
| | - H Manuvidhya
- Department of Dermatology, PSG Institute of Medical Sciences and Research, Coimbatore, India
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Emergencies in pediatric surgery. Indian J Pediatr 2014; 81:791-6. [PMID: 24243445 DOI: 10.1007/s12098-013-1273-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Accepted: 10/16/2013] [Indexed: 10/26/2022]
Abstract
Primary care physicians are often required to initially manage the children with surgical emergencies. Many neonates with congenital malformations delivered without supervision may also be managed initially by the family physicians. The role of the primary care physician in such cases should be to diagnose the condition correctly, provide immediate care and then refer the newborn or child to higher centre for appropriate management.
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Early identification of tethered cord syndrome: a clinical challenge. J Pediatr Health Care 2014; 28:e23-33. [PMID: 23932444 DOI: 10.1016/j.pedhc.2013.06.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Revised: 06/23/2013] [Accepted: 06/29/2013] [Indexed: 11/21/2022]
Abstract
Tethered cord syndrome (TCS) is a progressive clinical condition that arises from excessive spinal cord tension. The clinical signs and symptoms of TCS may be cutaneous, neurologic, musculoskeletal, genitourinary, and/or gastrointestinal. Patients also may be asymptomatic, which does not exclude the diagnosis of TCS. Although the exact etiology is unknown, early identification and lifelong surveillance or surgical treatment is an essential component of patient management. In this article we review the pathophysiology, various etiologies, clinical presentation, and long-term sequelae of TCS. This information will help pediatric nurse practitioners identify TCS early and anticipate the patient's needs and management requirements.
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Rehme C, Rübben I. Aspekte der Sexualität bei Adoleszenten mit einer Spina bifida. Urologe A 2014; 53:201-5. [DOI: 10.1007/s00120-013-3383-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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The prevalence of small intestinal bacterial overgrowth and methane production in patients with myelomeningocele and constipation. Spinal Cord 2013; 52:61-4. [PMID: 24247567 DOI: 10.1038/sc.2013.131] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Revised: 09/05/2013] [Accepted: 10/09/2013] [Indexed: 12/11/2022]
Abstract
STUDY DESIGN Prospective study. OBJECTIVES The objective of this study was to assess the prevalence of small intestinal bacterial overgrowth (SIBO), methane (CH4) production and orocecal transit time (OCTT) in children affected by myelomeningocele. SETTING This study was conducted at the Catholic University in Rome, Italy. METHODS Eighteen (6M/12F; 16.4±7.6 years) children affected by myelomeningocele were enrolled. All subjects underwent H2/CH4 lactulose breath tests to assess SIBO and OCTT. All patients performed a visual analog scale to investigate abdominal pain, bloating and flatulence, and maintained a diary of the frequency and consistency of the stool during the previous 7 days. A nephro-urological clinical evaluation of the number of urinary tract infections (UTIs) and neurogenic bowel disease score were also performed. RESULTS Thirty-nine percent (7/18) of the children showed SIBO and 61% (11/18) presented a delayed OCTT. Moreover 44.4% (8/18) produced high levels of CH4. Interestingly, all myelomeningocele children who produced CH4 showed a delayed OCTT and a higher incidence of UTI, with a lower frequency of evacuation, compared with those with a normal or accelerated OCTT. CONCLUSION The association between CH4 and constipation suggests that CH4 has an active role in the development of constipation. One of the most interesting features of our study is to identify a correlation between myelomeningocele, CH4, delayed OCTT and UTI. The intestinal decontamination with locally acting drugs in these children may reduce the number of UTIs and improve intestinal motility.
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McGovern M, Mulligan S, Carney O, Wall D, Moylett E. Ultrasound investigation of sacral dimples and other stigmata of spinal dysraphism. Arch Dis Child 2013; 98:784-6. [PMID: 23908189 DOI: 10.1136/archdischild-2012-303564] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To assess whether there was any relationship between the number of clinical markers for spinal dysraphism and its presence on ultrasound and whether there was any relationship between the presence of an isolated sacral dimple and the presence of spinal dysraphism. Outcomes and further imaging were also examined. METHODS All patients who underwent spinal ultrasound (SUS) in University Hospital Galway (UHG) over a 5-year period (2006-2011) were identified. Patients were excluded based on age (>14 years old excluded) and indication for imaging (only patients being investigated for suspected spinal dysraphism were included). Indications for imaging, ultrasound results and information on further imaging were accessed from the computerised radiology software in UHG. Statistical analysis was performed using SPSS-18. RESULTS Data were analysed for 216 patients. A single clinical indication was recorded for 174 ultrasound requests, ≥2 indications for 42 requests. Nineteen of 216 (8.8%) ultrasound images were abnormal, 7 having spinal dysraphism. Multiple clinical indications were 6 times more likely to have dysraphism than those imaged on the basis of a single marker (OR 6.0, 95% CI 1.289 to 27.922, p=0.022), and there was no significant correlation between the presence of a sacral dimple and the presence of dysraphism (95% CI 0.71 to 6.622, p=0.722). CONCLUSIONS SUS performed on the basis of multiple clinical indications is six times more likely to detect spinal dysraphism than imaging performed for isolated abnormalities or risk factors. Sacral dimple is a poor marker for occult spinal pathology.
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Affiliation(s)
- Matthew McGovern
- Academic Department of Paediatrics, National University of Ireland Galway, , Galway, Ireland
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Abstract
BACKGROUND AND PURPOSE Sprengel's deformity, a rare congenital malformation of the scapula, may be observed in combination with spinal dysraphism. The co-occurrence of these malformations suggests an unknown shared etiology. Therefore, we reviewed the medical records of eight children presenting with both malformations and performed a review of the literature. PATIENTS AND METHODS Databases from four university medical centers were searched for children presenting between 1992 and 2012 with spinal dysraphism and a Sprengel's deformity. CONCLUSION The combination of spinal dysraphism and Sprengel's deformity is rare, and is associated with segmentation defects of the spine and ribs. Although the etiology of both spinal dysraphism and Sprengel's deformity remains unclear, all deformities of the spine, ribs, and shoulder might result from a common genetic defect affecting somitogenesis.
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Ma Y, Li B, Wang L, Han X. The predictive factors of hydronephrosis in patients with spina bifida: reports from China. Int Urol Nephrol 2013; 45:687-93. [DOI: 10.1007/s11255-013-0409-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Accepted: 02/28/2013] [Indexed: 11/24/2022]
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Sexuality, pre-conception counseling and urological management of pregnancy for young women with spina bifida. Eur J Obstet Gynecol Reprod Biol 2012; 163:129-33. [DOI: 10.1016/j.ejogrb.2012.04.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2012] [Revised: 03/21/2012] [Accepted: 04/02/2012] [Indexed: 11/23/2022]
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[Expansion for skin closure of large myelomeningoceles]. ANN CHIR PLAST ESTH 2012; 59:261-5. [PMID: 22575769 DOI: 10.1016/j.anplas.2012.04.002] [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: 11/09/2011] [Accepted: 04/03/2012] [Indexed: 11/23/2022]
Abstract
BACKGROUND Closure of a large myelomeningocele requires stable durable coverage of the dural reconstruction. METHODS Twenty-seven cases of myelomeningoceles have been treated in the department of pediatric neurosurgery at the Timone Children's Hospital in the last 17 years. Six children have undergone plastic and reconstructive surgery. Among these six children, four were received several months after birth with a large myelomeningocele and underwent cutaneous expansion prior to closure. One child received lateral discharge incisions during the neonatal period. The sixth child, received at 15 years of age for persistent CSF leak despite numerous attempts to close the dura, was treated by rotational dorsal fasciocutaneous flap with dural plastic surgery. RESULTS In all of the cases, these techniques provided stable and durable closure with a maximum follow-up of 11 years. An expansion complication was observed with exposure of the prosthesis without secondary infection. CONCLUSIONS Cutaneous expansion is the technique of choice for late closure of large myelomeningoceles. It makes it possible to limit wound-healing problems and preserve muscle and skin resources in children who risk pressure sores.
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