A case of split notochord syndrome: Presenting with respiratory failure in the neonatal period

Multistage surgical repair for split notochord syndrome with neuroenteric fistula: case report

Split notochord syndrome (SNS) is a rare congenital defect of the central nervous system and has been associated with several anomalies affecting multiple organ systems. One association has been communication with the gastrointestinal tract and the spine, previously identified as a neuroenteric fistula (NEF). Here, the authors describe the unique case of a female infant with SNS and NEF treated with a multistage surgical repair. The three-stage operative plan included a two-stage repair of the defect and temporary subgaleal shunting followed by delayed ventriculoperitoneal shunt placement. The infant recovered well postsurgery and over a 5-year follow-up. A case description, surgical techniques, and rationale are reported. Additionally, a systematic review of the literature utilizing the MEDLINE database was performed.Treatment of SNS with NEF using a multidisciplinary multistaged approach to repair the intestinal defect, close the neural elements, and divert cerebrospinal fluid to the peritoneum is shown to be a safe and viable option for future cases.

Prenatal diagnosis of Fetal notochord syndrome: A case report and review of the literature

INTRODUCTION

Split notochord syndrome is a rare disorder characterized by fistula formation between the gastrointestinal tract and skin on the dorsum. Prenatal diagnosis is difficult and most cases are diagnosed postnatally.

CLINICAL FINDINGS AND DIAGNOSIS

A 29-year-old woman, gravida 3 para 2, was referred for fetal cystic chest mass on prenatal ultrasound for congenital pulmonary airway malformation (CPAM). Fetal magnetic resonance imaging (MRI) suggested foregut duplication, and this was confirmed on postnatal thoracotomy with mass excision. A spine dysraphism was suspected on prenatal ultrasound, but was not confirmed on fetal MRI at the time of the study. Neonatal MRI noted vertebral abnormalities, confirming split notochord syndrome. Retrospective examination of the fetal MRI images detected a dysraphism and confirmed the prenatal ultrasound findings.

OUTCOME

At 17 months of life, the child had mild symptoms of neurogenic bowel, but was meeting all milestones without neurodevelopmental delays. We present a mild form of split notochord syndrome.

CONCLUSION

Split notochord syndrome is difficult to diagnose prenatally and should be considered when a fetal cystic chest mass is found on ultrasound. Detailed vertebrae assessment may improve detection.

Case Report of an Anterior Thoracic Myelomeningocele: A Multidisciplinary Approach to Surgical Management

BACKGROUND

Cervicothoracic myelomeningocele (MMC) is a rare entity with only 2 reported cases in the literature of anterior thoracic MMC.

CASE DESCRIPTION

We report a third case in a 3-year-old boy. MMC was diagnosed during antenatal screening and later warranted surgical intervention. Despite being asymptomatic, radiologic surveillance demonstrated worsening syringomyelia, tonsillar descent, and cord signal change concerning for myelomalacia. Preoperative management involved respiratory assessment for pulmonary compromise, general pediatric consultation, gait analysis by physiotherapy, and serial imaging by radiology. Surgical management involved an anterior thoracotomy approach by cardiothoracic surgeons, repair of the MMC by neurosurgeons, and bone graft to ameliorate the bony defect in the vertebral body by orthopaedic surgeons. Postoperative care involved 4 days in the intensive care unit and 14 days on the pediatric neurosurgical ward. At 3-year follow-up, there was radiologic improvement of syringomyelia, tonsillar descent, and kyphoscoliosis with no neurological or pulmonary complications.

CONCLUSIONS

This case highlights the unique multidisciplinary surgical management of the rare entity of anterior thoracic MMC without scoliosis correction for radiologic progression.

A Case of Split Notochord Syndrome with Left Congenital Diaphragmatic Hernia: A Rare Association

Split notochord syndrome is a rare neural tube malformation involving the brain, spinal cord, and vertebral column. In nearly half of the cases, the malformation also involves the gastrointestinal tract in the form of a dorsal neurenteric fistula and imperforate anus. In the literature, less than 50 cases have been reported. To the best of my knowledge, this is the first reported case associated with a left congenital diaphragmatic hernia.