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Sergeenko OM, Savin DM, Diachkov KA. Association of spinal cord abnormalities with vertebral anomalies: an embryological perspective. Childs Nerv Syst 2024; 40:1415-1425. [PMID: 38441629 DOI: 10.1007/s00381-024-06336-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 02/26/2024] [Indexed: 04/19/2024]
Abstract
PURPOSE To analyze the relationship between spinal cord and vertebral abnormalities from the point of view of embryology. METHODS We analyzed the clinical and radiological data of 260 children with different types of spinal cord malformations in combination with vertebral abnormalities. RESULTS Among 260 individuals, approximately 109 presented with open neural tube defects (ONTDs), 83 with split cord malformations (SCMs), and 83 with different types of spinal lipomas. Pathological spina bifida emerged as the most frequent vertebral anomaly, affecting 232 patients, with a higher prevalence in ONTD. Vertebral segmentation disorders, including unsegmented bars, butterfly vertebrae, and hemivertebrae, were present in 124 cases, with a higher prevalence in SCM. The third most common spinal anomaly group consisted of various forms of sacral agenesis (58 cases), notably associated with blunt conus medullaris, spinal lipomas, and sacral myelomeningocele. Segmental aplasia of the spinal cord had a typical association with segmental spinal absence (N = 17). CONCLUSION The association between SCM and neuroenteric cyst/canal and vertebral segmentation disorders is strong. High ONTDs often coincide with pathological spina bifida posterior. Type 1 spinal lipomas and focal spinal nondisjunction also correlate with pathologic spina bifida. Segmental spinal absence or dysgenesis involves localized spinal and spinal cord aplasia, sometimes with secondary filar lipoma.
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Affiliation(s)
- Olga M Sergeenko
- Division of Spinal Surgery, Ilizarov Center, 6, M.Ulyanova Street, Kurgan, 640014, Russia.
| | - Dmitry M Savin
- Division of Spinal Surgery, Ilizarov Center, 6, M.Ulyanova Street, Kurgan, 640014, Russia
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Bedei I, Krispin E, Sanz Cortes M, Lombaard H, Zemet R, Whitehead WE, Belfort MA, Huisman TAGM. Prenatal diagnosis and postnatal outcome of closed spinal dysraphism. Prenat Diagn 2024; 44:499-510. [PMID: 38013494 DOI: 10.1002/pd.6454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 09/01/2023] [Accepted: 10/15/2023] [Indexed: 11/29/2023]
Abstract
OBJECTIVE To evaluate the prenatal diagnosis of closed dysraphism (CD) and its correlation with postnatal findings and neonatal adverse outcomes. METHODS A retrospective cohort study including pregnancies diagsnosed with fetal CD by prenatal ultrasound (US) and magnetic resonance imaging (MRI) at a single tertiary center between September 2011 and July 2021. RESULTS CD was diagnosed prenatally and confirmed postnatally in 12 fetuses. The mean gestational age of prenatal imaging was 24.2 weeks, in 17% the head circumference was ≤fifth percentile and in 25% the cerebellar diameter was ≤fifth percentile. US findings included banana sign in 17%, and lemon sign in 33%. On MRI, posterior fossa anomalies were seen in 33% of cases, with hindbrain herniation below the foramen magnum in two cases. Mean clivus-supraocciput angle (CSA) was 74°. Additional anomalies outside the CNS were observed in 50%. Abnormal foot position was demonstrated prenatally in 17%. Neurogenic bladder was present in 90% of patients after birth. CONCLUSION Arnold Chiari II malformation and impaired motor function can be present on prenatal imaging of fetuses with CD and may be associated with a specific type of CD. Prenatal distinction of CD can be challenging. Associated extra CNS anomalies are frequent and the rate of neurogenic urinary tract dysfunction is high.
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Affiliation(s)
- Ivonne Bedei
- Department of Prenatal Diagnosis and Fetal Therapy, Justus-Liebig University, Giessen, Germany
- Baylor College of Medicine Department of Obstetrics and Gynecology, Division of Fetal Therapy and Surgery and Texas Children's Hospital Fetal Center, Houston, Texas, USA
- Edward B. Singleton Department of Radiology, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA
| | - Eyal Krispin
- Boston Children's Hospital, Brigham and Women's Hospital, Beth Israel Deacones Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Magdalena Sanz Cortes
- Baylor College of Medicine Department of Obstetrics and Gynecology, Division of Fetal Therapy and Surgery and Texas Children's Hospital Fetal Center, Houston, Texas, USA
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital Pavilion for Women, Houston, Texas, USA
| | - Hennie Lombaard
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital Pavilion for Women, Houston, Texas, USA
| | - Roni Zemet
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas, USA
| | - William E Whitehead
- Department of Neurosurgery, Texas Children's Hospital & Baylor College of Medicine, Houston, Texas, USA
| | - Michael A Belfort
- Baylor College of Medicine Department of Obstetrics and Gynecology, Division of Fetal Therapy and Surgery and Texas Children's Hospital Fetal Center, Houston, Texas, USA
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital Pavilion for Women, Houston, Texas, USA
| | - Thierry A G M Huisman
- Edward B. Singleton Department of Radiology, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA
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Apte A, Fauser T, Carson Q, Liechty KW, Simpson LN, Avellino AM. In utero Diagnosis of Spinal Dermal Sinus. Fetal Diagn Ther 2024; 51:235-242. [PMID: 38402872 DOI: 10.1159/000536404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 01/14/2024] [Indexed: 02/27/2024]
Abstract
INTRODUCTION Congenital dermal sinus (CDS) is an open neural tube defect (NTD) that occurs in 1 in 2,500 births a year and often goes undetected until patients present with complications like infection and neurological deficits. Early diagnosis and repair of CDS may prevent formation of these complications. In utero diagnosis of these lesions may improve long-term outcomes by enabling referral to specialty services and planned postnatal repair; however, only 2 such cases have been reported in the literature. We present a third case of in utero diagnosis of CDS with a description and discussion of findings from surgical exploration and pathology. CASE PRESENTATION Routine prenatal ultrasound scan detected a tethered cystic structure arising from the back of the fetus at 20 weeks of gestation. Dedicated fetal ultrasound confirmed the presence of a cystic lesion protruding through a lamina defect, while fetal magnetic resonance imaging showed an intact spinal cord and meninges, suggesting a diagnosis of CDS. Neurosurgery followed along closely and took the child for surgical exploration on day 2 of life. A fibrous stalk with an intradural component and associated cord tethering was excised. Histology showed fibrous tissue without an epithelial-lined lumen. CONCLUSION CDS is a form of NTD that occurs from nondisjunction of the cutaneous ectoderm and neuroectoderm during formation of the neural tube. Slight differences in how this error occurs can explain variations seen in this spectrum of disease, including CDS without an epithelial-lined lumen as seen in this case. Newborns with CDS can go undiagnosed for years and present with long-term complications. Fetal imaging can assist in early recognition and surgical excision of CDS in newborns.
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Affiliation(s)
- Anisha Apte
- Department of Surgery, University of Arizona Tucson College of Medicine, Banner Children's at Diamond Children's Medical Center, Tucson, Arizona, USA
| | - Tobias Fauser
- Department of Surgery, University of Arizona Tucson College of Medicine, Banner Children's at Diamond Children's Medical Center, Tucson, Arizona, USA
| | - Quinlan Carson
- Department of Pathology, University of Arizona Tucson College of Medicine, Banner Children's at Diamond Children's Medical Center, Tucson, Arizona, USA
| | - Kenneth W Liechty
- Department of Surgery, University of Arizona Tucson College of Medicine, Banner Children's at Diamond Children's Medical Center, Tucson, Arizona, USA
| | - Lauren N Simpson
- Department of Neurosurgery, University of Arizona Tucson College of Medicine, Banner Children's at Diamond Children's Medical Center, Tucson, Arizona, USA
| | - Anthony M Avellino
- Department of Neurosurgery, University of Arizona Tucson College of Medicine, Banner Children's at Diamond Children's Medical Center, Tucson, Arizona, USA
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Kameda-Smith M, Tahir MZ, Kumar A, Thompson D, Pang D. Limited exposure to preserve stability and achieve complete excision of limited dorsal myeloschisis - the "Skip-Hop Laminectomy" technique: a technical note. Childs Nerv Syst 2024; 40:213-218. [PMID: 37428253 DOI: 10.1007/s00381-023-06069-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 07/05/2023] [Indexed: 07/11/2023]
Abstract
OBJECTIVE The fibroneural stalk of an LDM has variable thickness, complexity, and length, which can span 5 to 6 vertebral segments from its skin attachment to its "merge point" with the dorsal spinal cord. Therefore, complete resection may require extensive multi-level laminotomies. In this technical note, a modification of the procedure is presented that avoids long segment laminectomies while ensuring complete excision of long LDM stalks. RESULTS An illustrative case of resection of LDM is presented using skip laminectomies. The technique ensures complete removal of the stalk, thus reducing the risk of future intradural dermoid development, while at the same time minimizes the risk for delayed kyphotic deformity. CONCLUSIONS A technique of "skip-hop" proximal and distal short segment laminectomies in cases of LDM optimizes the objectives of complete stalk resection with preservation of spinal integrity.
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Affiliation(s)
- Michelle Kameda-Smith
- Great Ormond Street Hospital for Children, London, England
- Department of Paediatric Neurosurgery, London, England
| | - M Zubair Tahir
- Great Ormond Street Hospital for Children, London, England
- Department of Paediatric Neurosurgery, London, England
| | - Atul Kumar
- Department of Histopathology, London, England
| | - Dominic Thompson
- Great Ormond Street Hospital for Children, London, England
- Department of Paediatric Neurosurgery, London, England
| | - Dachling Pang
- Great Ormond Street Hospital for Children, London, England.
- Department of Paediatric Neurosurgery, London, England.
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Gine C, Maiz N, Arévalo S, Rodó C, López M, Carreras E. Ruptured saccular limited dorsal myeloschisis: good indication for fetal repair. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2024; 63:113-115. [PMID: 37606294 DOI: 10.1002/uog.27457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 07/27/2023] [Accepted: 08/04/2023] [Indexed: 08/23/2023]
Affiliation(s)
- C Gine
- Pediatric Surgery Department, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - N Maiz
- Maternal-Fetal Medicine Department, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - S Arévalo
- Maternal-Fetal Medicine Department, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - C Rodó
- Maternal-Fetal Medicine Department, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - M López
- Pediatric Surgery Department, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - E Carreras
- Maternal-Fetal Medicine Department, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
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Wong ST, Pang D. Focal Spinal Nondisjunctional Disorders: Including a Discussion on the Embryogenesis of Cranial Focal Nondisjunctional Lesions. Adv Tech Stand Neurosurg 2023; 47:65-128. [PMID: 37640873 DOI: 10.1007/978-3-031-34981-2_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
The publication of a comprehensive report on limited dorsal myeloschisis by the senior author (DP) in 2010 has brought full attention to the concept of limited myeloschisis that he first formulated in 1992 and ignited interests in the whole spectrum of focal spinal nondisjunctional disorders. Now that focal nondisjunctional disorders have become well known, new clinical reports on these conditions or relevant subjects are frequently seen. Here we present an updated review on the full spectrum of focal spinal nondisjunctional disorders and extend the scope to include a discussion on the embryogenesis of cranial focal nondisjunctional malformations.
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Affiliation(s)
- Sui-To Wong
- Department of Neurosurgery, Tuen Mun Hospital, Hong Kong, China
| | - Dachling Pang
- University of California, Davis, Davis, CA, USA
- Great Ormond Street Hospital for Children, NHS Trust, London, UK
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Foo YW, Lim JX, Primalani NK, Ng LP, Seow WT, Low DCY, Low SYY. Tethered cord secondary to focal nondisjunction of the primary neural tube: experience from a Singapore children's hospital. Br J Neurosurg 2022:1-7. [PMID: 36564943 DOI: 10.1080/02688697.2022.2159931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 12/13/2022] [Indexed: 12/25/2022]
Abstract
PURPOSE Tethered cord due to focal nondisjunction of primary neuralisation (FNPN) is a rare form of spinal dysraphism. We present our institutional experience in managing children diagnosed with FNPN. MATERIALS AND METHODS This is a single institution, retrospective study approved by the hospital ethics board. Patients below 18 years of age diagnosed with CDS, LDM or their mixed lesions, and subsequently underwent intervention by the Neurosurgical Service, KK Women's and Children's Hospital, are included. RESULTS From 2001 to 2021, 16 FNPN patients (50% males) were recruited. Eight of them had CDS (50.0%), seven had LDM (43.8%), and one patient had a mixed CDS and LDM lesion (6.2%). The average duration of follow up was 5.7 years and the mean age of surgery was 6 months old. Thirteen patients underwent prophylactic intent surgery (81.2%) and three had therapeutic intent surgery (18.8%). All patients did not have new neurological deficit or required repeat surgery for cord retethering. We observed that detethering surgery performed at or less than three months old was associated with having a wound infection (p = .022). CONCLUSIONS Our study reports that early recognition and timely intervention are mainstays of management for FNPN. We advocate a multi-disciplinary approach for good outcomes.
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Affiliation(s)
- Yi Wen Foo
- Neurosurgical Service, KK Women's and Children's Hospital, Singapore
| | - Jia Xu Lim
- Department of Neurosurgery, National Neuroscience Institute, Singapore
| | | | - Lee Ping Ng
- Neurosurgical Service, KK Women's and Children's Hospital, Singapore
| | - Wan Tew Seow
- Neurosurgical Service, KK Women's and Children's Hospital, Singapore
- Department of Neurosurgery, National Neuroscience Institute, Singapore
- Neuroscience Academic Clinical Program, SingHealth Duke-NUS, Singapore
| | - David C Y Low
- Neurosurgical Service, KK Women's and Children's Hospital, Singapore
- Department of Neurosurgery, National Neuroscience Institute, Singapore
- Neuroscience Academic Clinical Program, SingHealth Duke-NUS, Singapore
| | - Sharon Y Y Low
- Neurosurgical Service, KK Women's and Children's Hospital, Singapore
- Department of Neurosurgery, National Neuroscience Institute, Singapore
- Neuroscience Academic Clinical Program, SingHealth Duke-NUS, Singapore
- Paediatrics Academic Clinical Program, SingHealth Duke-NUS, Singapore
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Limited dorsal myeloschisis involving one hemicord of a split cord malformation - a "hemi-LDM". Childs Nerv Syst 2022; 38:2223-2230. [PMID: 35794361 DOI: 10.1007/s00381-022-05599-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 07/01/2022] [Indexed: 11/03/2022]
Abstract
This is a case report of an exceedingly rare case of a limited dorsal myeloschisis (LDM) with its stalk inserted on the midline dorsal surface of one of a pair of hemicords in a type II split cord malformation. This entity, literally a "hemi-LDM," has been seen only once by the senior author in his catalogue of over 200 cases of LDM (Pang et al., 2020), nor has it been reported elsewhere before. We postulate that here the mechanism of focal nondisjunction of the hemi-neural plate during primary neurulation, which produces LDMs, occurs at the cusp of the consecutive developmental stages of gastrulation and primary neurulation, right after the appearance of the hemi-neural plates and hemi-notochords caused by the endomesenchymal tract. This child also had a terminal lipoma attached to the end of the conus, indicating that disruption of all three tandem stages of neural tube formation, namely, gastrulation, primary neurulation, and secondary neurulation, can occur in the same individual.
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Kurogi A, Murakami N, Mukae N, Shimogawa T, Goto K, Shono T, Suzuki SO, Yoshimoto K, Morioka T. Congenital dermal sinus and filar lipoma located in close proximity at the dural cul-de-sac mimicking limited dorsal myeloschisis. INTERDISCIPLINARY NEUROSURGERY 2022. [DOI: 10.1016/j.inat.2021.101455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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