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Dworschak GC, Reutter HM, Ludwig M. Currarino syndrome: a comprehensive genetic review of a rare congenital disorder. Orphanet J Rare Dis 2021; 16:167. [PMID: 33836786 PMCID: PMC8034116 DOI: 10.1186/s13023-021-01799-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 03/30/2021] [Indexed: 11/10/2022] Open
Abstract
Background The triad of a presacral mass, sacral agenesis and an anorectal anomaly constitutes the rare Currarino syndrome (CS), which is caused by dorsal–ventral patterning defects during embryonic development. The major causative CS gene is MNX1, encoding a homeobox protein. Main body In the majority of patients, CS occurs as an autosomal dominant trait; however, a female predominance observed, implies that CS may underlie an additional mode(s) of inheritance. Often, the diagnosis of CS is established solely by clinical findings, impacting a detailed analysis of the disease. Our combined data, evaluating more than 60 studies reporting patients with CS-associated mutations, revealed a slightly higher incidence rate in females with a female-to-male ratio of 1.39:1. Overall, MNX1 mutation analysis was successful in only 57.4% of all CS patients investigated, with no mutation detected in 7.7% of the familial and 68% of the sporadic patients. Our studies failed to detect the presence of an expressed MNX1 isoform that might explain at least some of these mutation-negative cases. Conclusion Aside from MNX1, other genes or regulatory regions may contribute to CS and we discuss several cytogenetic studies and whole-exome sequencing data that have implicated further loci/genes in its etiology. Supplementary Information The online version contains supplementary material available at 10.1186/s13023-021-01799-0.
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Affiliation(s)
- Gabriel C Dworschak
- Institute of Human Genetics, Medical Faculty, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany. .,Institute of Anatomy and Cell Biology, Medical Faculty, University of Bonn, 53115, Bonn, Germany. .,Department of Pediatrics, University Hospital Bonn, 53127, Bonn, Germany.
| | - Heiko M Reutter
- Institute of Human Genetics, Medical Faculty, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.,Department of Neonatology and Pediatric Intensive Care, University Hospital Bonn, 53127, Bonn, Germany
| | - Michael Ludwig
- Department of Clinical Chemistry and Clinical Pharmacology, University of Bonn, 53127, Bonn, Germany
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Ferreira C, Santos AP, Fonseca J. Currarino syndrome - a pre and post natal diagnosis correlation: case report and literature review. J Matern Fetal Neonatal Med 2021; 35:5224-5226. [PMID: 33618589 DOI: 10.1080/14767058.2021.1876021] [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: 10/22/2022]
Abstract
Currarino syndrome is an uncommon genetic disease, with autosomal dominant inheritance, that is characterized by sacrococcygeal bone defect, presacral mass and anorectal malformation. There are many cases only diagnosed in adulthood, but early diagnosis is important to avoid life-threatening complications and to reduce morbidity, but it requires a high suspicion index and a multidisciplinary approach. If it is an unknown disease in the family, prenatal diagnosis is rare but possible. We discuss a case report of Currarino syndrome with an early diagnosis through fetal magnetic resonance imaging, studied during pregnancy for prenatal diagnosis purposes which showed similar defects in fetus spine and in the asymptomatic mother. We emphasize the inclusion of this rare syndrome in the differential diagnosis of fetal neural tube defects and caudal regression syndrome. The recognition of at-risk subjects should lead to better planning of pregnancies and appropriate management of affected children at birth.
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Affiliation(s)
| | | | - Joaquim Fonseca
- Hospital Prof. Doutor Fernando Fonseca, EPE, Lisbon, Portugal
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Cearns MD, Hettige S, De Coppi P, Thompson DNP. Currarino syndrome: repair of the dysraphic anomalies and resection of the presacral mass in a combined neurosurgical and general surgical approach. J Neurosurg Pediatr 2018; 22:584-590. [PMID: 30095346 DOI: 10.3171/2018.5.peds17582] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 05/22/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVEIt is well established that Currarino syndrome (CS) may be associated with spinal dysraphism. Here, the authors report on 10 CS patients with dysraphic anomalies who had undergone a combined neurosurgical and general surgical approach to repair the dysraphic anomalies and resect the presacral mass in a single operation. They discuss the spectrum of spinal dysraphism that may coexist in CS in the context of its developmental etiology.METHODSChildren with a confirmed CS diagnosis who had undergone the combined operative approach were identified from a departmental database. Presenting features were recorded and preoperative imaging was analyzed to record features of the presacral mass and the dysraphic anomalies. The histopathological nature of the resected presacral mass and the outcomes postoperatively and at the last follow-up were reviewed.RESULTSBetween 2008 and 2015, 10 patients presented with CS, 9 with constipation. Median age at the time of surgery was 1.3 years. Six of the 10 patients had anorectal malformation consisting of anal stenosis, rectal stenosis, or imperforate anus. Spinal anomalies included anterior meningocele (5 cases), low-lying conus (8), terminal syrinx (4), fatty filum (5), caudal lipoma (3), and intraspinal cyst (1). In all cases, the lumbosacral spinal canal was accessed via a midline approach with laminoplasty, allowing spinal cord untethering and repair of the dysraphic anomalies. Following dural closure, the incision was extended inferiorly to incorporate a posterior sagittal approach to resect the presacral mass. The histopathological nature of the mass was mature teratoma (8 cases), complex hamartomatous malformation (1), or neurenteric cyst (1). There were no new instances of neurological deterioration, with most instances of persisting morbidity related to constipation (6 cases) or neurogenic bladder dysfunction (8). There were no infective complications, no instances of cerebrospinal fluid fistula, no recurrences of the presacral mass, and no cases of retethering of the spinal cord.CONCLUSIONSAlthough not part of the original triad, spinal dysraphic anomalies are common in CS and in keeping with a disorder of secondary neurulation. Lumbosacral MRI is an essential investigation when CS is suspected. Children are at risk of sphincter impairment due to the anorectal malformation; however, both spinal cord tethering and compression from the presacral mass may further compromise long-term continence. A combined operative approach to repair the dysraphic anomalies and resect the presacral mass is described with good postoperative and long-term outcomes.
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Affiliation(s)
| | | | - Paolo De Coppi
- 2Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital, London, United Kingdom
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Little TA, Compson KE, Hall K, Murdoch MJ, Neas KR, Kenwright D, Stringer MD. Currarino syndrome with two synchronous presacral teratomas. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2018. [DOI: 10.1016/j.epsc.2018.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Serratrice N, Fievet L, Albader F, Scavarda D, Dufour H, Fuentes S. Multiple neurosurgical treatments for different members of the same family with Currarino syndrome. Neurochirurgie 2018; 64:211-215. [PMID: 29731315 DOI: 10.1016/j.neuchi.2018.01.009] [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] [Received: 09/26/2017] [Revised: 12/02/2017] [Accepted: 01/27/2018] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Currarino's syndrome (CS) is an autosomal dominant disorder of embryonic development causing a rare malformating syndrome characterized by a triad of an anorectal malformations, presacral mass (most commonly an anterior sacral meningocele) and sacral bony defects. Mutations of the HLXB9 gene have been identified in most CS cases, but a precise genotype-phenotype correlation has not been described so far. Family screening is obligatory. The diagnosis is usually made during childhood and rarely in adulthood. In this context, imaging, and especially MRI plays a major role in the diagnosis of this syndrome. Surgical management is provided by pediatric surgeons or neurosurgeons. FAMILIAL CASE REPORT Here, we present a family case report with CS requiring different neurosurgical management. The son, a 3-year-old boy, developed a tethered spinal cord syndrome associated to a lipoma of the filum terminale, a sacro-coccygeal teratoma and an anal adhesion. A combined surgical approach permitted a good evolution on the urinary and digestive functions despite a persistent fecal incontinence. The 2-year-old daughter presented with a cyst of the thyreoglossal tract infected and fistulized to the skin. She was also followed for a very small lipoma of the filum terminale that required a neurosurgical approach. The father, 44-year-old, manifested functional digestive and urinary disorders caused by a giant anterior sacral meningocele. The ligation of the neck of the cyst and aspiration of the liquid inside in full through a posterior partial approach permit a complete collapse of the cyst with an instantly satisfactory clinical outcome. CONCLUSION In these cases, cooperation between pediatric surgeons and neurosurgeons was crucial. The follow-up of these patients should be done in a spina bifida clinic. A geneticist evaluation must be offered to the patient in the case of a CS as well as a clinical evaluation of the relatives (parents, siblings).
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Affiliation(s)
- N Serratrice
- Department of neurosurgery, La Timone hospital, Assistance publique-Hôpitaux de Marseille, 13005 Marseille, France.
| | - L Fievet
- Department of pediatric surgery, La Timone hospital, Assistance publique-Hôpitaux de Marseille, 13005 Marseille, France.
| | - F Albader
- Department of neurosurgery, La Timone hospital, Assistance publique-Hôpitaux de Marseille, 13005 Marseille, France.
| | - D Scavarda
- Department of pediatric neurosurgery, La Timone hospital, Assistance publique-Hôpitaux de Marseille, 13005 Marseille, France.
| | - H Dufour
- Department of neurosurgery, La Timone hospital, Assistance publique-Hôpitaux de Marseille, 13005 Marseille, France.
| | - S Fuentes
- Department of neurosurgery, La Timone hospital, Assistance publique-Hôpitaux de Marseille, 13005 Marseille, France.
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AbouZeid AA, Mohammad SA, Abolfotoh M, Radwan AB, Ismail MME, Hassan TA. The Currarino triad: What pediatric surgeons need to know. J Pediatr Surg 2017; 52:1260-1268. [PMID: 28065719 DOI: 10.1016/j.jpedsurg.2016.12.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 11/14/2016] [Accepted: 12/20/2016] [Indexed: 11/20/2022]
Abstract
PURPOSE We report our experience in managing a group of patients with Currarino syndrome, highlighting diagnostic challenges, surgical techniques, in addition to a review of current neurosurgical options. PATIENTS AND METHODS The study included patients with Currarino syndrome who presented to our pediatric surgery department during the period 2010 through 2016. The 'sacral scimitar' in plain X-ray provided the clue for the diagnosis; while MRI examination was essential to define the nature of the presacral mass and associated spinal anomalies. RESULTS The study included 17 patients (13 girls and 4 boys). Their age at presentation ranged from 7months to 10years. We used posterior sagittal approach to correct anorectal anomalies, and excise presacral cysts that were subjected to histopathological examination. Two cases presented with a pelvic abscess (infected presacral dermoid cyst), which were initially drained followed by excision. The presacral mass consisted of either lipomyelocele (6), lipomyelomeningocele (3), or a developmental (dermoid) cyst (8). Tethering of the spinal cord was a common association (70%) CONCLUSION: Apart from diagnostic challenges, the management of Currarino syndrome is similar to the usual management of ARM regarding the surgical approach and probably the prognosis that mainly depends on degree of associated sacral dysplasia. LEVEL OF EVIDENCE This is a case series with no comparison group (level IV).
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Lee JK, Towbin AJ. Currarino Syndrome and the Effect of a Large Anterior Sacral Meningocele on Distal Colostogram in an Anorectal Malformation. J Radiol Case Rep 2016; 10:16-21. [PMID: 27761181 DOI: 10.3941/jrcr.v10i6.2068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Currarino syndrome is a congenital disorder, consisting of a triad of anomalies including an anorectal malformation, sacral anomaly, and a presacral mass. Anterior sacral meningoceles are the most common presacral mass. A young child presented to our institution with an unrepaired anorectal malformation and a large anterior sacral meningocele. We describe how the anterior meningocele affected the imaging work-up.
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Affiliation(s)
- Jason K Lee
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Alexander J Towbin
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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Dirix M, van Becelaere T, Berkenbosch L, van Baren R, Wijnen RM, Wijnen MH, van der Zee DC, Heij HA, Derikx JPM, van Heurn LWE. Malignant transformation in sacrococcygeal teratoma and in presacral teratoma associated with Currarino syndrome: a comparative study. J Pediatr Surg 2015; 50:462-4. [PMID: 25746708 DOI: 10.1016/j.jpedsurg.2014.07.014] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 07/14/2014] [Accepted: 07/25/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND/PURPOSE The risk of malignant transformation of sacrococcygeal teratoma (SCT) and of presacral teratoma in Currarino syndrome (CS) may differ despite the similar position and appearance. METHODS Malignant transformation and teratoma recurrence were assessed in a national retrospective comparative analysis of 205 SCT and 16 CS patients treated in one of the six pediatric surgical centers in the Netherlands between January 1981 and December 2010. RESULTS The malignancy free survival of patients with SCT was lower than for patients with a presacral teratoma associated with CS (80% and 58% after one and two years in SCT versus 100% after two years in CS, p=0.017) CONCLUSIONS: In SCT, malignancy and recurrence risk are high. Therefore, early and complete resection is mandatory. Our data show that the risk of malignant transformation of a presacral teratoma in CS is small.
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Affiliation(s)
- Marc Dirix
- Department of Pediatric Surgery, Maastricht University Medical Centre, The Netherlands
| | - Tine van Becelaere
- Department of Pediatric Surgery, Maastricht University Medical Centre, The Netherlands
| | - Lizanne Berkenbosch
- Department of Pediatric Surgery, Maastricht University Medical Centre, The Netherlands
| | - Robertine van Baren
- Department of Pediatric Surgery, University Medical Centre Groningen, The Netherlands
| | - Rene M Wijnen
- Department of Pediatric Surgery, Erasmus Medical Centre-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Marc H Wijnen
- Department of Pediatric Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - David C van der Zee
- Department of Pediatric Surgery, Wilhelmina Children's Hospital, University Medical Centre, Utrecht, The Netherlands
| | - Hugo A Heij
- Pediatric Surgical Centre of Amsterdam (Emma Children's Hospital AMC/VU University Medical Centre), The Netherlands
| | - Joep P M Derikx
- Department of Pediatric Surgery, Maastricht University Medical Centre, The Netherlands
| | - L W Ernest van Heurn
- Department of Pediatric Surgery, Maastricht University Medical Centre, The Netherlands.
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Akay S, Battal B, Karaman B, Bozkurt Y. Complete currarino syndrome recognized in adulthood. J Clin Imaging Sci 2015; 5:10. [PMID: 25861544 PMCID: PMC4374199 DOI: 10.4103/2156-7514.152339] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 01/19/2015] [Indexed: 11/12/2022] Open
Abstract
Currarino syndrome is a hereditary pathology that is characterized by sacrococcygeal bone defect, presacral mass, and anorectal malformation. Sacrococcygeal bone defect is almost always a part of the syndrome. The complete form of this entity displays all three abnormalities and is very uncommon. In this report, we present the magnetic resonance imaging findings of a case with complete form of Currarino syndrome recognized in adulthood.
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Affiliation(s)
- Sinan Akay
- Department of Radiology, Sirnak Military Hospital, Sirnak, Turkey
| | - Bilal Battal
- Department of Radiology, Gulhane Military Medical School, Ankara, Turkey
| | - Bulent Karaman
- Department of Radiology, Gulhane Military Medical School, Ankara, Turkey
| | - Yalcin Bozkurt
- Department of Radiology, Golcuk Military Hospital, Kocaeli, Turkey
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Patel RV, De Coppi P, Kiely E, Pierro A. Currarino's syndrome in twins presenting as neonatal intestinal obstruction--identical presentation in non-identical twins. BMJ Case Rep 2014; 2014:bcr-2014-204276. [PMID: 25199187 PMCID: PMC4158244 DOI: 10.1136/bcr-2014-204276] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
We report a case of non-identical twins who presented with identical neonatal intestinal obstruction with features of anorectal stenosis, presacral mass and sacral anomaly consistent with Currarino's syndrome or triad. Plain sacral radiograph, contrast enema and MRI were diagnostic. Initial management involved a defunctioning colostomy followed by a posterior sagittal anorectoplasty with excision of the teratoma ± anterior sacral meningocele and finally closure of colostomy in a staged multidisciplinary approach. The twins' father is also affected with features of Currarino's syndrome but was diagnosed during family screening. Currarino's syndrome presenting with identical neonatal low intestinal obstruction in a non-identical set of twins is rare and interesting. Antenatal diagnosis of Currarino's syndrome is difficult and may prove to be a challenge even in the postnatal period. Sacral spine radiograph, contrast enema and MRI are diagnostic. Management requires high index of suspicion, low threshold for MRI and multidisciplinary staged approach.
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Affiliation(s)
- Ramnik V Patel
- Department of Paediatric Urology, University College London Hospitals NHS Foundation Trust, London, UK
- Department of Paediatric Urology, Great Ormond Street Children Hospital NHS Trust, London, UK
| | - Paolo De Coppi
- Neonatal and Paediatric Surgery, ICH and Great Ormond Street Hospital, London, UK
| | - Edward Kiely
- Specialist Neonatal and Paediatric Surgery (SNAPS) Department,Great Ormond Street Hospital, London, UK
| | - Agostino Pierro
- Specialist Neonatal and Paediatric Surgery (SNAPS) Department,Great Ormond Street Hospital, London, UK
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Monclair T, Lundar T, Smevik B, Holm I, Ørstavik KH. Currarino syndrome at Rikshospitalet 1961-2012. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2014; 133:2364-8. [PMID: 24287836 DOI: 10.4045/tidsskr.13.0352] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Currarino syndrome is a rare hereditary condition with constipation as the main symptom. The typical patient has a combination of sacral, anorectal, intraspinal and presacral anomalies. Familial cases most often have a mutation in the MNX1 gene. The majority of Norwegian Currarino patients are treated at Rikshospitalet. This article gives an account of 50 years of experience with the condition. MATERIAL AND METHOD The study is based on the medical records of patients with Currarino syndrome, as well as some first-degree relatives, from the period 1961-2012. We recorded the results of mutation analysis, X-ray of the sacrum, and ultrasound, MRI and/or CT scans, as well as the treatments administered. RESULTS We treated 29 patients over the period in question, and in addition identified seven healthy relatives with a mutation in MNX1 and one relative with a pathognomonic sacral anomaly. There were 15 familial and 14 sporadic cases. Fourteen familial cases and one of the sporadic cases were shown to have a mutation in the MNX1 gene. Phenotypic variation was pronounced, and we saw no obvious correlation between genotype and phenotype. Twenty-six of the patients had constipation and 15 underwent a colostomy. Fourteen patients required neurosurgical and seven urogenital interventions. No patients had malignant disease. INTERPRETATION Patients with Currarino syndrome have a highly variable clinical presentation with constipation as the main problem. In patients with a familial syndrome, a mutation in the MNX1 gene can be expected.
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Novel MNX1 mutations and clinical analysis of familial and sporadic Currarino cases. Eur J Med Genet 2013; 56:648-54. [DOI: 10.1016/j.ejmg.2013.09.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Accepted: 09/20/2013] [Indexed: 11/19/2022]
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Patel RV, Shepherd G, Kumar H, Patwardhan N. Neonatal Currarino's syndrome presenting as intestinal obstruction. BMJ Case Rep 2013; 2013:bcr-2013-200310. [PMID: 24130205 PMCID: PMC3822079 DOI: 10.1136/bcr-2013-200310] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- Ramnik V Patel
- Department of Paediatric Urology, University College London Hospitals NHS Foundation Trust, London, UK
- Department of Paediatric Urology, Great Ormond Street Children Hospital NHS Trust, London, UK
| | - Gregory Shepherd
- Department of Paediatric Surgery, Leicester Royal Infirmary, Leicester, UK
| | - Hemant Kumar
- Department of Paediatric Surgery, Leicester Royal Infirmary, Leicester, UK
| | - Nitin Patwardhan
- Department of Paediatric Surgery, Leicester Royal Infirmary, Leicester, UK
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A case of Currarino's syndrome presenting as neonatal bowel obstruction. J Pediatr Surg 2012; 47:1600-3. [PMID: 22901924 DOI: 10.1016/j.jpedsurg.2012.05.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2011] [Revised: 04/24/2012] [Accepted: 05/01/2012] [Indexed: 11/24/2022]
Abstract
We describe a male infant presenting in the neonatal period with bowel obstruction who had features of anal stenosis, a presacral teratoma, and a sacral anomaly consistent with Currarino's syndrome. Initial management involved a defunctioning colostomy followed by a posterior sagittal excision of the teratoma and repair of the anorectal defect. The proband's eldest sister is also affected with features of Currarino's syndrome but was diagnosed later in life. The proband, his sister, and the mother have been identified to have the HLXB9 mutation mapped to chromosome 7q36.
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Lee NG, Gana R, Borer JG, Estrada CR, Khoshbin S, Bauer SB. Urodynamic Findings in Patients With Currarino Syndrome. J Urol 2012; 187:2195-200. [DOI: 10.1016/j.juro.2012.01.128] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2011] [Indexed: 10/28/2022]
Affiliation(s)
- Nora G. Lee
- Department of Urology, Boston University Medical Center, Boston, Massachusetts
| | - Renato Gana
- Department of Urology, Children's Hospital Boston, Boston, Massachusetts
| | - Joseph G. Borer
- Department of Urology, Children's Hospital Boston, Boston, Massachusetts
| | - Carlos R. Estrada
- Department of Urology, Children's Hospital Boston, Boston, Massachusetts
| | - Shahram Khoshbin
- Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Stuart B. Bauer
- Department of Urology, Children's Hospital Boston, Boston, Massachusetts
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Berghauser Pont LME, Dirven CMF, Dammers R. Currarino's triad diagnosed in an adult woman. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2012; 21 Suppl 4:S569-72. [PMID: 22526704 PMCID: PMC3369045 DOI: 10.1007/s00586-012-2311-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2011] [Accepted: 04/08/2012] [Indexed: 11/30/2022]
Abstract
PURPOSE To report on a female patient diagnosed with Currarino's triad in adulthood. CASE REPORT This case presents an adult patient with a medical history of a congenital anal atresia, a partial sacral agenesis, and a surgically treated ectopic anus. After a coincidentally observed presacral mass by MRI, due to unexplained constipation later in adulthood, Currarino's triad was suspected in this patient. This triad consists of anorectal malformation(s), sacrococcygeal defects and a presacral mass of various origin. Further investigation confirmed the mass to be a meningocele, and showed a tethered cord and a syrinx. CONCLUSIONS In (young) patients with anorectal malformations, although having no other symptoms, further examination might be required to exclude Currarino's triad. Importance of early diagnosis and multidisciplinary assessment is recommended to establish adequate treatment if needed.
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Affiliation(s)
- Lotte M E Berghauser Pont
- Department of Neurosurgery, Erasmus MC, 's Gravendijkwal 230, Office Hs-114, P.O. Box B2040, 3000, CA, Rotterdam, The Netherlands
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Bartels SAL, van Koperen PJ, van der Steeg AFW, Deurloo EE, Bemelman WA, Heij HA. Presacral masses in children: presentation, aetiology and risk of malignancy. Colorectal Dis 2011; 13:930-4. [PMID: 20478006 DOI: 10.1111/j.1463-1318.2010.02312.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
AIM The risk of malignant changes in presacral tumours in children was investigated in relation to age at diagnosis, type of presentation and origin of the tumour. METHOD A retrospective review was carried out in 17 patients surgically treated for congenital presacral masses over a 22-year period. RESULTS Constipation was the main symptom in 14 (82%) of 17 patients. The lesions were evident on digital examination in 14 patients. Mature teratoma (n = 9, 64%) was the most common lesion, including three malignancies. Currarino syndrome was diagnosed in 10 (71%) patients. Two unclassified variant HLXB9 gene mutations were found in five (29%) patients who underwent genetic testing. CONCLUSION Congenital presacral tumours in children were mostly mature teratomas, either as sacrococcygeal teratomas or as part of the Currarino syndrome. The risk of malignancy in patients older than 1 year necessitates early surgical resection.
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Affiliation(s)
- S A L Bartels
- Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands
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Bergeron E, Roux A, Demers J, Vanier LE, Moore L. A 40-Year-Old Woman With Cauda Equina Syndrome Caused by Rectothecal Fistula Arising From an Anterior Sacral Meningocele. Neurosurgery 2010; 67:E1464-7; discussion E1467-8. [DOI: 10.1227/neu.0b013e3181f352ba] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND AND IMPORTANCE:
We present a rare case of a rectothecal fistula arising from an anterior sacral meningocele in a patient with Currarino syndrome.
CLINICAL PRESENTATION:
The patient was a 40-year-old woman presenting with cauda equina syndrome and ascending meningitis. The meningocele was removed using an anterior abdominal approach. A sigmoid resection was performed with rectal on-table antegrade lavage followed by closure of the rectal fistula, closure of the rectal stump, and proximal colostomy. Closure of the sacral deficit was carried out by suturing a strip of well-vascularized omentum and fibrin glue.
CONCLUSION:
We discuss the characteristics, management, and evolution of this unusual case. Prompt surgical management using an anterior approach, resection of the sac, closure of the sacral deficit, and fecal diversion resulted in a satisfactory outcome.
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Affiliation(s)
- Eric Bergeron
- Departments of Neurosurgery, General Surgery, and Emergency Medicine, Charles LeMoyne Hospital, Canada Greenfield Park, Quebec, Canada
| | - Alain Roux
- Departments of Neurosurgery, General Surgery, and Emergency Medicine, Charles LeMoyne Hospital, Canada Greenfield Park, Quebec, Canada
| | - Jacques Demers
- Departments of Neurosurgery, General Surgery, and Emergency Medicine, Charles LeMoyne Hospital, Canada Greenfield Park, Quebec, Canada
| | - Laurent E Vanier
- Departments of Neurosurgery, General Surgery, and Emergency Medicine, Charles LeMoyne Hospital, Canada Greenfield Park, Quebec, Canada
| | - Lynne Moore
- Departments of Neurosurgery, General Surgery, and Emergency Medicine, Charles LeMoyne Hospital, Canada Greenfield Park, Quebec, Canada
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Abstract
BACKGROUND The aim of the study was to review the degree to which the long-term outcome and ongoing morbidity in Currarino syndrome (CS) has been established. METHODS Analysis of previously published reports that have included long-term outcome data in CS and review of five additional patients with CS. RESULTS Overall, long-term outcomes of children born with CS are not well described. Malignancy has been reported in six children of approximately 300 CS patients: four children with malignancy had a recurrence after primary excision. Malignancy has also occurred in four adults. Ongoing morbidity related to constipation, faecal incontinence, neurogenic bladder, urinary incontinence and presacral abscess, and more rarely meningitis, brain metastases, developmental delay and unusual gait. Almost certainly, previous reports have under-estimated the true incidence of these problems, given the methodology and focus of these series. CONCLUSIONS There is paucity of information on the long-term outcomes in CS. Few authors have focused on ongoing symptoms, such that we speculate the true incidence of long-term urinary and bowel dysfunction may have been under-estimated in CS. Greater emphasis on the functional assessment of these systems during childhood may help predict the long-term outcome in CS. The most severe cases are diagnosed during infancy and childhood, and these are also the ones who are more likely to have ongoing long-term morbidity.
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20
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van der Heijden M, Smits H, Willekes C, Marcus-Soekarman D, Wilmink J, Marcus M. Spinal anesthesia for a parturient with the triad of Currarino. Int J Obstet Anesth 2009; 18:173-5. [DOI: 10.1016/j.ijoa.2008.11.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2008] [Revised: 07/28/2008] [Accepted: 11/09/2008] [Indexed: 10/21/2022]
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21
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Fitouri Z, Ben Slima S, Matoussi N, Aloui N, Bellagha I, Kechrid A, Ben Becher S. Syndrome de Currarino cause rare de méningites purulentes récidivantes. Med Mal Infect 2007; 37 Suppl 3:S264-7. [DOI: 10.1016/j.medmal.2006.10.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2006] [Accepted: 10/04/2006] [Indexed: 10/22/2022]
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22
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Suomalainen A, Wester T, Koivusalo A, Rintala RJ, Pakarinen MP. Congenital funnel anus in children: associated anomalies, surgical management and outcome. Pediatr Surg Int 2007; 23:1167-70. [PMID: 17929036 DOI: 10.1007/s00383-007-2024-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Funnel anus (FA) is a rare and distinct type of anorectal malformation characterized by a skin-lined deep anal funnel, missing transitional epithelium and stenosis secondary to fibrotic internal sphincter. We aimed to characterize associated anomalies, surgical management and outcome of children with FA. The hospital records of 11 consecutive children (7 boys) treated for FA between 1992 and 2006 were screened. The collected data included the type of anorectal malformation, surgical management, associated anomalies, results of diagnostic investigations and outcome. Only one patient was free of any associated malformation. Six patients had a complete Currarino syndrome. Seven patients had a hemisacrum (scimitar) and tethered cord was present in two cases. Six patients underwent excision of a benign presacral teratoma. Anal stenosis associated with FA was managed by serial dilatations. Subsequent resection of the megarectosigmoid secondary to refractory constipation was performed on five occasions. Three patients underwent coloanal pull-through for Hirschsprung's disease (HD). The level of aganglionosis was at the rectosigmoid junction in two cases and low in the rectum in one. One additional patient had hypoganglionosis. Of the three patients with HD two also had Down's syndrome. After median follow-up of 6.5 (0.3-13.5) years four patients have normal bowel function and four suffer from soiling. Two patients with HD and Down's syndrome and one patient with an undefined syndrome are fecally incontinent. Associated anomalies are common and diverse in children with FA. Pelvic MRI, sacral radiography, evaluation of the urinary tract and rectal biopsies are recommended as routine investigations in cases of FA. Surgical care of these patients is demanding and should be confined to dedicated centers.
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Affiliation(s)
- Anna Suomalainen
- Hospital for children and Adolescents, University of Helsinki, Stenbäckinkatu 11, 00029-HUS, Helsinki, Finland
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23
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Fleury J, Picherot G, Cretolle C, Podevin G, David A, Caillon J, Roze JC, Gras-le Guen C. Currarino syndrome as an etiology of a neonatal Escherichia coli meningitis. J Perinatol 2007; 27:589-91. [PMID: 17724455 DOI: 10.1038/sj.jp.7211783] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
We report the case of a 29-day-old baby girl in whom Escherichia coli meningitis led to the diagnosis of Currarino syndrome (CS) (OMIM 176450), an autosomal-dominant genetic disorder associated with sacral agenesis, anorectal malformation, presacral masses and spinal cord malformations. Her condition improved with antibiotics and early surgical treatment. A familial study identified other genetically related individuals with similar symptoms.
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Affiliation(s)
- J Fleury
- Clinique Médicale Pédiatrique, Hôpital Mère Enfant CHU Nantes, CHU Nantes, France
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25
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Low G, Irwin GJ, Haddock G, Maroo SV. Currarino triad: Characteristic appearances on magnetic resonance imaging and plain radiography. ACTA ACUST UNITED AC 2006; 50:249-51. [PMID: 16732824 DOI: 10.1111/j.1440-1673.2006.01572.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The Currarino triad is a complex anomaly consisting of an anorectal malformation, a sacral bone defect and a presacral mass. It was first described in 1981 and since then, approximately 250 cases have been reported. Radiology has an important part to play in the diagnosis of this entity, as the imaging features are characteristic. We report a case of Currarino triad in an infant who presented with intractable constipation and discuss relevant MRI and plain radiography findings.
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Affiliation(s)
- G Low
- Department of Diagnostic Imaging, Royal Hospital for Sick Children, Glasgow, UK
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26
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Emans PJ, van Aalst J, van Heurn ELW, Marcelis C, Kootstra G, Beets-Tan RGH, Vles JSH, Beuls EAM. The Currarino Triad: Neurosurgical Considerations. Neurosurgery 2006; 58:924-9; discussion 924-9. [PMID: 16639328 DOI: 10.1227/01.neu.0000209945.87233.6a] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
OBJECTIVES:
The Currarino triad, a relatively uncommon hereditary disorder, is often associated with tethered cord and anterior myelomeningocele. Little is known of the implications of these neuroanatomic malformations or of the neurosurgical attitude. The objective of this study is to identify the spinal cord and meningeal malformations associated with the Currarino triad and to discuss the risks and benefits of surgical intervention.
METHODS:
We analyzed the spinal cord malformations and the neurosurgical involvement with the Currarino triad by retrospective chart review.
RESULTS:
The Currarino triad neuroanatomic malformations were identified in five patients. The Currarino triad was associated with a tethered cord in three patients, a myelomeningocele in five patients, a syrinx in two patients, a fistula between the colon and spinal canal in two patients, and an Arnold-Chiari Type 1 malformation in one patient.
CONCLUSION:
Full spine imaging is required for all patients diagnosed with the Currarino triad. Magnetic resonance imaging of the head should be performed in every patient with neuroanatomic anomalies. Surgery of an anterior myelomeningocele is not necessarily indicated, only in the rare case in which the space-occupying aspect is expected to cause constipation or problems during pregnancy or delivery. Constipation directly after birth is seen in virtually all patients with the triad. Therefore, constipation cannot be used to diagnose a tethered cord syndrome nor indicate tethered cord release. Fistulas between the spinal canal and colon have to be operated on directly.
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Affiliation(s)
- Pieter J Emans
- Department of Pediatric Surgery, University Hospital Maastricht, Maastricht, The Netherlands.
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27
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Crétolle C, Zérah M, Jaubert F, Sarnacki S, Révillon Y, Lyonnet S, Nihoul-Fékété C. New clinical and therapeutic perspectives in Currarino syndrome (study of 29 cases). J Pediatr Surg 2006; 41:126-31; discussion 126-31. [PMID: 16410121 DOI: 10.1016/j.jpedsurg.2005.10.053] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
PURPOSE The aim of the study was to clearly define the anomalies that compose the Currarino syndrome (CS). We highlight the frequency of associated malformations of the spinal cord and the possibility of a communication between the presacral tumor and the spinal canal, leading to neurological complications. METHODS We studied 29 patients with CS, including 12 familial cases; histological examination of the presacral tumor was performed, and cytogenetic and molecular biology studies of the HLXB9 locus were carried out. RESULTS All except 2 patients had a sacral malformation; 23 had an anorectal anomaly and 8 had isolated chronic intestinal pseudo-obstruction. There were 20 presacral tumors, one of which was malignant. There was a communication between the presacral tumor and the spinal canal in 12 cases, and tethering of the spinal cord in 17 cases. Twenty-five patients underwent surgery with a single-stage operation for 7, on both the intestinal and the presacral malformations, and, when required, the spinal cord anomalies. Twelve patients harbored a heterozygous point mutation of the coding sequence of HLXB9 gene. CONCLUSION By accurate evaluation of the 4 main features in the CS, the correct surgical management, including neurosurgery, can be performed in a 1-stage approach.
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Affiliation(s)
- Celia Crétolle
- Department of Pediatric Surgery, Hôpital Necker-Enfants Malades, 75015 Paris cedex 15, France
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28
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Abstract
BACKGROUND The Currarino triad is a relatively unknown hereditary disorder linked to the 7q36 region and characterized by an anorectal malformation, sacrococcygeal defect, and a presacral mass. PURPOSE The aim of the study was to report the highly variable expression in patients with the Currarino triad and provide a guideline for the clinician if the Currarino triad is suspected. METHODS We examined the symptoms and associated anomalies in 5 families with the Currarino triad by retrospective chart review. RESULTS Fifteen patients had Currarino-associated anomalies. This included anorectal malformation in 9, a presacral mass in 9, and a sacral bone defect in 15. Tethered cord was present in 4 patients. There were 12 symptomatic patients. Constipation was diagnosed in all of them. Other symptoms included recurrent urinary tract infections caused by bladder dysfunction in 5, abnormal gait in 1, and another patient who initially presented with meningitis. Two carriers of the genetic defect had no symptoms or anomalies. CONCLUSIONS The phenotypical expression of the gene mutations causing the Currarino triad can vary from asymptomatic to patients presenting with the complete triad. Presence of a crescent-shaped defect of the sacral bone may be used as initial screening method. As the penetration of the genetic defect is variable, DNA screening is the only method to fully exclude the triad.
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Affiliation(s)
- Pieter J Emans
- Department of Pediatric Surgery, University Hospital, 6202 AZ Maastricht, The Netherlands
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29
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Martucciello G, Torre M, Belloni E, Lerone M, Pini Prato A, Cama A, Jasonni V. Currarino syndrome: proposal of a diagnostic and therapeutic protocol. J Pediatr Surg 2004; 39:1305-11. [PMID: 15359381 DOI: 10.1016/j.jpedsurg.2004.05.003] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND/PURPOSE The Currarino syndrome (CS) is a peculiar form of caudal regression syndrome (CRS) characterized by the association of hemisacrum, anorectal malformation (ARM), and presacral mass. The authors analyzed retrospectively their series, and they propose a multidisciplinary diagnostic and therapuetic protocol that until now has not been introduced. METHODS A series of 6 patients with CS is presented. Five of them were treated initially in other centers. None of them had an early diagnosis. All presented associated anomalies; in 50%, Hirschsprung's disease (HD) and other dysganglionoses were present. One patient died of a presacral ectopic nephroblastoma. RESULTS Depending on the expressivity, 3 types of CS can be identified, complete, mild, and minimal. Dysganglionoses and HD can be considered part of CS. A multidisciplinary diagnostic and therapeutic protocol is presented. Main points are sacrum x-Ray, molecular genetic diagnosis, radiologic evaluation of every member of CS families, magnetic resonance (MR) evaluation of patient spine and pelvis, suction rectal biopsies, and search for associated anomalies. CONCLUSIONS This protocol could give a valid contribution to the treatment of CS, allowing an early diagnosis and proposing a rational timing of multidisciplinary surgical procedures. Early diagnosis and treatment are essential to avoid morbidity and mortality from an undiagnosed presacral mass.
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Affiliation(s)
- G Martucciello
- Division of Pediatric Surgery, Gaslini Children's Hospital, Genoa, Italy
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30
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Urioste M, Garcia-Andrade MDC, Valle L, Robledo M, González-Palacios F, Méndez R, Ferreirós J, Nuño J, Benítez J. Malignant degeneration of presacral teratoma in the Currarino anomaly. Am J Med Genet A 2004; 128A:299-304. [PMID: 15216552 DOI: 10.1002/ajmg.a.30028] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The autosomal dominant Currarino anomaly (CA) comprises a presacral mass, partial sacral agenesis, and anorectal defects. Chronic constipation in childhood related to anorectal defects is the most common presenting symptom and hemisacrum the most frequent malformation. The presacral mass may be an anterior meningomyelocele, teratoma, hamartoma, dermoid cyst, neuroenteric cyst, or a combination of these. Sepsis and meningitis are frequent serious problems related to the anterior meningomyelocele, whilst malignant transformation of presacral teratoma is a rare, severe complication in CA. Here, we report on a three-generation family segregating the CA, presenting with anorectal defects, severe constipation, and sacral involvement in affected relatives. Teratoma was the most frequent component of the presacral mass. In this kindred a 22-year-old man died of a neuroendocrine tumor, probably related to malignant change in a presacral teratoma. A novel mutation in HLXB9 consisting of a 24-bp deletion and insertion of 2-bp into exon 1, was identified in all patients and in also three asymptomatic members of this family. Anterior meningomyelocele is the most frequently reported component of the presacral masses in CA; however, presacral teratomas carry an inherent risk for malignancy that must be considered in the counseling, surgical treatment options, and follow-up of CA patients.
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Affiliation(s)
- Miguel Urioste
- Department of Human Genetics, Centro Nacional de Investigaciones Oncológicas, Madrid, Spain.
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31
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Haga Y, Cho H, Shinoda S, Masuzawa T. Recurrent Meningitis Associated With Complete Currarino Triad in an Adult-Case Report-. Neurol Med Chir (Tokyo) 2003; 43:505-8. [PMID: 14620204 DOI: 10.2176/nmc.43.505] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A 58-year-old woman presented with Currarino triad manifesting as recurrent meningitis. Currarino triad is a combination of a presacral mass, a congenital sacral bony abnormality, and an anorectal malformation, which is caused by dorsal-ventral patterning defects during embryonic development. She had a history of treatment for anal stenosis in her childhood. Radiographic examinations demonstrated the characteristic findings of Currarino triad and a complicated mass lesion. The diagnosis was recurrent meningitis related to the anterior sacral meningocele. Neck ligation of the meningocele was performed via a posterior transsacral approach after treatment with antibiotics. At surgery, an epidermoid cyst was observed inside the meningocele. The cyst content was aspirated. She suffered no further episodes of meningitis. The meningitis was probably part of the clinical course of Currarino triad. Radiography of the sacrum and magnetic resonance imaging are recommended for patients with meningitis of unknown origin. The early diagnosis and treatment of this condition are important.
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Affiliation(s)
- Yasushi Haga
- Department of Surgical Neurology, Jichi Medical School, Tochigi, Japan.
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Affiliation(s)
- Thomas E Herman
- Department of Radiology, Washington University School of Medicine, St. Louis Children's Hospital, 510 South Kingshighway Boulevard, St. Louis, MO 63110, USA
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Bitoh Y, Shimotake T, Sasaki Y, Iwai N. Development of the pelvic floor muscles of murine embryos with anorectal malformations. J Pediatr Surg 2002; 37:224-7. [PMID: 11819203 DOI: 10.1053/jpsu.2002.30259] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND/PURPOSE Recent biological studies have elucidated the molecular mechanism of muscle development, in which various regulatory molecules play key roles during embryogenesis. To determine possible myogenic abnormalities in anorectal malformations (ARM), the authors investigated the pelvic muscle development in murine embryos affected with ARM. METHODS ARM embryos were induced by all-trans retinoic acid (ATRA) on the ninth gestational day (E9.0). Embryonal specimens were obtained from the uteri between E10.5 and E16.0, and the frozen sections were prepared for immunohistochemistry using antibodies specific for MyoD, myogenin, and PGP9.5 molecules. RESULTS In ARM embryos, the neural tube was irregularly branched and formed an anomalous mass in the sacral region. Embryonal caudal somites differentiated into myogenic cells to form proper myotubes in the pelvis corresponding to the developmental stages between E12.5 and E15.0 both in affected embryos and the controls. CONCLUSIONS In ARM embryos, an impaired anatomic framework of the pelvis was caused by neural maldevelopment, whereas muscle development proceeded physiologically. These results support the hypothesis that pelvic floor muscles may function in ARM children, in whom neural abnormalities such as meningomyelocele or tethered spinal cord have been ruled out, if the surgical correction is appropriately completed.
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