1
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Cordero-Varela JA, Reyes-Corral M, Lao-Pérez M, Fernández-Santos B, Montenegro-Elvira F, Sempere L, Ybot-González P. Analysis of Gut Characteristics and Microbiota Changes with Maternal Supplementation in a Neural Tube Defect Mouse Model. Nutrients 2023; 15:4944. [PMID: 38068802 PMCID: PMC10708240 DOI: 10.3390/nu15234944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 11/03/2023] [Accepted: 11/24/2023] [Indexed: 12/18/2023] Open
Abstract
Adequate nutrient supply is crucial for the proper development of the embryo. Although nutrient supply is determined by maternal diet, the gut microbiota also influences nutrient availability. While currently there is no cure for neural tube defects (NTDs), their prevention is largely amenable to maternal folic acid and inositol supplementation. The gut microbiota also contributes to the production of these nutrients, which are absorbed by the host, but its role in this context remains largely unexplored. In this study, we performed a functional and morphological analysis of the intestinal tract of loop-tail mice (Vangl2 mutants), a mouse model of folate/inositol-resistant NTDs. In addition, we investigated the changes in gut microbiota using 16S rRNA gene sequencing regarding (1) the host genotype; (2) the sample source for metagenomics analysis; (3) the pregnancy status in the gestational window of neural tube closure; (4) folic acid and (5) D-chiro-inositol supplementation. We observed that Vangl2+/Lp mice showed no apparent changes in gastrointestinal transit time or fecal output, yet exhibited increased intestinal length and cecal weight and gut dysbiosis. Moreover, our results showed that the mice supplemented with folic acid and D-chiro-inositol had significant changes in their microbiota composition, which are changes that could have implications for nutrient absorption.
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Affiliation(s)
- Juan Antonio Cordero-Varela
- Institute of Biomedicine of Seville (IBiS)/Virgen del Rocío University Hospital/CSIC/University of Seville, 41013 Seville, Spain; (J.A.C.-V.); (M.L.-P.); (B.F.-S.); (F.M.-E.); (L.S.)
| | - Marta Reyes-Corral
- Institute of Biomedicine of Seville (IBiS)/Virgen del Rocío University Hospital/CSIC/University of Seville, 41013 Seville, Spain; (J.A.C.-V.); (M.L.-P.); (B.F.-S.); (F.M.-E.); (L.S.)
| | - Miguel Lao-Pérez
- Institute of Biomedicine of Seville (IBiS)/Virgen del Rocío University Hospital/CSIC/University of Seville, 41013 Seville, Spain; (J.A.C.-V.); (M.L.-P.); (B.F.-S.); (F.M.-E.); (L.S.)
| | - Beatriz Fernández-Santos
- Institute of Biomedicine of Seville (IBiS)/Virgen del Rocío University Hospital/CSIC/University of Seville, 41013 Seville, Spain; (J.A.C.-V.); (M.L.-P.); (B.F.-S.); (F.M.-E.); (L.S.)
| | - Fernando Montenegro-Elvira
- Institute of Biomedicine of Seville (IBiS)/Virgen del Rocío University Hospital/CSIC/University of Seville, 41013 Seville, Spain; (J.A.C.-V.); (M.L.-P.); (B.F.-S.); (F.M.-E.); (L.S.)
| | - Lluis Sempere
- Institute of Biomedicine of Seville (IBiS)/Virgen del Rocío University Hospital/CSIC/University of Seville, 41013 Seville, Spain; (J.A.C.-V.); (M.L.-P.); (B.F.-S.); (F.M.-E.); (L.S.)
| | - Patricia Ybot-González
- Institute of Biomedicine of Seville (IBiS)/Virgen del Rocío University Hospital/CSIC/University of Seville, 41013 Seville, Spain; (J.A.C.-V.); (M.L.-P.); (B.F.-S.); (F.M.-E.); (L.S.)
- Consejo Superior de Investigaciones Científicas (CSIC), Spain
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2
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Sinha P, Kumar A, Jana M, Kandasamy D. Multiple neural tube defects: rare developmental anomaly with an elusive embryological explanation. BJR Case Rep 2023; 9:20230005. [PMID: 37928696 PMCID: PMC10621580 DOI: 10.1259/bjrcr.20230005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 05/11/2023] [Accepted: 06/07/2023] [Indexed: 11/07/2023] Open
Abstract
Neural tube defect is a congenital anomaly resulting from the failure of fusion of the neural folds in the midline which occurs in the third and the fourth week of embryonic development. These defects can occur at any of the three embryological stages-gastrulation, primary neurulation and secondary neurulation. Presence of neural tube defects at multiple (two or more) sites along the craniospinal axis is an extremely rare anomaly and the management depends on clinical as well as imaging findings. These multiple defects are not well explained by the "Zipper closure" theory and can be better explained by the "Multisite closure theory", which will be highlighted in this manuscript. Few of these multiple site anomalies cannot be fully explained even by the multisite closure theory and more research is needed to decipher this entity.
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Affiliation(s)
- Pallavi Sinha
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Atin Kumar
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Manisha Jana
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Devasenathipathy Kandasamy
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
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3
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Maniou E, Farah F, Marshall AR, Crane-Smith Z, Krstevski A, Stathopoulou A, Greene NDE, Copp AJ, Galea GL. Caudal Fgfr1 disruption produces localised spinal mis-patterning and a terminal myelocystocele-like phenotype in mice. Development 2023; 150:dev202139. [PMID: 37756583 PMCID: PMC10617625 DOI: 10.1242/dev.202139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 09/11/2023] [Indexed: 09/29/2023]
Abstract
Closed spinal dysraphisms are poorly understood malformations classified as neural tube (NT) defects. Several, including terminal myelocystocele, affect the distal spine. We have previously identified a NT closure-initiating point, Closure 5, in the distal spine of mice. Here, we document equivalent morphology of the caudal-most closing posterior neuropore (PNP) in mice and humans. Closure 5 forms in a region of active FGF signalling, and pharmacological FGF receptor blockade impairs its formation in cultured mouse embryos. Conditional genetic deletion of Fgfr1 in caudal embryonic tissues with Cdx2Cre diminishes neuroepithelial proliferation, impairs Closure 5 formation and delays PNP closure. After closure, the distal NT of Fgfr1-disrupted embryos dilates to form a fluid-filled sac overlying ventrally flattened spinal cord. This phenotype resembles terminal myelocystocele. Histological analysis reveals regional and progressive loss of SHH- and FOXA2-positive ventral NT domains, resulting in OLIG2 labelling of the ventral-most NT. The OLIG2 domain is also subsequently lost, eventually producing a NT that is entirely positive for the dorsal marker PAX3. Thus, a terminal myelocystocele-like phenotype can arise after completion of NT closure with localised spinal mis-patterning caused by disruption of FGFR1 signalling.
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Affiliation(s)
- Eirini Maniou
- Developmental Biology and Cancer Department, UCL Great Ormond Street Institute of Child Health, London WC1N 1EH, UK
| | - Faduma Farah
- Developmental Biology and Cancer Department, UCL Great Ormond Street Institute of Child Health, London WC1N 1EH, UK
| | - Abigail R. Marshall
- Developmental Biology and Cancer Department, UCL Great Ormond Street Institute of Child Health, London WC1N 1EH, UK
| | - Zoe Crane-Smith
- Developmental Biology and Cancer Department, UCL Great Ormond Street Institute of Child Health, London WC1N 1EH, UK
| | - Andrea Krstevski
- Developmental Biology and Cancer Department, UCL Great Ormond Street Institute of Child Health, London WC1N 1EH, UK
| | - Athanasia Stathopoulou
- Developmental Biology and Cancer Department, UCL Great Ormond Street Institute of Child Health, London WC1N 1EH, UK
| | - Nicholas D. E. Greene
- Developmental Biology and Cancer Department, UCL Great Ormond Street Institute of Child Health, London WC1N 1EH, UK
| | - Andrew J. Copp
- Developmental Biology and Cancer Department, UCL Great Ormond Street Institute of Child Health, London WC1N 1EH, UK
| | - Gabriel L. Galea
- Developmental Biology and Cancer Department, UCL Great Ormond Street Institute of Child Health, London WC1N 1EH, UK
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4
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Wang X, Yu J, Wang J. Neural Tube Defects and Folate Deficiency: Is DNA Repair Defective? Int J Mol Sci 2023; 24:ijms24032220. [PMID: 36768542 PMCID: PMC9916799 DOI: 10.3390/ijms24032220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 01/13/2023] [Accepted: 01/19/2023] [Indexed: 01/26/2023] Open
Abstract
Neural tube defects (NTDs) are complex congenital malformations resulting from failure of neural tube closure during embryogenesis, which is affected by the interaction of genetic and environmental factors. It is well known that folate deficiency increases the incidence of NTDs; however, the underlying mechanism remains unclear. Folate deficiency not only causes DNA hypomethylation, but also blocks the synthesis of 2'-deoxythymidine-5'-monophosphate (dTMP) and increases uracil misincorporation, resulting in genomic instabilities such as base mismatch, DNA breakage, and even chromosome aberration. DNA repair pathways are essential for ensuring normal DNA synthesis, genomic stability and integrity during embryonic neural development. Genomic instability or lack of DNA repair has been implicated in risk of development of NTDs. Here, we reviewed the relationship between folate deficiency, DNA repair pathways and NTDs so as to reveal the role and significance of DNA repair system in the pathogenesis of NTDs and better understand the pathogenesis of NTDs.
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5
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Shiferaw MY, Akililu YB, Worku BY, T/Mariam TL, Aklilu AT. Multiple-site neural tube defects complicated by multiple-site split cord malformations and thickened filum terminale: experience at a pediatric neurosurgical teaching hospital in Ethiopia. Illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2022; 4:CASE22220. [PMID: 36593675 PMCID: PMC9514283 DOI: 10.3171/case22220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 08/17/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Multiple-site open neural tube defects (MNTDs) and multiple-site split cord malformations (MSCMs) are extremely rare congenital anomalies that are defined by the simultaneous noncontiguous occurrence of more than one neural tube defect (NTD) and split cord malformation (SCM), respectively, in a single case with normal neural tissue in between. This work shows the cooccurrence of MNTDs and MSCMs, which has never been reported in the literature. OBSERVATIONS A single-stage repair for a 13-day-old female neonate with a preoperative diagnosis of MNTDs (thoracic meningocele and thoracolumbar myelomeningocele) plus an additional intraoperative diagnosis of MSCMs (type 3c) of thoracic and thoracolumbar spine, and thickened filum terminale was done with a favorable smooth postoperative course. LESSONS The use of intraoperative meticulous surgical technique along with preoperative skin stigmata helped for anticipation, detection, and treatment of associated complex spinal MNTDs, especially in resource-limited settings, where preoperative magnetic resonance imaging is not routinely used. Whether to repair the MNTDs as a single- versus multiple-stage procedure is mainly a function of the patient's tolerance to the duration of anesthesia and the anticipated blood loss for the patient's age. The overall developmental biology and long-term clinical outcome of MNTDs compared to single NTD/SCM is poorly understood and needs further study.
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6
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Imaging of Congenital Spine Malformations. Clin Perinatol 2022; 49:623-640. [PMID: 36113926 DOI: 10.1016/j.clp.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Congenital malformations of the spine and spinal cord are a large and diverse group of diagnoses, which are often broadly referred to as spinal dysraphisms (SDs). Derived from the Greek words dys (bad) and raphe (suture), the term dysraphism describes missteps in the process of forming a midline seam during the zipper-like fusion of the neural folds in primary neurulation. As such, the term "spinal dysraphism" is a designation that should technically be reserved for malformations resulting from aberrations in primary neurulation. In medical practice, however, it is a catch-all designation regularly used to describe any of the numerous abnormalities demonstrating incomplete midline closure of mesenchymal, osseous, and nervous tissue, occurring at any point during embryologic development. For the sake of clarity and completeness, this article will also include that breadth in the discussion of congenital abnormalities of the spine.
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Cavalheiro S, da Costa MDS, Barbosa MM, Dastoli PA, Mendonça JN, Cavalheiro D, Moron AF. Hydrocephalus in myelomeningocele. Childs Nerv Syst 2021; 37:3407-3415. [PMID: 34435215 DOI: 10.1007/s00381-021-05333-2] [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: 07/17/2021] [Accepted: 08/09/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To investigate certain aspects of hydrocephalus in patients with myelomeningocele. METHODS We retrospectively analyzed data of 1050 patients with myelomeningocele who underwent surgical treatment between June 1991 and June 2021. These patients were divided into three groups: group 1 consisted of patients who underwent surgery after the first 6 h of life, group 2 consisted of patients who underwent surgery within the first 6 h, and group 3 consisted of patients who underwent surgery during the fetal period and before 26 6/7 weeks of gestation. RESULTS There were 125, 590, and 335 patients in groups 1, 2, and 3, respectively. In groups 1 and 2, 593 (83%) patients developed hydrocephalus after birth and required ventriculoperitoneal shunt placement in the maternity ward, mainly within the first 4 days of life. In contrast, in group 3, 24 (7.2%) patients required surgery to treat hydrocephalus after birth. Hydrocephalus was the primary cause of mortality in groups 1 and 2, with mortality rates of 35% and 10%, respectively. In group 3, the mortality rate was 0.8% and was not related to hydrocephalus. CONCLUSION The onset of hydrocephalus is directly related to myelomeningocele closure in neurosurgery.
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Affiliation(s)
- Sergio Cavalheiro
- Department Neurology and Neurosurgery, Universidade Federal de Sao Paulo, Rua Napoleão de Barros, 715, 6th Floor, Sao Paulo, SP, 04024-002, Brazil.,Department of Fetal Neurosurgery, Hospital e Maternidade Santa Joana, São Paulo, SP, Brazil
| | - Marcos Devanir Silva da Costa
- Department Neurology and Neurosurgery, Universidade Federal de Sao Paulo, Rua Napoleão de Barros, 715, 6th Floor, Sao Paulo, SP, 04024-002, Brazil. .,Department of Fetal Neurosurgery, Hospital e Maternidade Santa Joana, São Paulo, SP, Brazil.
| | - Mauricio Mendes Barbosa
- Department of Fetal Medicine, Hospital E Maternidade Santa Joana, São Paulo, SP, Brazil.,Department of Obstetrics, Faculdade de Medicina Einstein, São Paulo, SP, Brazil
| | - Patricia Alessandra Dastoli
- Department Neurology and Neurosurgery, Universidade Federal de Sao Paulo, Rua Napoleão de Barros, 715, 6th Floor, Sao Paulo, SP, 04024-002, Brazil.,Department of Fetal Neurosurgery, Hospital e Maternidade Santa Joana, São Paulo, SP, Brazil
| | - Jardel Nicácio Mendonça
- Department Neurology and Neurosurgery, Universidade Federal de Sao Paulo, Rua Napoleão de Barros, 715, 6th Floor, Sao Paulo, SP, 04024-002, Brazil.,Department of Fetal Neurosurgery, Hospital e Maternidade Santa Joana, São Paulo, SP, Brazil
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8
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Shiferaw MY, Awedew AF, T/Mariam TL, Aklilu AT, Akililu YB, Andualem AM. Multiple site neural tube defects at Zewuditu Memorial Hospital, Addis Ababa, Ethiopia: a case report. J Med Case Rep 2021; 15:429. [PMID: 34399841 PMCID: PMC8369642 DOI: 10.1186/s13256-021-02913-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 05/18/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Neural tube defects are common group of central nervous system anomalies of complex etiology and major public health importance worldwide. The occurrence of multiple neural tube defects, however, is an extremely rare event and has never been reported in Ethiopia so far. This study gives an insight into how the embryogenesis, management, and postoperative complications of multiple neural tube defects differ from the ordinary single neural tube defects on the basis of up-to-date existing literature. CASE PRESENTATION This paper highlights a case of an 8 days old female black race Ethiopian neonate who was brought by her mother with the chief complaint of lower back and lower neck swelling since birth. The findings were a 5 × 4 × 5 cm sized ulcerated placode at the mid-lumbosacral area and a 1.5 × 1.5 × 1 cm sized fluctuant, nontender, transilluminating mass with overlying unruptured defect dysplastic skin at the cervicothoracic junction. With a diagnosis of multiple neural tube defects secondary to unruptured cervicothoracic meningocele and ruptured lumbosacral myelomeningocele, single-stage repair of the defects was done with good outcome. CONCLUSION There is insufficient evidence as to the exact mechanism of development of multiple neural tube defects. Similarly, whether patients with multiple neural tube defects had increased risk of post repair hydrocephalus compared with patients who have single neural tube defect is unknown. Hence, more research on the embryogenesis, management, and long-term outcome of multiple neural tube defects in particular and single neural tube defects in general should be done to better help patients with this costly and crippling problem. Lastly, the practice of folic acid supplementation is very low in resource-limited countries such as Ethiopia and, hence, should be improved.
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Affiliation(s)
- Mestet Yibeltal Shiferaw
- Neurosurgery Division, Department of Surgery, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Atalel Fentahun Awedew
- Neurosurgery Division, Department of Surgery, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tsegazeab Laeke T/Mariam
- Neurosurgery Division, Department of Surgery, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Abenezer Tirsit Aklilu
- Neurosurgery Division, Department of Surgery, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Yemisirach Bizuneh Akililu
- Neurosurgery Division, Department of Surgery, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Aemiro Mazengia Andualem
- Neurosurgery Division, Department of Surgery, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
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Pal NL, Juwarkar AS, Viswamitra S. Encephalocele: know it to deal with it. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2021. [DOI: 10.1186/s43055-021-00489-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Encephaloceles refer to the herniation of intracranial contents through the defect in the dura and calvarium. This article aims to equip the radiologists with all the necessary information to approach a case of encephalocele in a systematic manner and report in an organized format. Thus reduce the reporting time without overlooking any detail.
Main text
An extensive literature review was performed searching through the standard textbooks and electronic databases to obtain thorough information on the various encephaloceles particularly from a radiological point of view. The author’s observations were also incorporated in the review. Among the available imaging modalities, magnetic resonance imaging is the most versatile and considered the imaging modality of choice because of superior anatomic resolution in the characterization of central nervous system malformation. This study provides the reporting radiologist with a methodical guide to approach a case of encephalocele discussing the imaging protocol, relevant anatomy, classification, associated abnormalities, and imaging prognostic factors.
Conclusion
Encephalocele has always been a subject of predicament for radiologists. Understanding the relevant terminologies, anatomy, imaging protocols, classification, associated malformations/anomalies, and imaging prognostic factors will help to methodically approach each case and provide a systematic and comprehensive report.
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Maurya VP, Singh Y, Srivastava AK, Das KK, Bhaisora KS, Sardhara J, Behari S. Spinal Dermoid and Epidermoid Cyst: An Institutional Experience and Clinical Insight into the Neural Tube Closure Models. J Neurosci Rural Pract 2021; 12:495-503. [PMID: 34295103 PMCID: PMC8289537 DOI: 10.1055/s-0041-1724229] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objectives
The spinal dermoid and epidermoid cysts (SDECs) are rare entities comprising less than 1% of pediatric intraspinal tumors. The present study aims to extrapolate the clinicoradiological data, in order to identify the most plausible neural tube closure model in human and provide a retrospective representation from our clinical experience.
Materials and Methods
We collected the details of all histologically proven, newly diagnosed primary SDECs who underwent excision over the past 20 years. Secondary or recurrent lesions and other spinal cord tumors were excluded. Surgical and follow-up details of these patients as well as those with associated spinal dysraphism were reviewed. Clinical and radiological follow-up revealed the recurrence in these inborn spinal cord disorders.
Results
A total of 73 patients were included retrospectively, having a mean age of 22.4 ± 13.3 years, and 41 (56.2%) cases fell in the first two decades of life. Twenty-four (32.9%) dermoid and 49 (67.1%) epidermoid cysts comprised the study population and 20 of them had associated spinal dysraphism. The distribution of SDECs was the most common in lumbosacral region (
n
= 30) which was 10 times more common than in the sacral region (
n
= 3). Bladder dysfunction 50 (68.5%) and pain 48 (65.7%) were the most common presenting complaints. During follow-up visits, 40/48 (83.3%) cases showed sensory improvement while 11/16 (68.7%) regained normal bowel function. There was no surgical mortality with recurrence seen in eight till the last follow-up.
Conclusions
The protracted clinical course of the spinal inclusion cysts mandates a long-term follow-up. The results of our study support the multisite closure model and attempt to provide a retrospective reflection of neural tube closure model in humans by using SDECs as the surrogate marker of neural tube closure defect.
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Affiliation(s)
- Ved P Maurya
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Yashveer Singh
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Arun K Srivastava
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Kuntal K Das
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Kamlesh S Bhaisora
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Jayesh Sardhara
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Sanjay Behari
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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da Silva AJF, Silva CSME, Mariano SCR. Amniotic band syndrome with double encephalocele: A case report. Surg Neurol Int 2020; 11:448. [PMID: 33408933 PMCID: PMC7771411 DOI: 10.25259/sni_454_2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 12/02/2020] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Amniotic band syndrome (ABS) is a rare condition of controversial etiology that is associated with varying degrees of anomalies. This study reports a case of a newborn with ABS associated with double encephalocele in the frontal region. CASE DESCRIPTION A 29-year-old primiparous woman with no history of prenatal infection or consanguineous marriage had a cesarean section at gestational week 38, giving birth to a newborn who was well but had limb anomalies (constriction rings, amputations, and syndactyly) and craniofacial anomalies, mainly double frontal encephalocele. The patient underwent surgical repair and subsequent placement of a ventriculoperitoneal shunt. CONCLUSION Studies clarifying this uncommon association with double encephalocele are limited. ABS associated with double encephalocele is rare and even more complex when associated with other anomalies. Thus, the conditions in such children are severe and require multidisciplinary monitoring.
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Affiliation(s)
- Aldo Jose Ferreira da Silva
- Department of Pediatric Neurosurgery, Santa Monica Maternity School - Alagoas State University of Health Sciences, Maceio, Alagoas, Brazil
| | | | - Sonaly C. R. Mariano
- Department of Pediatrics, Neonatal Intensive Care Unit, Santa Monica Maternity School, Maceio, Alagoas, Brazil
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12
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Elarjani T, Khairy S, Al-Karawi S. Presentation of a double myelomeningocele in the upper thoracic and thoracolumbar spine: A case report. Int J Surg Case Rep 2020; 76:484-487. [PMID: 33207415 PMCID: PMC7588744 DOI: 10.1016/j.ijscr.2020.10.060] [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: 08/23/2020] [Revised: 10/13/2020] [Accepted: 10/15/2020] [Indexed: 12/03/2022] Open
Abstract
Multiple neural tube defects is very uncommon. High morbidity in multiple neural tube defects compared to single defects. Association of other spinal cord and vertebral malformation with multiple neural tube defects.
Background Double myelomeningocele are rare pathologies, with multiple cases described in developing countries. Causative factors are multifactorial, with folate deficiency as a leading associated factor. We describe a case of double myelomeningocele in the upper thoracic and thoracolumbar spine associated with split cord malformation, with emphasis on imaging appearance of this case. Case description This is a full-term newborn baby boy delivered through a cesarean section due to an antenatal diagnosis of multiple myelomeningoceles in the upper thoracic and thoracolumbar spine. The baby was operated 24 h after delivery to repair the defects and insert a ventriculoperitoneal (VP) shunt for associated hydrocephalus. The baby tolerated the operation well and is being followed and managed by a multi-disciplinary team. Conclusion Antenatal screening for myelomeningocele is paramount for prompt management. Multiple myelomeningoceles are uncommon, yet their management remains similar to single myelomeningocele.
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Affiliation(s)
- Turki Elarjani
- King Faisal Specialist Hospital and Research Centre, Department of Neurosciences, Division of Neurosurgery, Riyadh, Saudi Arabia.
| | - Sami Khairy
- Division of Neurosurgery, Department of Surgery, King Abdulaziz Medical City, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Sarmad Al-Karawi
- Division of Neurosurgery, Department of Surgery, King Abdulaziz Medical City, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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13
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Panchal G, Raman VS, Dey SK, Dwivedi D. Double Meningocele: An Uncommon Entity. J Indian Assoc Pediatr Surg 2020; 25:411-412. [PMID: 33487949 PMCID: PMC7815023 DOI: 10.4103/jiaps.jiaps_208_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 08/02/2020] [Accepted: 08/04/2020] [Indexed: 11/28/2022] Open
Affiliation(s)
| | - V Shankar Raman
- Department of Paediatric Surgery, Command Hospital, Pune, Maharashtra, India
| | - Santosh K Dey
- Department of Paediatric Surgery, Command Hospital, Pune, Maharashtra, India
| | - Deepak Dwivedi
- Department of Paediatric Anaesthesiology, Command Hospital, Pune, Maharashtra, India
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14
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Deora H, Srinivas D, Shukla D, Devi BI, Mishra A, Beniwal M, Kannepalli NR, Somanna S. Multiple-site neural tube defects: embryogenesis with complete review of existing literature. Neurosurg Focus 2020; 47:E18. [PMID: 31574472 DOI: 10.3171/2019.8.focus19437] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 08/01/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Multiple-site neural tube defects (MNTDs) are very uncommon, with the predominant number of cases being reported in developing countries. The classic theory of neural tube closure fails to explain the occurrence of these defects. Multisite closure theory, first proposed in 1995, explains most of the occurrences with a few modifications specific to a few defects. In this paper, the authors endeavor to explain all the defects, along with their genetic and embryological bases, and to review the available literature and discuss their own experience in the management of these complex cases. METHODS The authors retrospectively reviewed the data of all the patients treated surgically for MNTDs over that past 14 years. All possible demographic data, clinical details, and radiological imaging data were reviewed. In addition, surgical parameters, complications, and status at follow-up of more than 12 months were evaluated. All previously reported cases of MNTD were analyzed, and comparisons with the present series were made. RESULTS A total of 3 major series (including the present one) on MNTDs have been from India. A total of 57 such cases (including those of the present series) have been reported in the available literature. While previous series reported a higher incidence of spinal defects, the present series had a higher rate of cephalic defects (55%). Among the reported cases, insertion of a ventriculoperitoneal shunt was necessary in 12 (26%), and only 4 patients were operated on in 2 stages. Neurological status at presentation dictated outcome. CONCLUSIONS MNTDs are extremely rare, and their embryogenesis is different from that of single neural tube defects. Simultaneous repair of 2 or even 3 defects is possible in a single-stage surgery. The requirement of a shunt is uncommon, and complications following surgery are rare. Folic acid supplementation may reduce the incidence of defects.
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15
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Jamous MA, Daoud SS, Abu-Aqoulah AM. Multiple Neural Tube Defects: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e922312. [PMID: 32350236 PMCID: PMC7209907 DOI: 10.12659/ajcr.922312] [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] [Indexed: 11/09/2022]
Abstract
BACKGROUND Incomplete closure of the neural tube results in congenital anomalies called neural tube defects (NTD). These defects are rarely multiple, and are characterized by loss of central nervous system soft tissue and bony coverings, along with herniation of the involved part of the CNS through the defect. CASE REPORT A newborn female infant was delivered through planned cesarean section due to large occipital encephalocele diagnosed antenatally. The pregnancy was unplanned and the mother did not take folic acid prior to conception. Birth weight was 3.41 Kg. Upon delivery, the newborn was healthy, with an Apgar score of 8. The physical examination revealed 2 large pouches; one was over the occiput, and the other swelling was located over the nape of the neck. Brain MRI revealed large occipital encephalocele and cervical myelomeningocele. The 2 defects were repaired separately, with an uneventful postoperative course. CONCLUSIONS We report the rare occurrence of multiple NTD. Early repair, either as single or multiple procedures, is mandatory to avoid dramatic complications.
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Affiliation(s)
- Mohammad Ahmad Jamous
- Department of Neurosurgery - Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Suleiman Shaheer Daoud
- Department of Neurosurgery - Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
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16
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Abstract
During embryonic development, the central nervous system forms as the neural plate and then rolls into a tube in a complex morphogenetic process known as neurulation. Neural tube defects (NTDs) occur when neurulation fails and are among the most common structural birth defects in humans. The frequency of NTDs varies greatly anywhere from 0.5 to 10 in 1000 live births, depending on the genetic background of the population, as well as a variety of environmental factors. The prognosis varies depending on the size and placement of the lesion and ranges from death to severe or moderate disability, and some NTDs are asymptomatic. This chapter reviews how mouse models have contributed to the elucidation of the genetic, molecular, and cellular basis of neural tube closure, as well as to our understanding of the causes and prevention of this devastating birth defect.
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Affiliation(s)
- Irene E Zohn
- Center for Genetic Medicine, Children's Research Institute, Children's National Medical Center, Washington, DC, USA.
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17
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Abstract
Spinal dysraphism is an umbrella term that encompasses a number of congenital malformations that affect the central nervous system. The etiology of these conditions can be traced back to a specific defect in embryological development, with the more disabling malformations occurring at an earlier gestational age. A thorough understanding of the relevant neuroembryology is imperative for clinicians to select the correct treatment and prevent complications associated with spinal dysraphism. This paper will review the neuroembryology associated with the various forms of spinal dysraphism and provide a clinical-pathological correlation for these congenital malformations.
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18
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Yadav JK, Khizar A, Yadav PK, Mustafa G, Bhatti SN. A case report of triple neural tube defect: revisiting the multisite closure theory. BMC Surg 2019; 19:164. [PMID: 31694612 PMCID: PMC6836406 DOI: 10.1186/s12893-019-0633-2] [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: 07/05/2019] [Accepted: 10/24/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Triple neural tube defects are rare. To the author's knowledge, there are only four reported cases available in the literature up to date. Controversies exist with regards to the development of neural tube defects. We revisit the multisite closure theory and try to explain the mechanism of neural tube defects in our case. CASE PRESENTATION We report a case of one-month-old baby boy who presented to us with three distinct neural tube defects. He had occipital and cervical encephaloceles along with thoracolumbar myelomeningocele accompanied by syrinx and mild hydrocephalus. All the three defects were surgically corrected with good neurological outcome. CONCLUSION In the multisite model of human neural tube closure, there are only two fusion sites and two neuropores unlike in mouse. This can explain the origin of open neural tube defects including anencephaly and myelomeningocele (as in our case) but cannot account for the development of encephalocele, which appears to be a post neurulation defect.
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Affiliation(s)
| | | | | | - Ghulam Mustafa
- Pakistan Institute of Medical Sciences, Islamabad, Pakistan
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19
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Update on the Role of the Non-Canonical Wnt/Planar Cell Polarity Pathway in Neural Tube Defects. Cells 2019; 8:cells8101198. [PMID: 31590237 PMCID: PMC6829399 DOI: 10.3390/cells8101198] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 09/26/2019] [Accepted: 10/01/2019] [Indexed: 12/11/2022] Open
Abstract
Neural tube defects (NTDs), including spina bifida and anencephaly, represent the most severe and common malformations of the central nervous system affecting 0.7–3 per 1000 live births. They result from the failure of neural tube closure during the first few weeks of pregnancy. They have a complex etiology that implicate a large number of genetic and environmental factors that remain largely undetermined. Extensive studies in vertebrate models have strongly implicated the non-canonical Wnt/planar cell polarity (PCP) signaling pathway in the pathogenesis of NTDs. The defects in this pathway lead to a defective convergent extension that is a major morphogenetic process essential for neural tube elongation and subsequent closure. A large number of genetic studies in human NTDs have demonstrated an important role of PCP signaling in their etiology. However, the relative contribution of this pathway to this complex etiology awaits a better picture of the complete genetic architecture of these defects. The emergence of new genome technologies and bioinformatics pipelines, complemented with the powerful tool of animal models for variant interpretation as well as significant collaborative efforts, will help to dissect the complex genetics of NTDs. The ultimate goal is to develop better preventive and counseling strategies for families affected by these devastating conditions.
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20
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Concepts in the neurosurgical care of patients with spinal neural tube defects: An embryologic approach. Birth Defects Res 2019; 111:1564-1576. [DOI: 10.1002/bdr2.1588] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 08/20/2019] [Accepted: 08/21/2019] [Indexed: 02/04/2023]
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21
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Turgut U, Kazan S, Cakin H, Ozak A. Valproic acid effect on neural tube defects is not prevented by concomitant folic acid supplementation: Early chick embryo model pilot study. Int J Dev Neurosci 2019; 78:45-48. [DOI: 10.1016/j.ijdevneu.2019.05.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 04/17/2019] [Accepted: 05/30/2019] [Indexed: 10/26/2022] Open
Affiliation(s)
- U. Turgut
- Akdeniz UniversityB Block 2nd Floor07000AntalyaTurkey
| | - S. Kazan
- Akdeniz UniversityB Block 2nd Floor07000AntalyaTurkey
| | - H. Cakin
- Akdeniz UniversityB Block 2nd Floor07000AntalyaTurkey
| | - A. Ozak
- Akdeniz UniversityB Block 2nd Floor07000AntalyaTurkey
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22
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Takayama E, Harada A, Ikura Y, Seto H. Two cases of aplasia cutis congenita with hair collar signs and macrophage hyperplasia. J Dermatol 2019; 46:734-738. [DOI: 10.1111/1346-8138.14946] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Accepted: 05/07/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Eriko Takayama
- Department of Dermatology Takatsuki General Hospital Takatsuki Japan
| | - Atsuko Harada
- Department of Pediatric Neurosurgery Takatsuki General Hospital Takatsuki Japan
| | - Yoshihiro Ikura
- Department of Pathology Takatsuki General Hospital Takatsuki Japan
| | - Hidenobu Seto
- Department of Dermatology Takatsuki General Hospital Takatsuki Japan
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23
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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] [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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24
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Role of Neurocognitive Factors in Academic Fluency for Children and Adults With Spina Bifida Myelomeningocele. J Int Neuropsychol Soc 2019; 25:249-265. [PMID: 30864535 DOI: 10.1017/s1355617718001200] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVES Fluency is a major problem for individuals with neurodevelopmental disorders, including fluency deficits for academic skills. The aim of this study was to determine neurocognitive predictors of academic fluency within and across domains of reading, writing, and math, in children and adults, with and without spina bifida. In addition to group differences, we expected some neurocognitive predictors (reaction time, inattention) to have similar effects for each academic fluency outcome, and others (dexterity, vocabulary, nonverbal reasoning) to have differential effects across outcomes. METHODS Neurocognitive predictors were reaction time, inattention, dexterity, vocabulary, and nonverbal reasoning; other factors included group (individuals with spina bifida, n=180; and without, n=81), age, and demographic and untimed academic content skill covariates. Univariate and multivariate regressions evaluated hypotheses. RESULTS Univariate regressions were significant and robust (R 2 =.78, .70, .73, for reading, writing, and math fluency, respectively), with consistent effects of covariates, age, reaction time, and vocabulary; group and group moderation showed small effect sizes (<2%). Multivariate contrasts showed differential prediction across academic fluency outcomes for reaction time and vocabulary. CONCLUSIONS The novelty of the present work is determining neurocognitive predictors for an important outcome (academic fluency), within and across fluency domains, across population (spina bifida versus typical), over a large developmental span, in the context of well-known covariates. Results offer insight into similarities and differences regarding prediction of different domains of academic fluency, with implications for addressing academic weakness in spina bifida, and for evaluating similar questions in other neurodevelopmental disorders. (JINS, 2019, 25, 249-265).
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25
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Abstract
The occurrence of multiple neural tube defects in a single patient is rare; the cases reported in the past are mostly of thoracic and lumbosacral region. Double occipital encephaloceles are rare; only four cases have been reported till date. Here we report a case of double encephalocele—one in the vertex and the other in the occiput, and a literature study on similar reports.
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Affiliation(s)
- Enono Yhoshu
- Department of Pediatric Surgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Vedarth Dash
- Department of Pediatric Surgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Monika Bawa
- Department of Pediatric Surgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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26
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Singh S, Mehrotra A, Pandey S, Gupta S, Bhaisora KS, Gajbhiye S, Sardhara JC, Das KK, Srivastava AK, Jaiswal AK, Behari S, Kumar R. Cystic Cervical Dysraphism: Experience of 12 Cases. J Pediatr Neurosci 2018; 13:39-45. [PMID: 29899770 PMCID: PMC5982491 DOI: 10.4103/jpn.jpn_30_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Introduction: Cystic spinal dysraphism of the cervical region is a relatively rare entity, which is more frequently associated with congenital anomalies such as split cord malformation, Chiari malformation, and corpus callosum agenesis, when compared to their lumbosacral counterpart. In our study, we have highlighted the clinical spectrum, associated anomalies (both neural and extra-neural), and surgical nuances of these. Materials and Methods: This study is a retrospective analysis of 225 patients from June 2010 to April 2017. Twelve patients who were between the age of 1 month and 16 years were included in our study. Average age was 32.6 months, and there were five female patients and seven male patients. All patients underwent neurological and radiological examinations followed by surgical excision of the sac and exploration of the intradural sac using the standard microsurgical technique. Neurological, Orthopedic and urological outcomes were studied in our description. Results: Of the 12 cases, 9 patients (75%) had some associated anomaly. Four of the 12 patients (25%) had split cord malformation, 3 had corpus callosum agenesis, and 5 had Chiari malformation. Patients with cervical spina bifida cystica (SBC) present with less neurologic deficits and greater association with CCA. Conclusion: The management strategy and association with other congenital anomalies separates cervical dysraphism as a different clinical entity rather than just group. These patients rather show favorable outcome with regard to neurologic, orthopedic, and urologic problems as compared to their caudal counterpart. Early surgical intervention even before the onset of symptoms is recommended. A proper radiological and urological evaluation is warranted.
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Affiliation(s)
- Suyash Singh
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Anant Mehrotra
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Satyadeo Pandey
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Shruti Gupta
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Kamlesh S Bhaisora
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Sanjog Gajbhiye
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Jayesh C Sardhara
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Kuntal Kanti Das
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Arun Kumar Srivastava
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Awadhesh K Jaiswal
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Sanjay Behari
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Raj Kumar
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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27
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Galea GL, Nychyk O, Mole MA, Moulding D, Savery D, Nikolopoulou E, Henderson DJ, Greene NDE, Copp AJ. Vangl2 disruption alters the biomechanics of late spinal neurulation leading to spina bifida in mouse embryos. Dis Model Mech 2018; 11:dmm.032219. [PMID: 29590636 PMCID: PMC5897727 DOI: 10.1242/dmm.032219] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 02/28/2018] [Indexed: 12/13/2022] Open
Abstract
Human mutations in the planar cell polarity component VANGL2 are associated with the neural tube defect spina bifida. Homozygous Vangl2 mutation in mice prevents initiation of neural tube closure, precluding analysis of its subsequent roles in neurulation. Spinal neurulation involves rostral-to-caudal ‘zippering’ until completion of closure is imminent, when a caudal-to-rostral closure point, ‘Closure 5’, arises at the caudal-most extremity of the posterior neuropore (PNP). Here, we used Grhl3Cre to delete Vangl2 in the surface ectoderm (SE) throughout neurulation and in an increasing proportion of PNP neuroepithelial cells at late neurulation stages. This deletion impaired PNP closure after the ∼25-somite stage and resulted in caudal spina bifida in 67% of Grhl3Cre/+Vangl2Fl/Fl embryos. In the dorsal SE, Vangl2 deletion diminished rostrocaudal cell body orientation, but not directional polarisation of cell divisions. In the PNP, Vangl2 disruption diminished mediolateral polarisation of apical neuroepithelial F-actin profiles and resulted in eversion of the caudal PNP. This eversion prevented elevation of the caudal PNP neural folds, which in control embryos is associated with formation of Closure 5 around the 25-somite stage. Closure 5 formation in control embryos is associated with a reduction in mechanical stress withstood at the main zippering point, as inferred from the magnitude of neural fold separation following zippering point laser ablation. This stress accommodation did not happen in Vangl2-disrupted embryos. Thus, disruption of Vangl2-dependent planar-polarised processes in the PNP neuroepithelium and SE preclude zippering point biomechanical accommodation associated with Closure 5 formation at the completion of PNP closure. Summary: Disruption of Vangl2-dependent planar-polarised processes in the posterior neuropore (PNP) neuroepithelium and surface ectoderm preclude zippering point biomechanical accommodation associated with Closure 5 formation at the completion of PNP closure.
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Affiliation(s)
- Gabriel L Galea
- Developmental Biology of Birth Defects, UCL GOS Institute of Child Health, London, WC1N 1EH, UK
| | - Oleksandr Nychyk
- Developmental Biology of Birth Defects, UCL GOS Institute of Child Health, London, WC1N 1EH, UK
| | - Matteo A Mole
- Developmental Biology of Birth Defects, UCL GOS Institute of Child Health, London, WC1N 1EH, UK
| | - Dale Moulding
- Developmental Biology of Birth Defects, UCL GOS Institute of Child Health, London, WC1N 1EH, UK
| | - Dawn Savery
- Developmental Biology of Birth Defects, UCL GOS Institute of Child Health, London, WC1N 1EH, UK
| | - Evanthia Nikolopoulou
- Developmental Biology of Birth Defects, UCL GOS Institute of Child Health, London, WC1N 1EH, UK
| | - Deborah J Henderson
- Cardiovascular Research Centre, Institute of Genetic Medicine, Newcastle University, Central Parkway, Newcastle upon Tyne, NE1 3BZ, UK
| | - Nicholas D E Greene
- Developmental Biology of Birth Defects, UCL GOS Institute of Child Health, London, WC1N 1EH, UK
| | - Andrew J Copp
- Developmental Biology of Birth Defects, UCL GOS Institute of Child Health, London, WC1N 1EH, UK
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28
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Junghans D, Herzog S. Cnn3 regulates neural tube morphogenesis and neuronal stem cell properties. FEBS J 2018; 285:325-338. [PMID: 29151265 DOI: 10.1111/febs.14338] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 10/25/2017] [Accepted: 11/15/2017] [Indexed: 12/15/2022]
Abstract
Calponin 3 (Cnn3) is a member of the Cnn family of actin-binding molecules that is highly expressed in the mammalian brain and has been shown to control dendritic spine morphology, density, and plasticity by regulating actin cytoskeletal reorganization and dynamics. However, little is known about the role of Cnn3 during embryonic development. In this study, we analyzed mutant animals deficient in Cnn3 to gain a better understanding of its role in brain morphogenesis. Embryos lacking Cnn3 exhibited massive malformation of the developing brain including exoencephaly, closure defects at the rostral neural tube, and strong enlargement of brain tissue. In wild-type animals, we found Cnn3 being localized to the apical lining of the neuroepithelium in close vicinity to beta-Catenin and N-cadherin. By performing immunohistochemistry on beta-Catenin and p-Smad, and furthermore taking advantage of Wnt-reporter animals, we provide evidence that the loss of Cnn3 during development can affect signaling pathways crucial for correct morphogenesis of the neural tube. In addition, we used embryonic neurosphere cultures to investigate the role of Cnn3 in embryonic neuronal stem cells (NSC). Here, we observed that Cnn3 deficiency in NSCs increased the number of newly formed neurospheres and increased neurosphere size without perturbing their differentiation potential. Together, our study provides evidence for an important role of Cnn3 during development of the embryonic brain and in regulating NSC function.
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Affiliation(s)
- Dirk Junghans
- Institute of Embryology and Stem Cell Biology, Department of Biomedicine, University of Basel, Switzerland
| | - Sebastian Herzog
- Division of Developmental Immunology, Biocenter, Medical University of Innsbruck, Austria
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29
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Hughes A, Greene NDE, Copp AJ, Galea GL. Valproic acid disrupts the biomechanics of late spinal neural tube closure in mouse embryos. Mech Dev 2017; 149:20-26. [PMID: 29225143 PMCID: PMC5846844 DOI: 10.1016/j.mod.2017.12.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 11/22/2017] [Accepted: 12/06/2017] [Indexed: 01/26/2023]
Abstract
Failure of neural tube closure in the early embryo causes neural tube defects including spina bifida. Spina bifida lesions predominate in the distal spine, particularly after exposure to the anticonvulsant valproic acid (VPA). How VPA specifically disturbs late stages of neural tube closure is unclear, as neurulation is usually viewed as a uniform 'zippering' process along the spine. We recently identified a novel closure site ("Closure 5") which forms at the caudal extremity of the mouse posterior neuropore (PNP) when completion of closure is imminent. Here we investigated whether distal spina bifida in VPA-exposed embryos involves disruption of Closure 5. Exposure of E8.5 mouse embryos to VPA in whole embryo culture had marked embryotoxic effects, whereas toxic effects were less pronounced in more developmentally advanced (E9) embryos. Only 33% of embryos exposed to VPA from E9 to E10.5 achieved PNP closure (control=90%). Short-term (8h) VPA treatment diminished supra-cellular F-actin cables which normally run along the lateral neural folds, and prevented caudal PNP narrowing normally characteristic of Closure 5 formation. Laser ablation of Closure 5 caused rapid neuropore widening. Equivalent ablations of the caudal PNP in VPA treated embryos resulted in significantly less widening, suggesting VPA prevents formation of Closure 5 as a biomechanically active structure. Thus, VPA exposure prevents morphological and biomechanical conversion of the caudal extreme of the PNP during late spinal closure. Closure 5 facilitates neural fold apposition when completion of closure is imminent, such that its disruption in VPA-exposed embryos may lead to distal spina bifida.
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Affiliation(s)
- Amy Hughes
- Developmental Biology of Birth Defects, UCL GOS Institute of Child Health, London, UK
| | - Nicholas D E Greene
- Developmental Biology of Birth Defects, UCL GOS Institute of Child Health, London, UK
| | - Andrew J Copp
- Developmental Biology of Birth Defects, UCL GOS Institute of Child Health, London, UK
| | - Gabriel L Galea
- Developmental Biology of Birth Defects, UCL GOS Institute of Child Health, London, UK.
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30
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Abstract
Clinical genetics is the application of advances in genetics and medicine to real human families. It involves diagnosis, care, and counseling concerning options available to affected individuals and their family members. Advances in medicine and genetics have led to dramatic changes in the scope and responsibilities of clinical genetics. This reflection on the last 50+ years of clinical genetics comes from personal experience, with an emphasis on the important contributions that clinical geneticists have made to the understanding of disease/disorder processes and mechanisms. The genetics clinic is a research laboratory where major advances in knowledge can and have been made.
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Affiliation(s)
- Judith G. Hall
- Department of Medical Genetics and Department of Pediatrics, University of British Columbia and BC Children's Hospital, Vancouver V6H 3N1, Canada
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de Bakker BS, Driessen S, Boukens BJD, van den Hoff MJB, Oostra RJ. Single-site neural tube closure in human embryos revisited. Clin Anat 2017; 30:988-999. [PMID: 28795440 DOI: 10.1002/ca.22977] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 08/06/2017] [Indexed: 12/16/2022]
Abstract
Since the multi-site closure theory was first proposed in 1991 as explanation for the preferential localizations of neural tube defects, the closure of the neural tube has been debated. Although the multi-site closure theory is much cited in clinical literature, single-site closure is most apparent in literature concerning embryology. Inspired by Victor Hamburgers (1900-2001) statement that "our real teacher has been and still is the embryo, who is, incidentally, the only teacher who is always right", we decided to critically review both theories of neural tube closure. To verify the theories of closure, we studied serial histological sections of 10 mouse embryos between 8.5 and 9.5 days of gestation and 18 human embryos of the Carnegie collection between Carnegie stage 9 (19-21 days) and 13 (28-32 days). Neural tube closure was histologically defined by the neuroepithelial remodeling of the two adjoining neural fold tips in the midline. We did not observe multiple fusion sites in neither mouse nor human embryos. A meta-analysis of case reports on neural tube defects showed that defects can occur at any level of the neural axis. Our data indicate that the human neural tube fuses at a single site and, therefore, we propose to reinstate the single-site closure theory for neural tube closure. We showed that neural tube defects are not restricted to a specific location, thereby refuting the reasoning underlying the multi-site closure theory. Clin. Anat. 30:988-999, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Bernadette S de Bakker
- Department of Medical Biology, Section Clinical Anatomy and Embryology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Stan Driessen
- Department of Medical Biology, Section Clinical Anatomy and Embryology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Bastiaan J D Boukens
- Department of Medical Biology, Section Clinical Anatomy and Embryology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Maurice J B van den Hoff
- Department of Medical Biology, Section Clinical Anatomy and Embryology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Roelof-Jan Oostra
- Department of Medical Biology, Section Clinical Anatomy and Embryology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Galea GL, Cho YJ, Galea G, Molè MA, Rolo A, Savery D, Moulding D, Culshaw LH, Nikolopoulou E, Greene NDE, Copp AJ. Biomechanical coupling facilitates spinal neural tube closure in mouse embryos. Proc Natl Acad Sci U S A 2017; 114:E5177-E5186. [PMID: 28607062 PMCID: PMC5495245 DOI: 10.1073/pnas.1700934114] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Neural tube (NT) formation in the spinal region of the mammalian embryo involves a wave of "zippering" that passes down the elongating spinal axis, uniting the neural fold tips in the dorsal midline. Failure of this closure process leads to open spina bifida, a common cause of severe neurologic disability in humans. Here, we combined a tissue-level strain-mapping workflow with laser ablation of live-imaged mouse embryos to investigate the biomechanics of mammalian spinal closure. Ablation of the zippering point at the embryonic dorsal midline causes far-reaching, rapid separation of the elevating neural folds. Strain analysis revealed tissue expansion around the zippering point after ablation, but predominant tissue constriction in the caudal and ventral neural plate zone. This zone is biomechanically coupled to the zippering point by a supracellular F-actin network, which includes an actin cable running along the neural fold tips. Pharmacologic inhibition of F-actin or laser ablation of the cable causes neural fold separation. At the most advanced somite stages, when completion of spinal closure is imminent, the cable forms a continuous ring around the neuropore, and simultaneously, a new caudal-to-rostral zippering point arises. Laser ablation of this new closure initiation point causes neural fold separation, demonstrating its biomechanical activity. Failure of spinal closure in pre-spina bifida Zic2Ku mutant embryos is associated with altered tissue biomechanics, as indicated by greater neuropore widening after ablation. Thus, this study identifies biomechanical coupling of the entire region of active spinal neurulation in the mouse embryo as a prerequisite for successful NT closure.
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Affiliation(s)
- Gabriel L Galea
- Newlife Birth Defects Research Centre, UCL Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, United Kingdom;
| | - Young-June Cho
- Newlife Birth Defects Research Centre, UCL Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, United Kingdom
| | - Gauden Galea
- Division of Noncommunicable Diseases and Promoting Health Through the Life Course, World Health Organization Regional Office for Europe, Copenhagen DK-2100, Denmark
| | - Matteo A Molè
- Newlife Birth Defects Research Centre, UCL Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, United Kingdom
| | - Ana Rolo
- Newlife Birth Defects Research Centre, UCL Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, United Kingdom
| | - Dawn Savery
- Newlife Birth Defects Research Centre, UCL Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, United Kingdom
| | - Dale Moulding
- Newlife Birth Defects Research Centre, UCL Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, United Kingdom
| | - Lucy H Culshaw
- Newlife Birth Defects Research Centre, UCL Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, United Kingdom
| | - Evanthia Nikolopoulou
- Newlife Birth Defects Research Centre, UCL Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, United Kingdom
| | - Nicholas D E Greene
- Newlife Birth Defects Research Centre, UCL Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, United Kingdom
| | - Andrew J Copp
- Newlife Birth Defects Research Centre, UCL Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, United Kingdom
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Alghamdi MA, Ziermann JM, Gregg L, Diogo R. A detailed musculoskeletal study of a fetus with anencephaly and spina bifida (craniorachischisis), and comparison with other cases of human congenital malformations. J Anat 2017; 230:842-858. [PMID: 28266009 PMCID: PMC5442139 DOI: 10.1111/joa.12601] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2017] [Indexed: 11/28/2022] Open
Abstract
Few descriptions of the musculoskeletal system of humans with anencephaly or spina bifida exist in the literature. Even less is published about individuals in which both phenomena occur together, i.e. about craniorachischisis. Here we provide a detailed report on the musculoskeletal structures of a fetus with craniorachischisis, as well as comparisons with the few descriptions for anencephaly and with musculoskeletal anomalies found in other congenital malformations. We focused in particular on the comparison with trisomies 13, 18, and 21 because neural tube defects have been associated with such chromosomal defects. Our results showed that many of the defects found in the fetus with craniorachischisis are similar not only to anomalies previously described in the available works on musculoskeletal phenotypes seen in fetuses with anencephaly and spina bifida, but also to a wide range of other different conditions/syndromes including trisomies 13, 18 and 21, and cyclopia. The fact that similar anomalies are seen commonly not only in a wide range of different syndromes, but also as variants of the normal human population and as the 'normal' phenotype of other animals, supports Pere Alberch's unfortunately named idea of a 'logic of monsters'. That is, it supports the idea that development is so constrained that both in 'normal' and abnormal development one sees certain outcomes being produced again and again because ontogenetic constraints only allow a few possible outcomes, thus also leading to cases where the anatomical defects of some organisms are similar to the 'normal' phenotype of other organisms. In fact, this applies not only to specific anomalies but also to general patterns, such as the fact that in pathological conditions affecting different regions of the body, one consistently sees more defects on the upper limbs than on the lower limbs. Such general patterns are, again, seen in the fetus examined for this study, which had 29 muscle anomalies on the right upper limb and 22 muscle anomalies on the left upper limb, vs. seven muscle anomalies on the right lower limb and two on the left lower limb. It is therefore hoped that this work, which is part of our effort to describe and compile information on human musculoskeletal defects found in a wide range of conditions, will contribute not only to a better understanding of craniorachischisis in particular and of human congenital malformations in general, but also to broader discussions on the fields of comparative anatomy, and developmental and evolutionary biology.
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Affiliation(s)
- Malak A. Alghamdi
- Department of AnatomyHoward University College of MedicineWashingtonDCUSA
| | - Janine M. Ziermann
- Department of AnatomyHoward University College of MedicineWashingtonDCUSA
| | - Lydia Gregg
- Division of Interventional NeuroradiologyDepartment of Art as Applied to MedicineJohns Hopkins University School of MedicineBaltimoreMDUSA
| | - Rui Diogo
- Department of AnatomyHoward University College of MedicineWashingtonDCUSA
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Rethmann C, Scheer I, Meuli M, Mazzone L, Moehrlen U, Kellenberger CJ. Evolution of posterior fossa and brain morphology after in utero repair of open neural tube defects assessed by MRI. Eur Radiol 2017; 27:4571-4580. [DOI: 10.1007/s00330-017-4807-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2016] [Revised: 02/23/2017] [Accepted: 03/13/2017] [Indexed: 11/29/2022]
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Wang LL, Bierbrauer KS. Congenital and Hereditary Diseases of the Spinal Cord. Semin Ultrasound CT MR 2017; 38:105-125. [PMID: 28347415 DOI: 10.1053/j.sult.2016.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Congenital anomalies of the spinal cord can pose a diagnostic dilemma to the radiologist. Several classification systems of these anomalies exist. Antenatal ultrasound and fetal magnetic resonance imaging is playing an increasingly important role in the early diagnosis and management of patients. Understanding the underlying anatomy as well as embryology of these disorders can be valuable in correctly identifying the type of spinal cord dysraphic defect. Hereditary spinal cord diseases are rare but can be devastating. When the onset is in adulthood, delay in diagnosis is common. Although the spine findings are nonspecific, some imaging features combined with brain imaging findings can be distinctive. Sometimes, the radiologist may be the first to raise the possibility of these disorders.
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Affiliation(s)
- Lily L Wang
- Department of Radiology, University of Cincinnati Medical Center, Cincinnati, OH; Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH.
| | - Karin S Bierbrauer
- Division of Pediatric Neurosurgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
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Abstract
OBJECTIVE Spinal lipomas are generally thought to occur as a result of failed primary neurulation. However, some clinical features cannot be explained by this theory. The authors propose a novel classification of spinal lipomas based on embryonic changes seen during primary and secondary neurulation. METHODS A total of 677 patients with occult spinal dysraphism underwent 699 surgeries between August 2002 and May 2015 at the National Center for Child Health and Development and Tokyo Metropolitan Children's Medical Center. This group of patients had 378 spinal lipomas, including 119 conus spinal lipomas, 27 lipomyelomeningoceles, and 232 filum lipomas, which the authors classified into 4 types based on neural tube formation during embryonic development. Type 1 is defined as pure primary neurulation failure; Type 2 ranges from primary to secondary neurulation failure; Type 3 consists of secondary neurulation failure (early phase); and Type 4 is defined as secondary neurulation failure (late phase). The authors also review embryogenesis in secondary neurulation and analyze the clinical utility of the new classification. RESULTS There were 55 Type 1 spinal lipomas, 29 Type 2, 62 Type 3, and 232 Type 4. All filum lipomas fell into the Type 4 spinal lipoma category. Association with anorectal and/or sacral anomalies was seen in none of the Type 1 cases, 15 (52%) of Type 2, 35 (56%) of Type 3, and 31 (13%) of Type 4. Urogenital anomalies were observed in none of the Type 1 or Type 2 cases, 1 (2%) of Type 3, and 28 (12%) of Type 4. Anomaly syndromes were present in none of the Type 1 cases, 6 (21%) of Type 2, 3 (5%) of Type 3, and 16 (7%) of Type 4. Associated anomalies or anomaly syndromes were clearly observed only for Type 2-4 spinal lipomas encompassing failed secondary neurulation. Radical resection was feasible for Type 1 spinal lipomas. CONCLUSIONS Secondary neurulation of the spinal cord gives rise to the conus medullaris and filum terminale, which are often involved in spinal lipomas. Formation of spinal lipomas seems to be a continuous process overlapping primary and secondary neurulation in some cases. Association with other anomalies was higher in Type 2-4 spinal lipomas, which included failed secondary neurulation, than in Type 1 lipomas, with failed primary neurulation. On the other hand, radical resection was indicated for Type 1, but not for Type 2, spinal lipomas. The new classification of spinal lipomas based on embryonic stage has the potential for clinical use and agrees well with both clinical and surgical findings. The classification proposed here is still preliminary. Further studies and verification are necessary to establish its clinical utility.
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Affiliation(s)
- Nobuhito Morota
- Division of Neurosurgery, Tokyo Metropolitan Children's Medical Center
| | - Satoshi Ihara
- Division of Neurosurgery, Tokyo Metropolitan Children's Medical Center
| | - Hideki Ogiwara
- Division of Neurosurgery, National Center for Child Health and Development, Tokyo, Japan
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Multiple neural tube defects: a rare combination of limited dorsal myeloschisis, diplomyelia with dorsal bony spur, sacral meningocoele, syringohydromyelia, and tethered cord. Childs Nerv Syst 2017; 33:699-701. [PMID: 27942921 DOI: 10.1007/s00381-016-3310-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 11/29/2016] [Indexed: 10/20/2022]
Abstract
Multiple neural tube defects are relatively rare. They account for less than 1% reported neural tube defects. Cases of limited dorsal myeloschisis (LDM) and diplomyelia (two cords in single sac without intervening bony or fibrous septae) with dorsal bony spur are also a rare event. Here, the authors report a rare case of neonate with thoracic LDM, diplomyelia with dorsal bony spur, sacral meningocoele with syringohydromyelia, and low-lying tethered cord. The child also had a ventricular septal defect (VSD) and bilateral rocker bottom feet. Various environmental factors and genetic mutations in transmembrane proteins have been studied in animal models explaining the origin of neural tube defects. To the best of author's knowledge, this is the first case of varied multiple neural tube defects with diplomyelia reported in world literature.
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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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Intracranial Neurenteric Cyst with an Enhanced Mural Nodule and Melanin Pigmentation: Radiologic-Pathologic Correlation. World Neurosurg 2017; 97:758.e11-758.e19. [DOI: 10.1016/j.wneu.2016.09.126] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 09/26/2016] [Accepted: 09/29/2016] [Indexed: 11/19/2022]
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Cacciola F, Lippa L. Segmental spinal dysgenesis associated with occult dysraphism: Considerations on management strategies. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2017; 8:144-148. [PMID: 28694599 PMCID: PMC5490349 DOI: 10.4103/jcvjs.jcvjs_35_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Segmental spinal dysgenesis is a rare and challenging entity especially when associated with occult dysraphism. Experience with a female patient followed during a period of 10 years spanning from 5 to 15 years of age is reported. During that period the girl underwent three spinal operations consisting in one decompression and spinal cord untethering, one posterior instrumented fusion and a spinal cord re-untethering. Clinical and radiological features are discussed and considerations on optimization of management strategies are made.
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Affiliation(s)
- Francesco Cacciola
- Department of Neurosurgery, Università degli Studi di Siena, Policlinico "Santa Maria alle Scotte", Siena, Italy
| | - Laura Lippa
- Department of Neurosurgery, Università degli Studi di Siena, Policlinico "Santa Maria alle Scotte", Siena, Italy
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Ingstrup KG, Wu CS, Olsen J, Nohr EA, Bech BH, Li J. Maternal Antenatal Bereavement and Neural Tube Defect in Live-Born Offspring: A Cohort Study. PLoS One 2016; 11:e0163355. [PMID: 27685943 PMCID: PMC5042438 DOI: 10.1371/journal.pone.0163355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 09/07/2016] [Indexed: 11/27/2022] Open
Abstract
Background Maternal emotional stress during pregnancy has previously been associated with congenital neural malformations, but most studies are based on data collected retrospectively. The objective of our study was to investigate associations between antenatal maternal bereavement due to death of a close relative and neural tube defects (NTDs) in the offspring. Methods We performed a register-based cohort study including all live-born children (N = 1,734,190) from 1978–2008. Exposure was bereavement due to loss of a close relative from one year before conception to the end of the first trimester of pregnancy. The outcome was NTDs in the offspring according to the International Classification of Disease. We used multivariate logistic regression to estimate prevalence odds ratios (ORs). Results A total of 2% children were born to mothers who lost a close relative prenatally. During 30 years of follow-up, 1,115 children were diagnosed with any NTDs: spina bifida (n = 889), anencephaly (n = 85) and encephalocele (n = 164). And 23 children were diagnosed with two types of NTDs. Overall, when comparing bereaved mothers to non-bereaved mothers, no significant increased prevalence of NTDs in the offspring was seen (OR = 0.84; 95% confidence interval: 0.52–1.33). Conclusion Overall maternal bereavement in the antenatal period was not related to NTDs in liveborn offspring.
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Affiliation(s)
- Katja Glejsted Ingstrup
- Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus C, Denmark
- * E-mail:
| | - Chun Sen Wu
- Research Unit for Obstetrics and Gynecology, Institute of Clinical Research, University of Southern Denmark, Odense C, Denmark
| | - Jørn Olsen
- Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus C, Denmark
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA, United States of America
| | - Ellen Aagaard Nohr
- Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus C, Denmark
- Research Unit for Obstetrics and Gynecology, Institute of Clinical Research, University of Southern Denmark, Odense C, Denmark
| | - Bodil Hammer Bech
- Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus C, Denmark
| | - Jiong Li
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark
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Irwin RE, Pentieva K, Cassidy T, Lees-Murdock DJ, McLaughlin M, Prasad G, McNulty H, Walsh CP. The interplay between DNA methylation, folate and neurocognitive development. Epigenomics 2016; 8:863-79. [PMID: 27319574 DOI: 10.2217/epi-2016-0003] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
DNA methylation provides an attractive possible means for propagating the effects of environmental inputs during fetal life and impacting subsequent adult mental health, which is leading to increasing collaboration between molecular biologists, nutritionists and psychiatrists. An area of interest is the potential role of folate, not just in neural tube closure in early pregnancy, but in later major neurodevelopmental events, with consequences for later sociocognitive maturation. Here, we set the scene for recent discoveries by reviewing the major events of neural development during fetal life, with an emphasis on tissues and structures where dynamic methylation changes are known to occur. Following this, we give an indication of some of the major classes of genes targeted by methylation and important for neurological and behavioral development. Finally, we highlight some cognitive disorders where methylation changes are implicated as playing an important role.
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Affiliation(s)
- Rachelle E Irwin
- EpiFASSTT study, Biomedical Sciences, Ulster University, Coleraine, UK
| | - Kristina Pentieva
- EpiFASSTT study, Biomedical Sciences, Ulster University, Coleraine, UK
| | - Tony Cassidy
- EpiFASSTT study, Psychology, Ulster University, Coleraine, UK
| | | | | | - Girijesh Prasad
- EpiFASSTT study, Computer Sciences Research Institutes, Ulster University, Londonderry, UK
| | - Helene McNulty
- EpiFASSTT study, Biomedical Sciences, Ulster University, Coleraine, UK
| | - Colum P Walsh
- EpiFASSTT study, Biomedical Sciences, Ulster University, Coleraine, UK
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Nagata Y, Takeuchi K, Kato M, Chu J, Wakabayashi T. Lateral temporal encephaloceles: case-based review. Childs Nerv Syst 2016; 32:1025-31. [PMID: 27041373 DOI: 10.1007/s00381-016-3076-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Accepted: 03/28/2016] [Indexed: 11/25/2022]
Abstract
PURPOSE Lateral temporal encephalocele is an extremely rare clinical condition, with only 18 cases presented in the literature to date. No review articles have examined lateral temporal encephalocele in depth. We therefore reviewed past cases of lateral encephalocele to clarify the clinical characteristics of this extremely rare deformity. We also present a case of lateral encephalocele with arachnoid cyst which has never been reported in past reports. METHODS We identified 8 reports describing 18 cases of lateral temporal encephalocele. We therefore reviewed 19 cases of lateral temporal encephalocele, including our own experience, and discussed the clinical characteristics of this pathology. RESULTS All the cases with lateral temporal encephalocele were detected at birth except for an occult case. The majority occurred at the pterion, and occurrence at the asterion appears much rarer. Due to the preference for the pterion, the ipsilateral orbital wall was also distorted in some cases. Lateral temporal encephalocele seems to have fewer associated malformations: only 3 cases of lateral temporal encephalocele had associated malformations, including our case which was associated with intracranial arachnoid cyst. The only case of lateral temporal encephalocele to have shown hydrocephalus was our own case. Patients with this deformity have relatively good prognoses: only 3 of the 19 cases showed delayed psychomotor development during follow-up. CONCLUSIONS Provision of adequate treatment is likely to achieve a good prognosis in patients with lateral temporal encephalocele, so we should keep in mind this deformity when encountering pediatric patients with mass lesions on the temporal cranium.
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Affiliation(s)
- Yuichi Nagata
- Department of Neurosurgery, Nagoya University, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan.
| | - Kazuhito Takeuchi
- Department of Neurosurgery, Nagoya University, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Mihoko Kato
- Department of Neurosurgery, Aichi Children's Health and Medical Center, Obu City, Aichi, Japan
| | - Jonsu Chu
- Department of Neurosurgery, Nagoya University, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Toshihiko Wakabayashi
- Department of Neurosurgery, Nagoya University, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
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Sharma S, Ojha BK, Chandra A, Singh SK, Srivastava C. Parietal and occipital encephalocele in same child: A rarest variety of double encephalocele. Eur J Paediatr Neurol 2016; 20:493-6. [PMID: 26876766 DOI: 10.1016/j.ejpn.2015.12.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Revised: 11/14/2015] [Accepted: 12/06/2015] [Indexed: 10/22/2022]
Abstract
An encephalocele is a protrusion of the brain and/or meninges through a defect in the skull. Based on the location of the skull defect they are classified into sincipital, basal, occipital or parietal varieties. Occurrence of more than one Encephalocele in a patient is very rare and very few cases of double encephalocele are reported. We report an interesting case where a parietal and an occipital encephalocele were present together. The patient was a 2 months boy who was brought to us with complaints of two swelling on the scalp since birth. Neuroimaging studies confirmed it to be a case of double encephalocele. The rarity of the findings prompted us to report this case. The presentation and management of the case along with and review of the relevant literature is presented.
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Affiliation(s)
- Somnath Sharma
- Department of Neurosurgery, King George's Medical University, Chowk, Lucknow, U.P. 226003, India.
| | - Bal Krishan Ojha
- Department of Neurosurgery, King George's Medical University, Chowk, Lucknow, U.P. 226003, India.
| | - Anil Chandra
- Department of Neurosurgery, King George's Medical University, Chowk, Lucknow, U.P. 226003, India.
| | - Sunil Kumar Singh
- Department of Neurosurgery, King George's Medical University, Chowk, Lucknow, U.P. 226003, India.
| | - Chhitij Srivastava
- Department of Neurosurgery, King George's Medical University, Chowk, Lucknow, U.P. 226003, India.
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Price EM, Peñaherrera MS, Portales-Casamar E, Pavlidis P, Van Allen MI, McFadden DE, Robinson WP. Profiling placental and fetal DNA methylation in human neural tube defects. Epigenetics Chromatin 2016; 9:6. [PMID: 26889207 PMCID: PMC4756451 DOI: 10.1186/s13072-016-0054-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Accepted: 01/25/2016] [Indexed: 12/16/2022] Open
Abstract
Background The incidence of neural tube defects (NTDs) declined by about 40 % in Canada with the introduction of a national folic acid (FA) fortification program. Despite the fact that few Canadians currently exhibit folate deficiency, NTDs are still the second most common congenital abnormality. FA fortification may have aided in reducing the incidence of NTDs by overcoming abnormal one carbon metabolism cycling, the process which provides one carbon units for methylation of DNA. We considered that NTDs persisting in a folate-replete population may also occur in the context of FA-independent compromised one carbon metabolism, and that this might manifest as abnormal DNA methylation (DNAm). Second trimester human placental chorionic villi, kidney, spinal cord, brain, and muscle were collected from 19 control, 22 spina bifida, and 15 anencephalic fetuses in British Columbia, Canada. DNA was extracted, assessed for methylenetetrahydrofolate reductase (MTHFR) genotype and for genome-wide DNAm using repetitive elements, in addition to the Illumina Infinium HumanMethylation450 (450k) array. Results No difference in repetitive element DNAm was noted between NTD status groups. Using a false discovery rate <0.05 and average group difference in DNAm ≥0.05, differentially methylated array sites were identified only in (1) the comparison of anencephaly to controls in chorionic villi (n = 4 sites) and (2) the comparison of spina bifida to controls in kidney (n = 3342 sites). Conclusions We suggest that the distinctive DNAm of spina bifida kidneys may be consequent to the neural tube defect or reflective of a common etiology for abnormal neural tube and renal development. Though there were some small shifts in DNAm in the other tested tissues, our data do not support the long-standing hypothesis of generalized altered genome-wide DNAm in NTDs. This finding may be related to the fact that most Canadians are not folate deficient, but it importantly opens the field to the investigation of other epigenetic and non-epigenetic mechanisms in the etiology of NTDs. Electronic supplementary material The online version of this article (doi:10.1186/s13072-016-0054-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- E Magda Price
- Child and Family Research Institute, 950 W 28th Ave, Vancouver, BC V5Z 4H4 UK ; Dept of Medical Genetics, University of British Columbia, C201-4500 Oak St, Vancouver, BC V6H 3N1 UK ; Dept of Obstetrics and Gynaecology, University of British Columbia, C420-4500 Oak St, Vancouver, BC V6H 3N1 UK
| | - Maria S Peñaherrera
- Child and Family Research Institute, 950 W 28th Ave, Vancouver, BC V5Z 4H4 UK ; Dept of Medical Genetics, University of British Columbia, C201-4500 Oak St, Vancouver, BC V6H 3N1 UK
| | | | - Paul Pavlidis
- Centre for High-Throughput Biology, University of British Columbia, 2185 East Mall, Vancouver, V6T 1Z4 UK ; Dept of Psychiatry, University of British Columbia, 2255 Wesbrook Mall, Vancouver, BC V6T 2A1 UK
| | - Margot I Van Allen
- Dept of Medical Genetics, University of British Columbia, C201-4500 Oak St, Vancouver, BC V6H 3N1 UK
| | - Deborah E McFadden
- Dept of Medical Genetics, University of British Columbia, C201-4500 Oak St, Vancouver, BC V6H 3N1 UK ; Dept of Pathology and Laboratory Medicine, Rm G227-2211, Wesbrook Mall, Vancouver, BC V6T 2B5 UK
| | - Wendy P Robinson
- Child and Family Research Institute, 950 W 28th Ave, Vancouver, BC V5Z 4H4 UK ; Dept of Medical Genetics, University of British Columbia, C201-4500 Oak St, Vancouver, BC V6H 3N1 UK
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Kandasamy V, Subramanian M, Rajilarajendran H, Ramanujam S, Saktivel S, Sivaanandam R. A Study on The Incidence of Neural Tube Defects in A Tertiary Care Hospital Over A Period of Five Years. J Clin Diagn Res 2015; 9:QC01-4. [PMID: 26393168 PMCID: PMC4573000 DOI: 10.7860/jcdr/2015/14815.6190] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 06/17/2015] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Several congenital malformations affect developing fetuses, among which Neural tube defect (NTD) is most common. Folic acid supplementation brought decline in the incidence of NTDs. The present study aims at finding the incidence of NTDs in a tertiary care hospital and compares the results with the similar Indian studies published earlier. MATERIALS AND METHODS The study was done at Chettinad Hospital & Research Institute (CHRI), Kelambakkam. The total number of deliveries was recorded for a period of five years from 2009 to 2013. Fetuses which were still born with neural defect were collected and observed in detail externally for the sex, type of NTD and other associated anomalies. Indian studies published between 1987 and 2014 reporting the incidence of NTDs among the births occurred were retrieved from the Internet and their various observations were used for comparison. RESULTS The number of deliveries conducted between 2009 and 2013 at CHRI was 3220. Of these, babies born with NTDs were nine (5 males and 4 females). The incidence of fetuses with meroanencephaly, holoanencephaly, craniorachischisis, encephalocele and myelocele were 0.62, 0.62, 0.93, 0.31 and 0.31 per 1000 births respectively. Overall incidence of NTDs in the present study was 2.79/1000 births. Fetuses with NTDs also had the following anomalies - Club foot, cleft lip and palate and exomphalos. CONCLUSION Comparing the results with the previous studies it is clearly evident that the incidence of NTDs have significantly reduced from 11.42/1000 births to 2.79/1000 births. In most of the previous studies NTDs had a female preponderance whereas present study has a male preponderance.In older studies, spina bifida was the most common NTDs followed by anencephaly. But in the present study anencephaly was the common NTD than spina bifida. Incidence of NTDs has reduced due to various reasons like prenatal screening for fetal anomalies and folic acid supplementation.
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Affiliation(s)
- Vijayalakshmi Kandasamy
- Associate Professor, Department of Obstetrics & Gynaecology, Chettinad Hospital & Research Institute, Rajiv Gandhi Salai, Kelambakkam, Tamil Nadu, India
| | - Manickam Subramanian
- Assistant Professor, Department of Anatomy, Chettinad Hospital & Research Institute, Rajiv Gandhi Salai, Kelambakkam, Tamil Nadu, India
| | | | - Sailatha Ramanujam
- Associate Professor, Department of Obstetrics & Gynaecology, Chettinad Hospital & Research Institute, Rajiv Gandhi Salai, Kelambakkam, Tamil Nadu, India
| | - Sathiya Saktivel
- Assistant Professor, Department of Obstetrics & Gynaecology, Chettinad Hospital & Research Institute, Rajiv Gandhi Salai, Kelambakkam, Tamil Nadu, India
| | - Renuka Sivaanandam
- Assistant Professor, Department of Obstetrics & Gynaecology, Chettinad Hospital & Research Institute, Rajiv Gandhi Salai, Kelambakkam, Tamil Nadu, India
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Abstract
As the information obtained from previable fetal and stillbirth autopsies is used not only to explain the loss to the parents, but for future pregnancy planning, general pathologists need to be comfortable in dealing with these autopsies. The importance of an adequate fetal examination has been emphasized in a recent policy on the subject by the American Board of Pathology http://www.abpath.org/FetalAutopsyPolicy.pdf. This review paper covers the approach to the fetal and stillbirth autopsy. This first article covers the approach to the nonanomalous and anomalous autopsy. Hydrops fetalis will be covered in the second part of this series to be published subsequently.
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Canaz H, Ayçiçek E, Akçetin MA, Akdemir O, Alataş I, Özdemir B. Supra- and infra-torcular double occipital encephalocele. Neurocirugia (Astur) 2015; 26:43-7. [DOI: 10.1016/j.neucir.2014.09.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 09/04/2014] [Accepted: 09/07/2014] [Indexed: 10/24/2022]
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Multiple neural tube defect with split cord malformation - a rare entity. Indian J Pediatr 2014; 81:982-3. [PMID: 24633967 DOI: 10.1007/s12098-014-1383-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 02/17/2014] [Indexed: 10/25/2022]
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