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Chen-Carrington A, Leonard D, Goodreau A, Rhodes J, Tye GW. Prenatal diagnosis of meningomyelocele resolves as a mature cystic teratoma in the thoracolumbar region. Childs Nerv Syst 2024:10.1007/s00381-024-06396-7. [PMID: 38684568 DOI: 10.1007/s00381-024-06396-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 04/06/2024] [Indexed: 05/02/2024]
Abstract
A mature cystic teratoma is a mass with heterogeneous appearance, consisting of adult tissue with two or three layers: endoderm, mesoderm, and ectoderm. It is a rare, benign transformation of somatic tissue most commonly found in the sacrococcygeal region and may resemble an uncomplicated spina bifida on prenatal ultrasonography. In this case report, we describe a female newborn with an extremely rare mature cystic teratoma in the thoracolumbar region. She presented prenatally with a preliminary diagnosis of meningomyelocele, diastematomyelia, and Chiari II malformation and a possible teratoma. However, a mass containing solid glandular tissues and bony calcifications approximately 3 × 4 cm in size was observed in the thoracolumbar region upon birth. During surgical resection, no nerve roots were found in the associated meningocele. The patient retained full lower body function postoperatively following surgical excision of the thecal sac and teratoma.
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Affiliation(s)
- Annie Chen-Carrington
- Division of Plastic Surgery, Department of Surgery, West Hospital, Virginia Commonwealth University School of Medicine, 1200 East Broad Street, 16th Floor, West Wing, Box 980645, Richmond, VA, 23298-0645, USA.
| | - Dean Leonard
- Division of Neurosurgery, Department of Surgery, West Hospital, Virginia Commonwealth University School of Medicine, 1200 East Broad Street, 16th Floor, West Wing, Box 980645, Richmond, VA, 23298-0645, USA
| | - Adam Goodreau
- Division of Plastic Surgery, Department of Surgery, West Hospital, Virginia Commonwealth University School of Medicine, 1200 East Broad Street, 16th Floor, West Wing, Box 980645, Richmond, VA, 23298-0645, USA
| | - Jennifer Rhodes
- Division of Plastic Surgery, Department of Surgery, West Hospital, Virginia Commonwealth University School of Medicine, 1200 East Broad Street, 16th Floor, West Wing, Box 980645, Richmond, VA, 23298-0645, USA
| | - Gary W Tye
- Division of Neurosurgery, Department of Surgery, West Hospital, Virginia Commonwealth University School of Medicine, 1200 East Broad Street, 16th Floor, West Wing, Box 980645, Richmond, VA, 23298-0645, USA
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2
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Barillot C, Capelli S, Mazzetto I, Leocata A, Pozzi F, Agresta G, Locatelli D. Preliminary Experience with 3-Dimensional-Exoscopic Untethering of a Type II Diastematomyelia: Technical Note and Review of the Literature. World Neurosurg 2024:S1878-8750(24)00516-3. [PMID: 38554858 DOI: 10.1016/j.wneu.2024.03.129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 03/21/2024] [Indexed: 04/02/2024]
Abstract
OBJECTIVE To describe the use of a high-definition 3-dimensional (3D) exoscope (VITOM 3D exoscope; KARL STORZ GmbH) for the neurosurgical treatment of a rare pediatric disease, type II diastematomyelia with associated tethered cord. METHODS A 13-year-old girl who presented with diastematomyelia type II with a tethered cord was surgically treated with the aid of a high-definition 3D exoscope, with a third operator moving and pivoting its arm. Intraoperative monitoring and mapping were arranged. The surgery required a bilateral access to address both the split cord malformation and the tethering of the filum terminale. The filum terminale was identified and cut, and the connective fibrovascular tissue separating the 2 medullary halves was unraveled. These steps were performed with no changes of intraoperative monitoring. Pertinent literature was addressed carefully. RESULTS The surgery was successful, and the patient was discharged home on the eleventh postoperative day without any complications. The 3-month postoperative magnetic resonance imaging scan demonstrated regular surgical outcomes; no dynamic motor disturbances were reported. To our knowledge, this is the first spinal congenital malformation treated with the use of a 3D exoscope. CONCLUSIONS The use of 3D exoscope is advancing in spinal surgery, as it provides magnification, stereopsis, lighting, and definition comparable with the operating microscope; the addition of a third operator simplified the operations of moving around the arm, releasing these burdens for the surgeons. Our preliminary experience proved that the use of a 3D exoscope is feasible and safe for the surgical management of a type II diastematomyelia with tethered cord.
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Affiliation(s)
- Cedric Barillot
- Division of Neurosurgery, Department of Biotechnology and Life Sciences, Ospedale di Circolo e Fondazione Macchi, Varese, Italy.
| | - Sergio Capelli
- Division of Neurosurgery, Department of Biotechnology and Life Sciences, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Immacolata Mazzetto
- Division of Neurosurgery, Department of Biotechnology and Life Sciences, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Antonio Leocata
- Division of Neurosurgery, Department of Biotechnology and Life Sciences, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Fabio Pozzi
- Division of Neurosurgery, Department of Biotechnology and Life Sciences, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Gianluca Agresta
- Division of Neurosurgery, Department of Biotechnology and Life Sciences, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Davide Locatelli
- Division of Neurosurgery, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
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3
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Goacher E, Lee C. Cervical split cord malformation ( diastematomyelia) with associated Klippel-Feil deformity presenting in adulthood with bimanual synkinesis. Eur Spine J 2024:10.1007/s00586-023-08068-7. [PMID: 38227213 DOI: 10.1007/s00586-023-08068-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 10/29/2023] [Accepted: 11/27/2023] [Indexed: 01/17/2024]
Abstract
BACKGROUND Split cord malformation (SCM) is a rare congenital malformation of the spinal cord in which the cord is split longitudinally. Identification and diagnosis in adulthood is rare, with the majority of cases diagnosed in the paediatric population. Isolated segmental cervical SCM is rarer still. CASE PRESENTATION Here, the authors present the case of a 26-year-old female who presented with neck pain and longstanding bimanual synkinesis secondary to an isolated type II SCM in the C4-C7 region. The authors present this novel presenting symptom in adulthood and finding of isolated cervical SCM with associated blocked cervical vertebrae, in an otherwise normal neuroaxis and spinal column. CONCLUSIONS The case serves to highlight the importance of knowledge of this rare congenital condition to surgeons, physicians and radiologists involved in the care of both adult and paediatric patients presenting with spinal pathology.
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Affiliation(s)
- Edward Goacher
- Department of Neurosurgery, Hull University Teaching Hospitals, Hull, UK.
| | - Christopher Lee
- Department of Neurosurgery, Hull University Teaching Hospitals, Hull, UK
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4
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Arbelo-Pérez P, de Ganzo-Suárez T, de Luis-Escudero JF. Prenatal Diagnosis of Diastematomyelia: a Case Report and Literature Review. Reprod Sci 2023; 30:3563-3567. [PMID: 37491555 DOI: 10.1007/s43032-023-01307-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 07/10/2023] [Indexed: 07/27/2023]
Abstract
Diastematomyelia is a type of closed spinal dysraphism in which there is splitting of the spinal cord. It is a rare entity that accounts for less than 3% of closed spinal dysraphisms and affects females 1.3 to 6 times more frequently than males. Lesions are usually found in the lower thoracic and upper lumbar regions. It is characterised by two hemicords separated by a bony or cartilaginous spur. In most cases, it is an isolated malformation with a favourable prognosis. However, it may be associated with other abnormalities and sonography is the imaging test par excellence for early prenatal diagnosis. We report a case of diastematomyelia diagnosed by prenatal sonography at 24 weeks' gestation. Amniotic fluid alpha-fetoprotein (AF-AFP) was normal, while amniotic fluid acetylcholinesterase (AF-AChE) was positive. After birth, the diagnosis was confirmed with magnetic resonance imaging (MRI). The anomaly was associated with a spinal lipoma, tethered cord and dermal sinus. A review of all the cases described in the literature to date is carried out.
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Affiliation(s)
- Paula Arbelo-Pérez
- Department of Gynecology and Obstetrics, Hospital Universitario Nuestra Señora de Candelaria, Carretera General del Rosario, 145, 38010, Santa Cruz de Tenerife, Spain.
| | - Tania de Ganzo-Suárez
- Department of Gynecology and Obstetrics, Hospital Universitario Nuestra Señora de Candelaria, Carretera General del Rosario, 145, 38010, Santa Cruz de Tenerife, Spain
| | - José Fernando de Luis-Escudero
- Department of Gynecology and Obstetrics, Hospital Universitario Nuestra Señora de Candelaria, Carretera General del Rosario, 145, 38010, Santa Cruz de Tenerife, Spain
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Peeters SM, Uhr L, Chivukula S, McBride D, Everson R, Duong D, Yang I, Cornford M, Mlikotic A, Yong W, Kim W. Cervicomedullary junction mature teratoma with pulmonary differentiation and diastematomyelia in an adult - A rare case. Surg Neurol Int 2023; 14:334. [PMID: 37810313 PMCID: PMC10559391 DOI: 10.25259/sni_633_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 08/15/2023] [Indexed: 10/10/2023] Open
Abstract
Background Intradural extramedullary teratomas in the cervical or cervicomedullary region are rare in adults. Case Description We report a symptomatic, mature teratoma at the cervicomedullary junction in a 52-year-old Hispanic female who also has a type I diastematomyelia in the thoracolumbar spine. The patient underwent surgical resection of the lesion with the resolution of presenting symptoms. Histopathology of the lesion revealed a mature cystic teratoma with pulmonary differentiation. Conclusion We discuss the case along with a review of pertinent literature and considerations with regard to the diagnosis, etiology, prognosis, and management of this unusual pathology.
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Affiliation(s)
- Sophie M. Peeters
- Department of Neurosurgery, University of California Los Angeles (UCLA), Los Angeles, California, United States
| | - Lauren Uhr
- Department of Neurosurgery, University of California Los Angeles (UCLA), Los Angeles, California, United States
| | - Srinivas Chivukula
- Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Duncan McBride
- Department of Neurosurgery, University of California Los Angeles (UCLA), Los Angeles, California, United States
| | - Richard Everson
- Department of Neurosurgery, University of California Los Angeles (UCLA), Los Angeles, California, United States
| | - Duc Duong
- Department of Neurosurgery, Harbor UCLA Medical Center, Torrance, United States
| | - Isaac Yang
- Department of Neurosurgery, University of California Los Angeles (UCLA), Los Angeles, California, United States
| | - Marcia Cornford
- Department of Pathology, Harbor UCLA Medical Center, Torrance, United States
| | - Anton Mlikotic
- Department of Radiology, Harbor UCLA Medical Center, Torrance, United States
| | - William Yong
- Department of Pathology, UCLA, Los Angeles, California, United States
| | - Won Kim
- Department of Neurosurgery, University of California Los Angeles (UCLA), Los Angeles, California, United States
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6
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Hazneci J, Bastacı F, Börekci A, Öztürk ÖÇ, İş M, Somay A, Ekşi MŞ, Çelikoğlu E. Split cord malformation concomitant with spinal teratoma without open spinal dysraphism. Childs Nerv Syst 2022; 38:1977-1986. [PMID: 35687168 DOI: 10.1007/s00381-022-05578-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 05/24/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE Split cord malformation (SCM) presenting concomitant with spinal teratoma without any open spinal dysraphism has rarely been reported in the literature. We aimed to make a systematic review and qualitative analysis of the literature about the topic and present the first case of SCM concomitant with spinal teratoma harboring papillary thyroid carcinoma (PTC) component. METHODS Two big search tools (Pubmed/MEDLINE) and Scopus were used. The search strategy was compatible to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). An exemplary case of ours was also presented. RESULTS There were 30 patients (15 pediatric and 15 adult). Female and male distribution was even. Median age of the patients was 18 years (range = 0-66 years). The most common presenting symptoms were back pain and lower limb weakness. Spinal teratoma and SCM mostly presented at thoracic/thoracolumbar region in children and lumbar region in adults. Surgical outcome was better in the children compared to the adults. CONCLUSION Thoracolumbar region is the most common location for such entity in children, whereas lumbar region for the adults. Surgical resection should be done as much as possible under neuromonitorization. The resected material should be evaluated thoroughly not to miss any malign pathology. Surgical outcome is better when it is done at an early age.
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Affiliation(s)
- Jülide Hazneci
- FSM Training and Research Hospital, Neurosurgery Clinic, Istanbul, Turkey
| | - Feryal Bastacı
- FSM Training and Research Hospital, Neurosurgery Clinic, Istanbul, Turkey
| | - Ali Börekci
- FSM Training and Research Hospital, Neurosurgery Clinic, Istanbul, Turkey
| | | | - Merih İş
- Private Practice, Neurosurgery, Istanbul, Turkey
| | - Adnan Somay
- FSM Training and Research Hospital, Pathology Clinic, Istanbul, Turkey
| | - Murat Şakir Ekşi
- FSM Training and Research Hospital, Neurosurgery Clinic, Istanbul, Turkey.
- School of Medicine, Neurosurgery Research Laboratory, Yeditepe University, Istanbul, Turkey.
- , Istanbul, Turkey.
| | - Erhan Çelikoğlu
- FSM Training and Research Hospital, Neurosurgery Clinic, Istanbul, Turkey
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Sergeenko Pavlova OM, Savin DM, Ryabykh SO. Treatment of spinal deformity with diastematomyelia type I: one-stage, two-stage surgery and new technique (vertebral column resection through wide bony septum). Childs Nerv Syst 2022; 38:163-72. [PMID: 34626222 DOI: 10.1007/s00381-021-05382-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 09/28/2021] [Indexed: 10/20/2022]
Abstract
STUDY DESIGN Case series, literature review, and technical note. OBJECTIVES To compare two different approaches to treat the spinal deformity with split cord malformation type I (SCM I). To present a new method of one-stage surgical treatment of congenital spinal deformity with wide bony septum (SCM I). METHODS Analysis of the literature on the different types of combined surgical treatment of spinal deformities with SCM I was performed. We have provided our own data on 27 patients treated for congenital spinal deformity and SCM I, one of which underwent Schwab IV type osteotomy at the apex of the deformity through the bony septum and pedicles. Inclusion criteria were presence of spinal deformity in combination with SCM 1, performed surgery to correct spinal deformity, and follow-up period of at least 2 years. RESULTS The result of the literature review was controversial and requires additional research. The average age of patients was 8.8 ± 6.6 years old. One-stage treatment of SCM I and spinal deformity was performed in 10 patients (group I) and two-stage in 14 patients (group II). Three patients with severe myelodysplasia, SCM I, and congenital kyphoscoliosis underwent correction of spinal deformity without SCM I removing (group III). The group I had the longest surgery duration (mean 289 ± 75 min) and largest blood loss (mean 560 ± 386 ml), a high percentage of deformity correction (mean 69.6%), and the highest rate of complications (60%). The most optimal was the two-stage treatment with the mean surgery duration 191 ± 137 min, mean blood loss 339 ± 436 ml, mean correction rate 63%, and frequency of complications 21%. The average follow-up time was 6.0 ± 2.6 years. CONCLUSIONS One stage surgery associated with a large surgical invasion and a large number of complications. It can be used in some cases, for example when the wide bony septum (SCM I) is localized at the apex of the congenital scoliosis or kyphosis. In all other cases, it is worth adhering to a two-stage treatment. Many new works demonstrate the relative safety and effectiveness of deformity correction without removing the SCM. In our opinion, indications for treatment of spinal deformity without SCM I removing can be the need to perform a shortening ostetomy outside the SCM zone. The remaining cases require a thorough assessment and a balanced decision.
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8
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Apostolopoulou K, Andalib A, Zaki H, deLacy P. Diastematomyelia type I associated with intramedullary lipoma and dermoid cyst. Childs Nerv Syst 2021; 37:2949-2952. [PMID: 33403491 DOI: 10.1007/s00381-020-05033-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 12/29/2020] [Indexed: 11/29/2022]
Abstract
Dysraphic entities like diastematomyelia are not uncommon. However, the co-existence of split cord malformation with two pathologically different lesions on the same hemicord is extremely rare. We report a case of a young child who presented with an unusual combination of diastematomyelia, intramedullary lipoma, and dermoid cyst.
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Affiliation(s)
| | - Amin Andalib
- Department of Neurosurgery, Sheffield Children's NHS Foundation Trust, Sheffield, UK
| | - Hesham Zaki
- Department of Neurosurgery, Sheffield Children's NHS Foundation Trust, Sheffield, UK
| | - Patricia deLacy
- Department of Neurosurgery, Sheffield Children's NHS Foundation Trust, Sheffield, UK
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9
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Balci M, Yuksel U, Akkaya MA, Akkaya S, Sagsoz N. Mature cystic teratoma mimicking meningomyelocele. Childs Nerv Syst 2021; 37:2245-2249. [PMID: 33404722 DOI: 10.1007/s00381-020-05017-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 12/16/2020] [Indexed: 11/30/2022]
Abstract
Teratomas are benign germ cell tumors originating from at least two germ layers, mostly of ectodermal and mesodermal origin. Mature teratomas are the most common subtype and develop from well-differentiated germ cells. Although the location is extragonadal in infants and young children, gonadal involvement occurs in adults. Midline defects can be diagnosed on prenatal imaging. In this case report, a newborn with mature cystic teratoma and a prenatal lumbar midline closure defect was presented. The perinatal preliminary diagnosis was meningomyelocele. However, a cystic sac containing exophytic solid tumoral tissues approximately 5 × 5 × 3 cm in size was seen macroscopically in the lumbar region after the birth, and this tumor was totally resected. After tumor excision, spina bifida aperta and vertebral exophytic bony tissue compatible with diastematomyelia were observed at the bottom of the surgical field and were totally resected. In the short-term follow-up, no additional problem occurred. The histopathological diagnosis was "mature cystic teratoma." In conclusion, extragonadal teratoma accompanying diastematomyelia could easily be mistaken for meningomyelocele or other common malformations. Perinatal diagnosis should be provided using radiodiagnostic methods, and total surgical excision and accurate pathological diagnosis are essential to avoid the risk of recurrence.
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Affiliation(s)
- Mahi Balci
- Department of Pathology, Faculty of Medicine, Kirikkale University, Kirikkale, Turkey
| | - Ulas Yuksel
- Department of Neurosurgery, Faculty of Medicine, Kirikkale University, Yahsihan Yerleskesi, 71450, Kirikkale, Turkey
| | - Merva Aydemir Akkaya
- Department of Pathology, Faculty of Medicine, Kirikkale University, Kirikkale, Turkey
| | - Suleyman Akkaya
- Department of Neurosurgery, Faculty of Medicine, Kirikkale University, Yahsihan Yerleskesi, 71450, Kirikkale, Turkey.
| | - Nevin Sagsoz
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kirikkale University, Kirikkale, Turkey
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Oh T, Avalos LN, Burke JF, Mummaneni N, Safaee M, Gupta N, Clark AJ. A Type II Split Cord Malformation in an Adult Patient: An Operative Case Report. Oper Neurosurg (Hagerstown) 2021; 20:E148-E151. [PMID: 33294923 DOI: 10.1093/ons/opaa334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 08/11/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND IMPORTANCE Split cord malformations (SCMs) are rare conditions in which the spinal cord is split into two hemicords within either a single thecal sac or two separate thecal sacs. The hemicords are typically split by a bony or fibrous structure. We present an adult patient who presented with a type II SCM with tethered cord. This is the first case of such a presentation with an accompanying intraoperative video. Unusual features of the case were the presence of an incomplete fibrous septum and lack of a discrete filum terminale. CLINICAL PRESENTATION A 50-yr-old woman presented with back pain, radiculopathy, urinary urgency, and episodic fecal incontinence. Her exam was notable for weakness of the right extensor hallicus longus. Imaging showed an SCM extending from L3 to S1, a fibrous septum located at L4-5, and a low-lying conus at S4. She was treated with a decompressive L3-S4 laminectomy and disconnection of all the dural attachment points. She required lumbar drain placement postoperatively and reoperation for wound dehiscence and persistent pseudomeningocele. At the time of last follow-up, she was neurologically intact with improvement in bowel/bladder function. CONCLUSION SCM is an uncommon presentation in adults and is often accompanied by findings of skin stigmata, tethered cord, and other central nervous system/skeletal anomalies. Obtaining full multimodal imaging is critical to understanding subtle anatomic variations that can pose operative challenges. We report the treatment of an adult patient with type II SCM, and provide an intraoperative video demonstrating the removal of an incomplete midline fibrous septum.
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Affiliation(s)
- Taemin Oh
- Division of Pediatric Neurosurgery, UCSF Benioff Children's Hospital, San Francisco, California
| | - Lauro Nathaniel Avalos
- Division of Pediatric Neurosurgery, UCSF Benioff Children's Hospital, San Francisco, California
| | - John Frederick Burke
- Division of Pediatric Neurosurgery, UCSF Benioff Children's Hospital, San Francisco, California
| | - Nikhil Mummaneni
- Division of Pediatric Neurosurgery, UCSF Benioff Children's Hospital, San Francisco, California
| | - Michael Safaee
- Division of Pediatric Neurosurgery, UCSF Benioff Children's Hospital, San Francisco, California
| | - Nalin Gupta
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California.,Division of Pediatric Neurosurgery, UCSF Benioff Children's Hospital, San Francisco, California
| | - Aaron J Clark
- Division of Pediatric Neurosurgery, UCSF Benioff Children's Hospital, San Francisco, California
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11
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Kobets AJ, Oliver J, Cohen A, Jallo GI, Groves ML. Split cord malformation and tethered cord syndrome: case series with long-term follow-up and literature review. Childs Nerv Syst 2021; 37:1301-1306. [PMID: 33242106 DOI: 10.1007/s00381-020-04978-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 11/17/2020] [Indexed: 01/17/2023]
Abstract
PURPOSE To date, the description of the natural course of concurrent tethered cord syndrome with a low-lying conus medullaris and split cord malformation is lacking in the literature. We report a cohort of adult and pediatric patients with concurrent malformations and long-term follow-up. METHODS Patients with concurrent diagnoses of split cord malformation and tethered cord (radiographic evidence supporting clinical symptomatology) were identified between 2000 and 2020. Patients without sufficient documentation or at least 6-month follow-up were excluded. RESULTS Nine patients were identified with an average of 8.9 years follow-up (range 2-31 years). The most common symptoms were radiating leg pain and lower extremity paresthesias, occurring in 44% of patients; and bladder/bowel dysfunction, worsening scoliosis, and acute motor deterioration were less common. Two patients were successfully treated conservatively for mild leg pain and paresthesias. For those who underwent surgery, all experienced symptomatic relief upon first follow-up. Two had late symptomatic recurrence; one 4 and 8 years after initial surgery; and the other, 11, 26, and 31 years after initial surgery. CONCLUSION The rarity of concurrent split cord and tethered cord syndrome with a low-lying conus makes management difficult to formulate. This series supplements our knowledge of the long-term outcomes and lessons learned from the management of these patients. Approximately 25% of patients were managed conservatively and had symptomatic improvement. For surgically managed patients, with intractable pain or worsening neurological function, symptoms can still recur over a decade after intervention. Reoperation, however, can still be beneficial, can provide years of relief, and should be considered.
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Affiliation(s)
- Andrew J Kobets
- Department of Neurosurgery, Division of Pediatric Neurosurgery, Johns Hopkins School of Medicine, 600 N Wolfe Street, Phipps Building, 5th Floor, Baltimore, MD, USA.
| | - Jeffrey Oliver
- Department of Neurosurgery, Division of Pediatric Neurosurgery, Johns Hopkins School of Medicine, 600 N Wolfe Street, Phipps Building, 5th Floor, Baltimore, MD, USA
| | - Alan Cohen
- Department of Neurosurgery, Division of Pediatric Neurosurgery, Johns Hopkins School of Medicine, 600 N Wolfe Street, Phipps Building, 5th Floor, Baltimore, MD, USA
| | - George I Jallo
- Department of Neurosurgery, Division of Pediatric Neurosurgery, Johns Hopkins School of Medicine, 600 N Wolfe Street, Phipps Building, 5th Floor, Baltimore, MD, USA.,Department of Neurosurgery, Division of Pediatric Neurosurgery, All Children's Hospital, St. Petersburg, FL, USA
| | - Mari L Groves
- Department of Neurosurgery, Division of Pediatric Neurosurgery, Johns Hopkins School of Medicine, 600 N Wolfe Street, Phipps Building, 5th Floor, Baltimore, MD, USA
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12
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Laurent D, Bardhi O, Gregory J, Yachnis A, Governale LS. Pediatric pathology all grown up - An interesting case of adult tethered spinal cord. Surg Neurol Int 2020; 11:362. [PMID: 33194295 PMCID: PMC7655999 DOI: 10.25259/sni_641_2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 10/02/2020] [Indexed: 11/12/2022] Open
Abstract
Background: Cervical myelopathy in an adult is typically the result of degenerative disease or trauma. Dysraphism is rarely the cause. Case Description: The authors report the case of a 35-year-old male drywall installer who presented with 2 years of progressive left upper extremity weakness, numbness, and hand clumsiness. Only upon detailed questioning did he mention that he had neck surgery just after birth, but he did not know what was done. He then also reported that he routinely shaved a patch of lower back hair, but denied bowel, bladder, or lower extremity dysfunction. Magnetic resonance imaging of the cervical spine demonstrated T2 hyperintensity at C4-C5 with dorsal projection of the neural elements into the subcutaneous tissues concerning for a retethered cervical myelomeningocele. Lumbar imaging revealed a diastematomyelia at L4. He underwent surgical intervention for detethering and repaired of the cervical myelomeningocele. Four months postoperatively, he had almost complete resolution of symptoms, and imaging showed a satisfactory detethering. The diastematomyelia remained asymptomatic and is being observed. Conclusion: Tethered cervical cord is a rare cause for myelopathy in the adult patient. In the symptomatic patient, surgical repair with detethering is indicated to prevent disease progression and often results in clinical improvement.
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Affiliation(s)
- Dimitri Laurent
- Department of Neurosurgery University of Florida, Gainesville, Florida, United States
| | - Olgert Bardhi
- Department of Neurosurgery University of Florida, Gainesville, Florida, United States
| | - Jason Gregory
- Department of Pathology, University of Florida, Gainesville, Florida, United States
| | - Anthony Yachnis
- Department of Pathology, University of Florida, Gainesville, Florida, United States
| | - Lance S Governale
- Department of Neurosurgery University of Florida, Gainesville, Florida, United States
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Jagadeesh NH, Mallepally AR, Marathe N, Sharma A, Tandon V. Sympathetic Outflow Disturbance After Posterior Deformity Correction: A Rare Complication. World Neurosurg 2020; 140:89-95. [PMID: 32407923 DOI: 10.1016/j.wneu.2020.05.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 05/02/2020] [Accepted: 05/04/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Sympathetic system injury is a known but rare complication in scoliosis deformity correction. It is not common following posterior correction. We report a case of diastematomyelia with neuromuscular scoliosis with unusual complication of sympathetic outflow disturbance, after posterior instrumented correction. CASE DESCRIPTION A 13-year-old girl presented with complaints of deformity in the back first noticed 4 years ago. Roentgenogram revealed a right thoracolumbar kyphoscoliotic deformity of 105° with apex at T8 with non-structural lumbar and cervicothoracic curves with positive sagittal alignment. Magnetic resonance imaging showed split-cord malformation with bony crest near the apex of the curve. Detethering followed by removal of the bony crest and restoration of the dual dural sleeves of the split cord into single neural tube was done in the first stage. In the second stage, pedicle screw fixation with was done from D3 to L3. Deformity correction was achieved using multilevel Smith Peterson osteotomy and concave rib osteotomy. On the second postoperative day, intensive care unit staff noticed persistent sinus tachycardia and profuse sweating in both upper limbs, chest, and upper-back. Twenty-four-hour Holter monitoring did not reveal any abnormality. Patient improved gradually and was discharged on postoperative day 9 when both sinus tachycardia and hyperhidrosis resolved. CONCLUSIONS Sympathetic chain disturbances after surgery recover with time. The exact time duration needed for recovery is not yet defined, however. Spine surgeons should be aware of this postsurgical complication and identify it so that management can be initiated. The symptoms may be long and drawn out, thus the roles of communication with and counseling of the patient as cannot be underemphasized.
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Affiliation(s)
| | | | - Nandan Marathe
- Department of Spine Services, Indian Spinal Injuries Centre, New Delhi, India
| | - Arun Sharma
- Department of Spine Services, Indian Spinal Injuries Centre, New Delhi, India
| | - Vikas Tandon
- Department of Spine Services, Indian Spinal Injuries Centre, New Delhi, India
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14
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Srinivasan ES, Mehta VA, Smith GC, Than KD, Terry AR. Klippel-Feil Syndrome with Cervical Diastematomyelia in an Adult with Extensive Cervicothoracic Fusions: Case Report and Review of the Literature. World Neurosurg 2020; 139:274-280. [PMID: 32339744 DOI: 10.1016/j.wneu.2020.04.148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 04/17/2020] [Accepted: 04/18/2020] [Indexed: 11/27/2022]
Abstract
Split cord malformation (SCM) is a developmental disorder that is usually symptomatic and diagnosed in childhood. The majority of these lesions are in the thoracic and lumbar spine, with only 1%-3% of cases found in the cervical spine. This is a case report of a 55-year-old female patient with an unremarkable medical history who presented with neck pain. Upon workup, she was found to have extensive developmental anomalies throughout her cervical and thoracic spine, including an incidentally found type 2 SCM and multiple autofused vertebrae. There are only 6 similar studies published in the literature. There was extensive facet degeneration in her cervical spine, which was suspected to be the etiology of her neck pain. This case illustrates the rare finding of asymptomatic adult cervical SCM and the likely significance of her autofused vertebrae causing accelerated symptomatic facet spondylosis.
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Affiliation(s)
| | - Vikram A Mehta
- Duke University School of Medicine, Durham, North Carolina, U.S.A; Division of Spine, Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, U.S.A..
| | - Gabriel C Smith
- Duke University School of Medicine, Durham, North Carolina, U.S.A; Division of Spine, Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, U.S.A
| | - Khoi D Than
- Duke University School of Medicine, Durham, North Carolina, U.S.A; Division of Spine, Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, U.S.A
| | - Anna R Terry
- Duke University School of Medicine, Durham, North Carolina, U.S.A; Division of Spine, Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, U.S.A
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15
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Karim Ahmed A, Howell EP, Harward S, Sankey EW, Ehresman J, Schilling A, Wang T, Pennington Z, Gray L, Sciubba DM, Goodwin CR. Split cord malformation in adults: Literature review and classification. Clin Neurol Neurosurg 2020; 193:105733. [PMID: 32146230 DOI: 10.1016/j.clineuro.2020.105733] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 01/27/2020] [Accepted: 02/07/2020] [Indexed: 11/16/2022]
Abstract
The objective of this study was to summarize the available literature describing the presentation, diagnostic evaluation, and management for adults with Type 1 and Type 2 split spinal cord malformations. A review of the literature was performed using the CINAHL, PubMed, Embase, and Web of Science database, alongside all associated bibliographies, to include studies describing Type 1 and Type 2 split cord malformations diagnosed in patients above the age of 18. All relevant studies of split cord malformations were included, regardless of the year published and terminology used to describe the dysraphism. Clinical case series (≥ 2 patients), cohort studies, and review articles comprising adult patients with radiographically diagnosed diastematomyelia, diplomyelia, or dimyelia were included (Class of Evidence I-IV). A total of 17 unique articles, describing 146 unique adult spinal cord malformation subjects, were included. The most common associated condition was tethered cord syndrome (59.8 %). Operative management for symptomatic split cord malformation was performed in 72.3 % of cases. For those with preoperative neurologic deficits, operative management resulted in symptomatic improvement in 96.6 %, compared to 0 % conservative management (p < 0.05). For those with pain alone, operative management resulted in improvement of 91.1 %, compared to 12.5 % conservative management (p < 0.05). To date, this is the only literature review to include all split cord malformations (SCM Types I and II) presenting in adulthood, with clinical characteristics, associated conditions, and long-term treatment outcomes.
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Affiliation(s)
- A Karim Ahmed
- Department of Neurosurgery. The Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Elizabeth P Howell
- Department of Neurosurgery. Duke University Medical Center, Durham, NC, USA
| | - Stephen Harward
- Department of Neurosurgery. Duke University Medical Center, Durham, NC, USA
| | - Eric W Sankey
- Department of Neurosurgery. Duke University Medical Center, Durham, NC, USA
| | - Jeffrey Ehresman
- Department of Neurosurgery. The Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Andrew Schilling
- Department of Neurosurgery. The Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Timothy Wang
- Department of Neurosurgery. Duke University Medical Center, Durham, NC, USA
| | - Zachary Pennington
- Department of Neurosurgery. The Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Linda Gray
- Department of Radiology. Duke University Medical Center, Durham, NC, USA
| | - Daniel M Sciubba
- Department of Neurosurgery. The Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - C Rory Goodwin
- Department of Neurosurgery. Duke University Medical Center, Durham, NC, USA.
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16
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Alnefaie N, Alharbi A, Alamer OB, Khairy I, Khairy S, Saeed MA, Azzubi M. Split Cord Malformation: Presentation, Management, and Surgical Outcome. World Neurosurg 2020; 136:e601-e607. [PMID: 31981783 DOI: 10.1016/j.wneu.2020.01.092] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 01/11/2020] [Accepted: 01/13/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Split cord malformation (SCM) is a rare anomaly characterized by a split along the midline of the cord, which divides it into 2 symmetric or nonsymmetric entities. SCM surgical indications and outcomes are still debatable, the signs and symptoms are generally nonspecific and are commonly associated with other anomalies and deficits. METHODS We retrospectively searched the hospital database at King Abdulaziz Medical City, Riyadh, Saudi Arabia for patients with SCM between 1998 and 2018. Descriptive statistics were used to present categorical data as percentages and frequencies. RESULTS A total of 25 patients were included in this series. The mean age of patients at the time of diagnosis was 4.4 years. A total of 18 patients (72%) underwent surgical correction. The mean difference between the age at diagnosis and the age at correction was 7 months. All patients underwent intraoperative neurophysiologic monitoring. Postoperative complications were minimal. Cerebrospinal fluid leakage was noted in 2 patients, transient urinary retention was noted in 1 patient, and transient unilateral leg paresis was noted in 1 patient. Most patients (n = 15, 83%), were discharged within 19 days after surgery, and 81% showed improvement postoperatively. Over the long-term follow-up, none of the patients developed new urologic or neurologic deficits. CONCLUSIONS Most patients with SCM present during childhood. Postoperative complications after SCM corrective surgery are generally minimal, and the overall outcomes, mainly including partial or complete symptomatic improvement and/or symptom stability and hydronephrosis resolution, were favorable.
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Affiliation(s)
- Nada Alnefaie
- College of Medicine, Kind Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
| | - Ahoud Alharbi
- College of Medicine, Kind Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Othman Bin Alamer
- College of Medicine, Kind Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Ibtesam Khairy
- Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - Sami Khairy
- College of Medicine, Kind Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; Division of Neurosurgery, Department of Surgery, King Abdulaziz Medical City, Ministry of the National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Mahfood Abdullah Saeed
- College of Medicine, Kind Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; Division of Neurosurgery, Department of Surgery, King Abdulaziz Medical City, Ministry of the National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Moutasem Azzubi
- College of Medicine, Kind Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; Division of Neurosurgery, Department of Surgery, King Abdulaziz Medical City, Ministry of the National Guard Health Affairs, Riyadh, Saudi Arabia
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17
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D'Agostino EN, Calnan DR, Makler VI, Khan I, Kanter JH, Bauer DF. Type I split cord malformation and tethered cord syndrome in an adult patient: A case report and literature review. Surg Neurol Int 2019; 10:90. [PMID: 31528428 PMCID: PMC6744800 DOI: 10.25259/sni-66-2019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Accepted: 02/04/2019] [Indexed: 11/14/2022] Open
Abstract
Background: In a split cord malformation (SCM), the spinal cord is divided longitudinally into two distinct hemicords that later rejoin. This can result in a tethered cord syndrome (TCS). Rarely, TCS secondary to SCM presents in adulthood. Here, we present an adult female with Type I SCM resulting in TCS and a review of literature. Case Description: A 57-year-old female with a history of spina bifida occulta presented with a 2-year history of worsening back and left leg pain, difficulty with ambulation, and intermittent urinary incontinence; she had not responded to conservative therapy. Magnetic resonance imaging (MRI) revealed a tethered cord secondary to lumbar type I SCM. The patient underwent an L1–S1 laminectomy for resection of the bony septum with cord detethering. At 2-month follow-up, the patient had improvement in her motor symptoms and less pain. In literature, 25 cases of adult-onset surgically managed SCM with TCS were identified (between 1936 and 2018). Patients averaged 37 years of age at the time of diagnosis, and 56% were female. Conclusion: TCS can present secondary to SCM in adulthood and is characterized predominantly by back and leg pain.
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Affiliation(s)
- Erin N D'Agostino
- Department of Neurosurgery, Geisel School of Medicine, Dartmouth College, Hanover, United States
| | - Daniel R Calnan
- Dartmouth-Hitchcock Medical Center, Section of Neurosurgery, 1 Medical Center Drive, Lebanon, New Hampshire, United States
| | - Vyacheslav I Makler
- Section of Neurology, 1 Medical Center Drive, Lebanon, New Hampshire, United States
| | - Imad Khan
- Dartmouth-Hitchcock Medical Center, Section of Neurosurgery, 1 Medical Center Drive, Lebanon, New Hampshire, United States
| | - John H Kanter
- Dartmouth-Hitchcock Medical Center, Section of Neurosurgery, 1 Medical Center Drive, Lebanon, New Hampshire, United States
| | - David F Bauer
- Dartmouth-Hitchcock Medical Center, Section of Neurosurgery, 1 Medical Center Drive, Lebanon, New Hampshire, United States
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18
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Górriz-Martín L, Neßler J, Voelker I, Reinartz S, Tipold A, Distl O, Beineke A, Rehage J, Heppelmann M. Split spinal cord malformations in 4 Holstein Friesian calves. BMC Vet Res 2019; 15:307. [PMID: 31455313 PMCID: PMC6712784 DOI: 10.1186/s12917-019-2055-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Accepted: 08/19/2019] [Indexed: 05/30/2023] Open
Abstract
Background The split spinal cord malformation (SSCM) is an uncommon congenital malformation of the vertebral canal in which parts of the spinal cord are longitudinally duplicated. In SSCM Type I, each spinal cord has its own dura tube. In the SSCM Type II, both parts of the spinal cord are surrounded by a common dura tube. Cases presentation During the clinical examination one calf showed ambulatory paresis and 3 calves non-ambulatory paraparesis. Calf 4 additionally had a congenital tremor. The examination of calf 4 using magnetic resonance imaging (MRI) showed a median hydrosyringomyelia at the level of the 4th lumbar vertebra. The caudal part of this liquid-filled cavity was split longitudinally through a thin septum. From there, the spinal cord structures duplicated with an incomplete division, so that the transverse section of the spinal cord appeared peanut-shaped and in each half a central canal could be observed. The pathological-anatomical examination after euthanasia showed a duplication of the spinal cord in the area of the lumbar vertebral column in all calves. The histopathological examination revealed two central lumbar vertebral column channels. The two spinal cord duplicates were each surrounded by two separate meninges in calf 2 (SSCM type I); in the other calves (1, 3, 4, and) the two central canals and the spinal cord were covered by a common meninx (SSCM type II). A pedigree analysis of calves 2, 3 and 4 showed a degree of relationship suggestive of a hereditary component. This supports the hypothesis of a possible recessive inheritance due to common ancestors, leading to partial genetic homozygosity. Conclusions The clinical appearance of SSCM can vary widely. In calves with congenital paralysis SSCM should always be considered as a differential diagnosis. A reliable diagnosis intra vitam is possible only with laborious imaging procedures such as MRI. Further studies on the heritability of this malformation are necessary to confirm a genetic cause of this disease.
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Affiliation(s)
- Lara Górriz-Martín
- Clinic for Cattle, University of Veterinary Medicine Hannover, Hanover, Germany.
| | - Jasmin Neßler
- Department Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Hanover, Germany
| | - Iris Voelker
- Institute for Pathology, University of Veterinary Medicine Hannover, Hanover, Germany
| | - Sina Reinartz
- Institute for Animal Breeding and Genetics, University of Veterinary Medicine Hannover, Hanover, Germany
| | - Andrea Tipold
- Department Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Hanover, Germany
| | - Ottmar Distl
- Institute for Animal Breeding and Genetics, University of Veterinary Medicine Hannover, Hanover, Germany
| | - Andreas Beineke
- Institute for Pathology, University of Veterinary Medicine Hannover, Hanover, Germany
| | - Juergen Rehage
- Clinic for Cattle, University of Veterinary Medicine Hannover, Hanover, Germany
| | - Maike Heppelmann
- Clinic for Cattle, University of Veterinary Medicine Hannover, Hanover, Germany
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19
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Hamidi H, Foladi N. Misdiagnosed adult presentation of diastematomyelia and tethered cord. Radiol Case Rep 2019; 14:1123-6. [PMID: 31338139 DOI: 10.1016/j.radcr.2019.06.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 06/29/2019] [Accepted: 06/29/2019] [Indexed: 11/24/2022] Open
Abstract
Diastematomyelia with tethered cord is an uncommon congenital anomaly that is generally diagnosed in childhood but may rarely present in adulthood, we present the case of a 48-year-old man with diastematomyelia and tethered cord whose diagnosis was initially missed, leading to unnecessary spine surgery. The correct diagnosis was made from follow-up imaging. Because common clinical complaints such as back pain may be caused by unusual conditions, the authors suggest that radiologists and treating physicians should remain vigilant for unusual presentations of rare diseases.
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20
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Dutta G, Shah A, Garg M, Gupta R, Singhal G, Singh D, Jagetia A, Singh H, Srivastava A, Saran R. Complex spinal dysraphism: myelomenigocele associated with dorsal bony spur, split cord malformation type I, syringomyelia, lipoma and tethered cord. Br J Neurosurg 2019:1-3. [PMID: 30836021 DOI: 10.1080/02688697.2019.1584660] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Variations in split cord malformation (SCM) are known. However, association of SCM type I with myelomeningocele along with same level dorsal bony spur has not been described previously. We report a 1-year old male child who presented with these findings with associated syringomyelia, lipoma and tethered cord.
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Affiliation(s)
- Gautam Dutta
- a Govind Ballabh Pant Institute of Postgraduate Medical Education and Research (GIPMER) , Neurosurgery , New Delhi , India
| | - Ankit Shah
- a Govind Ballabh Pant Institute of Postgraduate Medical Education and Research (GIPMER) , Neurosurgery , New Delhi , India
| | - Manish Garg
- a Govind Ballabh Pant Institute of Postgraduate Medical Education and Research (GIPMER) , Neurosurgery , New Delhi , India
| | - Robin Gupta
- a Govind Ballabh Pant Institute of Postgraduate Medical Education and Research (GIPMER) , Neurosurgery , New Delhi , India
| | - Ghanshyam Singhal
- a Govind Ballabh Pant Institute of Postgraduate Medical Education and Research (GIPMER) , Neurosurgery , New Delhi , India
| | - Daljit Singh
- a Govind Ballabh Pant Institute of Postgraduate Medical Education and Research (GIPMER) , Neurosurgery , New Delhi , India
| | - Anita Jagetia
- a Govind Ballabh Pant Institute of Postgraduate Medical Education and Research (GIPMER) , Neurosurgery , New Delhi , India
| | - Hukum Singh
- a Govind Ballabh Pant Institute of Postgraduate Medical Education and Research (GIPMER) , Neurosurgery , New Delhi , India
| | - Arvind Srivastava
- a Govind Ballabh Pant Institute of Postgraduate Medical Education and Research (GIPMER) , Neurosurgery , New Delhi , India
| | - Ravindra Saran
- a Govind Ballabh Pant Institute of Postgraduate Medical Education and Research (GIPMER) , Neurosurgery , New Delhi , India
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21
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Senkoylu A, Cetinkaya M, Aktas E, Cetin E. Excision and short segment fusion of a double ipsilateral lumbar hemivertebrae associated with a diastematomyelia and fixed pelvic obliquity. Acta Orthop Traumatol Turc 2019; 53:160-4. [PMID: 30718132 DOI: 10.1016/j.aott.2019.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 01/05/2019] [Accepted: 01/10/2019] [Indexed: 11/29/2022]
Abstract
We report the surgical treatment course of a 4-year-old girl with congenital scoliosis, diastematomyelia and double adjacent hemivertebrae. She had a lumbar curve with an apparent pelvic obliquity. Simultaneous excision of double segmented sequential hemivertebra at the L3–L4 level and fusion with short-segment instrumentation was performed via a posterior approach. Intraoperative radiographs revealed satisfactory curve correction and 0° pelvic obliquity. Following the excision of double adjacent hemivertebrae, three adjacent nerve roots were placed in one intervertebral foramen bilaterally. Nevertheless, no neurological deficit was developed, and the patient was able to ambulate with a brace at day one. Pelvic balance and deformity correction were maintained with no implant failure at the fifth year follow-up. Excision of two ipsilateral adjacent hemivertebra and short-segment posterior fusion performed via posterior-only approach simultaneously is an effective, safe, and less invasive technique for the treatment of the described case.
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22
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Vepakomma D, Kumar N, Alladi A. Tethered Cord Syndrome-Role of Early Surgery. J Indian Assoc Pediatr Surg 2019; 24:124-128. [PMID: 31105399 PMCID: PMC6417055 DOI: 10.4103/jiaps.jiaps_49_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose: 1. To evaluate the clinical course and effects of surgery on preexisting neurodeficits. 2. To address the issue of timing of intervention. Materials: A prospective study at department of pediatric surgery, Bangalore Medical College and Research Institute and other hospitals from 2013 to 2017. Results: There were 44 patients. Over 3/4 presented with a cutaneous marker while 9 had deficits and no markers. The commonest marker was a swelling on the back. 1/3 of infants had neurological sequelae while almost all midline older children presented with bowel/bladder/gait disturbances. All underwent detethering. Post-operative complications were minor and self-limiting. None of the children had associated Chiari malformation and 2 had a syrinx which at last follow up has been static and shown no clinical signs. Recovery was mostly seen in infants and only in one older child. Conclusion: Most of the patients with lipomeningomyelocele have early onset deficits and is recommended to operate at diagnosis. Children presenting with only deficits need to be evaluated for tethered cord syndrome but generally show poor or no recovery of deficits. Early prophylactic detethering is safe, feasible and advisable.
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Affiliation(s)
- Deepti Vepakomma
- Department of Paediatric Surgery, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
| | - Nitin Kumar
- Department of Paediatric Surgery, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
| | - Anand Alladi
- Department of Paediatric Surgery, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
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23
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Beuriat PA, Di Rocco F, Szathmari A, Mottolese C. Management of split cord malformation in children: the Lyon experience. Childs Nerv Syst 2018; 34:883-891. [PMID: 29582170 DOI: 10.1007/s00381-018-3772-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Accepted: 03/01/2018] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Split cord malformation (SCM) is a rare congenital spinal abnormality. Clinical presentation varies. Other congenital defects can be associated. Management is surgical. MATERIAL AND METHODS We retrospectively reviewed all our SCM cases and reported our experience for its management. From 1990 to 2014, 37 patients were operated. Five situations lead to the diagnosis (orthopedic disorders (n = 8), orthopedic and neurological disorders (n = 16), pure neurological disorders (n = 5), no symptoms except cutaneous signs (n = 7), antenatal diagnosis (n = 1)). Scoliosis was the most common associated condition. The level of the spur was always under T7 except in one case. There were more type I (n = 22) than type II (n = 15) SCM. RESULTS Patients with preoperative neurological symptoms (n = 21) were improved in 71.4%. Five out of nine patients that had preoperative bladder dysfunction were improved. Eleven patients needed surgical correction of the scoliosis. CONCLUSIONS For us, the surgical procedure is mandatory even in case of asymptomatic discovery in order to avoid late clinical deterioration. In any case, the filum terminale need to be cut in order to untether completely the spinal cord. In case a surgical correction of a spinal deformity is needed, we recommend a two-stage surgery, for both SCM type. The SCM surgery can stop the evolution of the scoliosis and it may just need an orthopedic treatment with a brace.
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Affiliation(s)
- Pierre-Aurélien Beuriat
- Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, Hospice Civil de Lyon, 59 Boulevard Pinel, 69677, Lyon Cedex, France
| | - Federico Di Rocco
- Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, Hospice Civil de Lyon, 59 Boulevard Pinel, 69677, Lyon Cedex, France
| | - Alexandru Szathmari
- Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, Hospice Civil de Lyon, 59 Boulevard Pinel, 69677, Lyon Cedex, France
| | - Carmine Mottolese
- Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, Hospice Civil de Lyon, 59 Boulevard Pinel, 69677, Lyon Cedex, France.
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Abstract
La diastématomyélie est une forme de dysraphisme spinal rare qui consiste en un dédoublement du canal vertébral et de son contenu. Deux types de diastématomyélie ont été décrits. Nous rapportons le cas d'un patient agé de 12 ans, de sexe masculin qui se présente pour une diminution de la force musculaire des membres inférieurs sans troubles sphinctériens associés. Le patient a bénéficié d'une imagerie par résonance magnétique (IRM) de la colonne vertébrale en séquence pondérée en T1 et T2, en coupe axiale, sagittale et coronale. L'IRM montre un aspect bifide de la moelle thoraco-lombaire en deux hémi-cordes sans éperon osseux séparant les deux hémi-moelles, compatible avec une diastématomyélie de type 1. Il s'y associe une moelle bas attachée avec cavité syringomyélique intéressant l'hémi moelle gauche et une lésion kystique biloculée au niveau de l'hémi moelle droite compatible avec un kyste neuro-enterique. L'IRM montre également la présence d'un défaut de fermeture de l'arc postérieur de D12 qui communique avec une poche sous cutanée en rapport avec un sinus dermique. La diastématomyélie est une anomalie rare de la colonne vertébrale qui peut être associée à d'autres malformations. La stratégie thérapeutique dépend essentiellement de la progression des signes cliniques (neurologiques) et des malformations associées.
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Affiliation(s)
- Sadik Zbair
- Université Hassan II, Faculté de Médecine et de Pharmacie, Service de Radiologie Pédiatrique, Hôpital Abderrahim Harouchi, CHU IBN Rochd, Casablanca, Maroc
| | - Asmaa Adnane
- Université Hassan II, Faculté de Médecine et de Pharmacie, Service de Radiologie Pédiatrique, Hôpital Abderrahim Harouchi, CHU IBN Rochd, Casablanca, Maroc
| | - Kamilia Chbani
- Université Hassan II, Faculté de Médecine et de Pharmacie, Service de Radiologie Pédiatrique, Hôpital Abderrahim Harouchi, CHU IBN Rochd, Casablanca, Maroc
| | - Siham Salam
- Université Hassan II, Faculté de Médecine et de Pharmacie, Service de Radiologie Pédiatrique, Hôpital Abderrahim Harouchi, CHU IBN Rochd, Casablanca, Maroc
| | - Lahcen Ouzidane
- Université Hassan II, Faculté de Médecine et de Pharmacie, Service de Radiologie Pédiatrique, Hôpital Abderrahim Harouchi, CHU IBN Rochd, Casablanca, Maroc
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25
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Vogt L, Rodermond B, Post P, Iborra S, Stickeler E, Schiefer J, Alt JP, Rossaint R, Röhl A. [Intramedullary injection with tethered cord : Case report of a rare complication during spinal anesthesia]. Anaesthesist 2017; 67:131-134. [PMID: 29270665 DOI: 10.1007/s00101-017-0400-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 12/01/2017] [Accepted: 12/01/2017] [Indexed: 10/18/2022]
Abstract
Although very rare, severe neurological complications can occur when undergoing spinal anesthesia. This report describes and analyses a case of spinal injury due to an undiagnosed tethered cord (TC) during spinal anesthesia for a cesarean section of a 31-year-old woman expecting twins. As a consequence of spinal dysraphism during embryogenesis, an atypically low conus level can occur and increase the risk of injury during neuraxial anesthesia, especially in the absence of symptoms. Injuries can be caused by mechanical trauma from direct needle injury, hematoma or neurotoxicity from local anesthetics. Special attention should therefore be paid to frequent symptoms, such as a hairy nevus on the back, deformities of the feet or bladder and bowels, voiding and micturition dysfunction in order to reduce the risk of complications.
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Affiliation(s)
- L Vogt
- Klinik für Anästhesiologie, Medizinische Fakultät, Uniklinik RWTH Aachen, Aachen, Deutschland.
| | - B Rodermond
- Klinik für Anästhesiologie, Medizinische Fakultät, Uniklinik RWTH Aachen, Aachen, Deutschland
| | - P Post
- Klinik für Anästhesiologie, Medizinische Fakultät, Uniklinik RWTH Aachen, Aachen, Deutschland
| | - S Iborra
- Klinik für Gynäkologie und Geburtsmedizin, Medizinische Fakultät, Uniklinik RWTH Aachen, Aachen, Deutschland
| | - E Stickeler
- Klinik für Gynäkologie und Geburtsmedizin, Medizinische Fakultät, Uniklinik RWTH Aachen, Aachen, Deutschland
| | - J Schiefer
- Klinik für Neurologie, Medizinische Fakultät, Uniklinik RWTH Aachen, Aachen, Deutschland
| | - J P Alt
- Klinik für Diagnostische und Interventionelle Neuroradiologie, Medizinische Fakultät, Uniklinik RWTH Aachen, Aachen, Deutschland
| | - R Rossaint
- Klinik für Anästhesiologie, Medizinische Fakultät, Uniklinik RWTH Aachen, Aachen, Deutschland
| | - A Röhl
- Klinik für Anästhesiologie, Medizinische Fakultät, Uniklinik RWTH Aachen, Aachen, Deutschland
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26
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Abstract
Split cord malformation (SCM) is a rare congenital anomaly. The presence of bony spurs seen in type 1 SCM are usually partial and unequivocally are found attached to the dorsal surface of the vertebral body. We present here a unique case of SCM where the bony spur was found attached to the ventral aspect of the posterior arch and there were three different types of spurs (Type 1A, 1B and 1C) in the same patient.
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Affiliation(s)
- Kanwaljeet Garg
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Vivek Tandon
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
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27
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Saker E, Oskouian RJ, Loukas M, Johnston JM, Tubbs RS, Conklin M. A never before reported variant of the sacrum. Surg Radiol Anat 2016; 39:807-809. [PMID: 27826717 DOI: 10.1007/s00276-016-1772-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 10/28/2016] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Several important steps occur in order for the sacrum to develop properly. Embryological derailment can result in several different anatomical variants. CASE REPORT Herein, we report, to our knowledge, the first case of a duplicated sacrum in the sagittal plane. CONCLUSIONS Clinicians and radiologists should be aware of such a finding if found during imaging. We would hypothesize that such a variant occurred near the 29th day of development and probably arose from an error in the HOX gene. To our knowledge, this represents the first reported case.
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Affiliation(s)
- Erfanul Saker
- Department of Anatomical Sciences, St. George's University, Grenada, WI, USA.
| | | | - Marios Loukas
- Department of Anatomical Sciences, St. George's University, Grenada, WI, USA
| | | | | | - Michael Conklin
- Section of Pediatric OrthopedicsChildren's of Alabama, Birmingham, AL, USA
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28
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Lituania M, Tonni G, Araujo Júnior E. First trimester diagnosis of cervico-thoracic diastematomyelia and diplomyelia using three-dimensional ultrasound. Childs Nerv Syst 2015; 31:2245-8. [PMID: 26438550 DOI: 10.1007/s00381-015-2926-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2015] [Accepted: 09/28/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Diastematomyelia and diplomyelia are rare form of spinal cord malformations (SCM) characterized by sagittal cleft in the spinal cord, conus medullaris, and/or filum terminale with splaying of the posterior vertebral elements and duplication of the spinal cord into two twin cords. Prenatal diagnosis of these diseases by two-dimensional ultrasound has been reported usually late in pregnancy and only recently in the first trimester. OBJECTIVE We describe the first case of cervico-thoracic diastematomyelia and diplomyelia diagnosed early in pregnancy using three-dimensional ultrasound.
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Affiliation(s)
- Mario Lituania
- Preconceptional and Prenatal Medicine, Department of Obstetrics and Gynecology, IRCCS Galliera Hospital, Genoa, Italy
| | - Gabriele Tonni
- Department of Obstetrics & Gynecology, AUSL Reggio Emilia, Guastalla Civil Hospital, Reggio Emilia, Italy
| | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine - Federal University of São Paulo (EPM-UNIFESP), Rua Belchior de Azevedo, 156 apto. 111 Torre Vitoria, São Paulo, SP, CEP 05089-030, Brazil.
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29
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Korostyshevskaya A, Makogon A, Savelov A, Avdeeva D, Tulupov A. Fetal diastematomyelia associated with vertebral malformation: ultrasound, MRI, and pathomorphological findings. J Med Ultrason (2001) 2015; 42:559-63. [PMID: 26576982 DOI: 10.1007/s10396-015-0637-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Accepted: 04/24/2015] [Indexed: 11/25/2022]
Abstract
Using a specific clinical example, we demonstrate the ability of prenatal magnetic resonance imaging (MRI) to diagnose associated spine and spinal cord malformations in the group of spinal dysraphisms. Thus, the original ultrasound (US) and MRI results for the affected fetus at week 21 are illustrated and described in detail. The paucity of reports of prenatal MR-semiotic findings of split cord malformation comparing US and pathomorphological findings at a relatively early gestational age makes the present case unique and instructive. The outstanding capability of MRI to diagnose spinal pathologies indicates the necessity of including prenatal MRI in the diagnostic algorithm to determine the severity of the lesions and the appropriate management during pregnancy, childbirth, and the early postnatal period.
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Affiliation(s)
- Aleksandra Korostyshevskaya
- The Institute International Tomography Center of the Russian Academy of Sciences, Institutskaya Str. 3 A, 630090, Novosibirsk, Russia
| | - Arkadiy Makogon
- Institute of Chemical Biology and Fundamental Medicine Siberian Branch of the Russian Academy of Sciences, Novosibirsk, Russia
| | - Andrey Savelov
- The Institute International Tomography Center of the Russian Academy of Sciences, Institutskaya Str. 3 A, 630090, Novosibirsk, Russia
| | - Darya Avdeeva
- The Institute International Tomography Center of the Russian Academy of Sciences, Institutskaya Str. 3 A, 630090, Novosibirsk, Russia
| | - Andrey Tulupov
- The Institute International Tomography Center of the Russian Academy of Sciences, Institutskaya Str. 3 A, 630090, Novosibirsk, Russia. .,Novosibirsk State University, Novosibirsk, Russia.
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30
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Abstract
Variations in split cord malformation (SCM) have been described earlier. However, a true hemimyelomeningocele (HMM) as only congenital malformation is extremely rare and is reported infrequently in published literature. We are reporting the case of a 3-month-old girl child who presented with a swelling on the lower back since birth. Magnetic resonance imaging revealed a type 1 SCM with right hemicord forming a HMM. Precise diagnosis and thorough anatomical detail of dysraphism is essential for optimal, individualized neurosurgical management.
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Affiliation(s)
- Neha Singh
- Department of Radiodiagnosis and Imaging, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Deepak Kumar Singh
- Department of Neurosurgery, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Rakesh Kumar
- Department of Neurosurgery, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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31
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Abstract
Diastematomyelia means sagittal division of the spinal cord into two hemi cords. It is a congenital malformation which results from an abnormal adhesion between ectoderm and endoderm. It is more common in females (3:1). This abnormal adhesion which splits the cord may be in the form of fibrous tissue or purely a calcific bar or purely an ossific bar or even a combination of the earlier mentioned entities. The health impacts of this entity are enormous, as the patients may be asymptomatic to begin with, until gradually; progressive spinal cord dysfunction sets in. Imaging plays a vital role in establishing the diagnosis and it may aid in easing the quality of life by making an early diagnosis. The affected individual and the afflicted families need psycho-social guidance and counselling. We are presenting here, imaging findings in two cases of diastematomyelia.
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Affiliation(s)
- Sushil G. Kachewar
- Professor, Department of Radio Diagnosis, Rural Medical College (RMC), PIMS, Loni, India
| | - Smita B. Sankaye
- Assistant Professor, Department of Pathology, Rural Medical College (RMC), PIMS, Loni, India
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32
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Azimi P, Mohammadi HR. Diastematomyelia Presenting With no Pain in a 53-Year-Old Man: A Case Report. Iran Red Crescent Med J 2013; 15:522-5. [PMID: 24349753 PMCID: PMC3840842 DOI: 10.5812/ircmj.4195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Revised: 01/02/2013] [Accepted: 01/20/2013] [Indexed: 11/26/2022]
Abstract
Initial presentation of diastematomyelia is rarely seen in adults. The purpose of this case report is to present a case of clinically silent diastematomyelia unrecognized into adulthood and review of the literature. A 53-year-old Persian man was admitted to our hospital with gait disturbance, weakness of the right lower extremity, sensory loss of the left and right lower extremity of two weeks’ duration, with no pain or sphincter dysfunction. The patient underwent radiological examinations, and diastematomyelia was diagnosed. The deteriorating condition of our patient led to the decision to perform a surgery. A laminectomy was performed from L-3 to L-5 with resection of the soft-tissue mass and excision of the bony spur, and the patient was followed for 6 months. Postoperatively, the patient did not show new neurologic deficit and he returned to work 4 months after surgery. Our case was unique because of the absence of any pain, neurologic signs, and precipitating acute event leading to diagnosis, until 53 years of age. Surgical decompression of bony spur provided relative improvement of his symptoms.
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Affiliation(s)
- Parisa Azimi
- Department of Neurosurgery, Imam Hossain Medical Center, University of Shahid Beheshti Medical Sciences, Tehran, IR Iran
- Corresponding author: Parisa Azimi, Imam Hossain Medical Center, University of Shahid Beheshti Medical Sciences, Shahid Madani Street, PA 1617763141, Tehran, IR Iran, Tel/Fax: +98-2177558081, E-mail:
| | - Hassan Reza Mohammadi
- Department of Neurosurgery, Imam Hossain Medical Center, University of Shahid Beheshti Medical Sciences, Tehran, IR Iran
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33
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Abstract
MRI is increasingly being used in the diagnosis of fetal anomalies suspected on USG. The USG evaluation of fetal spinal anomalies is limited by acoustic shadowing, fetal position and the amount of liquor. Fetal MRI is able to show spinal anomalies well, as in our case of fetal diastematomyelia with a dorsal dermal sinus, suspected on USG at 28 weeks gestation.
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