Ultrasound of the neonatal conus medullaris: Normal position and use in identification of occult spinal dysraphism

1994 ◽  
Vol 49 (10) ◽  
pp. 741
Author(s):  
C.A. Rowland Hill ◽  
P.J. Gibson ◽  
J.A. Britton ◽  
D.M.B. Hall
Keyword(s):  
Spinal Dysraphism ◽  
Conus Medullaris ◽  
Occult Spinal Dysraphism ◽  
Normal Position

scholarly journals Spinal lipomas: clinical spectrum, embryology, and treatment

2007 ◽  
Vol 23 (2) ◽  
pp. 1-12 ◽  
Author(s):  
Michael A. Finn ◽  
Marion L. Walker
Keyword(s):  
Surgical Treatment ◽  
Clinical Presentation ◽  
Wide Spectrum ◽  
Spinal Dysraphism ◽  
Treatment Options ◽  
Conus Medullaris ◽  
Clinical Spectrum ◽  
Pathological Features ◽  
Occult Spinal Dysraphism ◽  
Pathological Mechanism

✓Spinal lipomas, particularly lipomas of the conus medullaris and terminal filum, are the most common form of occult spinal dysraphism and represent a wide spectrum of disease with regard to anatomy, clinical presentation, and treatment options. These lesions, however, are united by a similar embryology and pathological mechanism by which symptoms arise. Recently, the treatment of these lesions has generated much controversy, with some physicians advocating surgical treatment for all patients regardless of symptoms and others proposing that surgery be withheld until symptoms develop. The authors discuss lumbosacral spinal lipomas, with particular attention to the theories of their origin, anatomical and pathological features, and treatment options, including a review of current controversies.

scholarly journals Use of magnetic resonance imaging to detect occult spinal dysraphism in infants

2017 ◽  
Vol 19 (2) ◽  
pp. 217-226 ◽  
Author(s):  
Brent R. O'Neill ◽  
Danielle Gallegos ◽  
Alex Herron ◽  
Claire Palmer ◽  
Nicholas V. Stence ◽  
...  
Keyword(s):  
Congenital Anomalies ◽  
Imaging Modality ◽  
Spinal Dysraphism ◽  
Sinus Tract ◽  
Conus Medullaris ◽  
Dermal Sinus ◽  
Occult Spinal Dysraphism ◽  
Disc Space ◽  
Dermal Sinus Tract ◽  
Study Population

OBJECTIVE Cutaneous stigmata or congenital anomalies often prompt screening for occult spinal dysraphism (OSD) in asymptomatic infants. While a number of studies have examined the results of ultrasonography (US) screening, less is known about the findings when MRI is used as the primary imaging modality. The object of this study was to assess the results of MRI screening for OSD in infants. METHODS The authors undertook a retrospective review of all infants who had undergone MRI of the lumbar spine to screen for OSD over a 6-year period (September 2006–September 2012). All images had been obtained on modern MRI scanners using sequences optimized to detect OSD, which was defined as any fibrolipoma of the filum terminale (FFT), a conus medullaris ending at or below the L2–3 disc space, as well as more complex lesions such as lipomyelomeningocele (LMM). RESULTS Five hundred twenty-two patients with a mean age of 6.2 months at imaging were included in the study. Indications for imaging included isolated dimple in 235 patients (45%), asymmetrically deviated gluteal cleft in 43 (8%), symmetrically deviated (Y-shaped) gluteal cleft in 38 (7%), hemangioma in 28 (5%), other isolated cutaneous stigmata (subcutaneous lipoma, vestigial tail, hairy patch, and dysplastic skin) in 31 (6%), several of the above stigmata in 97 (18%), and congenital anomalies in 50 (10%). Twenty-three percent (122 patients) of the study population had OSD. Lesions in 19% of these 122 patients were complex OSD consisting of LMM, dermal sinus tract extending to the thecal sac, and lipomeningocele. The majority of OSD lesions (99 patients [81%]) were filar abnormalities, a group including FFT and low-lying conus. The rate of OSD ranged from 12% for patients with asymmetrically deviated gluteal crease to 55% for those with other isolated cutaneous stigmata. Isolated midline dimple was the most common indication for imaging. Among this group, 20% (46 of 235) had OSD. There was no difference in the rate of OSD based on dimple location. Those with OSD had a mean dimple position of 15 mm (SD 11.8) above the coccyx. Those without OSD had a mean dimple position of 12.2 mm (SD 19) above the coccyx (p = 0.25). CONCLUSIONS The prevalence of OSD identified with modern high-resolution MRI screening is significantly higher than that reported with US screening, particularly in patients with dimples. The majority of OSD lesions identified are FFT and low conus. The clinical significance of such lesions remains unclear.

International survey on the management of lumbosacral cutaneous stigmata in infants with suspected occult spinal dysraphism

2021 ◽  
pp. 1-8
Author(s):  
Konstantina Svokos ◽  
Lígia Batista-Silverman ◽  
Sarah J. Graber ◽  
Brent R. O’Neill ◽  
Michael H. Handler
Keyword(s):  
Decision Making ◽  
Practice Patterns ◽  
Spinal Dysraphism ◽  
Conus Medullaris ◽  
Ultrasound Screening ◽  
Filum Terminale ◽  
Occult Spinal Dysraphism ◽  
Surgical Decision ◽  
Asymptomatic Patients ◽  
Surgical Decision Making

OBJECTIVE Occult spinal dysraphism (OSD) is a common pediatric neurosurgical diagnosis rife with controversy surrounding both the screening of asymptomatic infants and the threshold to offer a prophylactic detethering operation. The authors sought to clarify international practice patterns with a survey of pediatric neurosurgeons. METHODS A survey asked pediatric neurosurgeons whether they would perform imaging in patients with a variety of cutaneous stigmata associated with OSD and whether they would offer prophylactic detethering surgery for asymptomatic patients with a variety of imaging findings on the OSD spectrum. RESULTS Completed surveys were received from 141 pediatric neurosurgeons. Broad consensus was demonstrated on the need for obtaining images in sample patients with more severe stigmata ranging from large lipoma with a skin appendage to focal dysplastic skin in the lumbar midline. Ninety percent of respondents would perform MRI for these patients. In contrast, for patients with a low-sacral dimple, flat hemangioma, and symmetric (Y-shaped) splaying of the intergluteal cleft, opinion on the need for imaging varied considerably (between 57% and 89% recommended imaging). Respondents differed on the type of imaging that they would perform, with 31% to 38% recommending ultrasound screening. The responses reflected less consensus on when to offer surgery to patients with simple spinal tethering (low-lying conus medullaris and fatty filum terminale). Both a lower level of the conus and increased thickness of the filum terminale affected decision-making. CONCLUSIONS The results of this survey showed significant consensus on the recommendation for screening imaging in patients with more dramatic cutaneous stigmata, although these stigmata are the rarest. A significant variance in opinions was reflected in the recommendation for imaging of the most common cutaneous stigmata. Consensus was also lacking on which lesions deserve prophylactic detethering surgery. Significant equipoise exists for future study of screening imaging and of surgical decision-making in patients with asymptomatic OSD and associated cutaneous stigmata.

Congenital Dermal Sinus Elements in Each Tethering Stalk of Coexisting Thoracic Limited Dorsal Myeloschisis and Retained Medullary Cord

2020 ◽  
pp. 1-8
Author(s):  
Takato Morioka ◽  
Nobuya Murakami ◽  
Masako Ichiyama ◽  
Takeshi Kusuda ◽  
Satoshi O. Suzuki
Keyword(s):  
Present Article ◽  
Dermoid Cyst ◽  
Spinal Dysraphism ◽  
Conus Medullaris ◽  
Dermal Sinus ◽  
Case Presentation ◽  
Upper Tract ◽  
Secondary Neurulation ◽  
Extradural Space ◽  
Congenital Dermal Sinus

<b><i>Introduction:</i></b> The embryogenesis of limited dorsal myeloschisis (LDM) likely involves impaired disjunction between the cutaneous and neural ectoderms during primary neurulation. Because LDM and congenital dermal sinus (CDS) have a shared origin in this regard, CDS elements can be found in the LDM stalk. Retained medullary cord (RMC) is a closed spinal dysraphism involving a robust, elongated, cord-like structure extending from the conus medullaris to the dural cul-de-sac. Because the RMC is assumed to be caused by impaired secondary neurulation, concurrent RMC and CDS cannot be explained embryologically. In the present article, we report a case in which CDS elements were noted in each tethering stalk of a coexisting LDM and RMC. <b><i>Case Presentation:</i></b> A 2.5-month-old boy with left clubfoot and frequent urinary and fecal leakage had 2 tethering tracts. The upper tract, which ran from the thoracic tail-like cutaneous appendage, had CDS elements in the extradural stalk and a tiny dermoid cyst in the intradural stalk immediately after the dural entry. In the lower tract, which ran from the lumbosacral dimple, the CDS as an extradural stalk continued to the RMC at the dural cul-de-sac. Both stalks were entirely resected through skip laminotomy/laminectomy at 1 stage to untether the cord and resect the CDS elements. <b><i>Conclusion:</i></b> Surgeons should be aware that CDS elements, in addition to LDM, may coexist with RMC that extends out to the extradural space.

The Incidence of Occult Spinal Dysraphism and the Onset of Neurovesical Dysfunction in Children with Anorectal Anomalies

1994 ◽  
Vol 4 (S 1) ◽  
pp. 12-14 ◽  
Author(s):  
M. De Gennaro ◽  
M. Rivosecchi ◽  
M. Lucchetti ◽  
M. Silveri ◽  
G. Fariello ◽  
...  
Keyword(s):  
Spinal Dysraphism ◽  
Occult Spinal Dysraphism ◽  
Anorectal Anomalies

Midline cutaneous lumbosacral lesions: not always a sign of occult spinal dysraphism

2006 ◽  
Vol 22 (6) ◽  
pp. 623-627 ◽  
Author(s):  
Juan F. Martínez-Lage ◽  
Belen Ferri Ñiguez ◽  
Miguel A. Pérez-Espejo ◽  
María J. Almagro ◽  
Concepción Maeztu
Keyword(s):  
Spinal Dysraphism ◽  
Occult Spinal Dysraphism

Occult Spinal Dysraphism: A Rare but Detectable Cause of Voiding Dysfunction

1980 ◽  
Vol 7 (2) ◽  
pp. 349-356
Author(s):  
James Mandell ◽  
Stuart B. Bauer ◽  
Mark Hallett ◽  
Shahram Khoshbin ◽  
Frances M. Dyro ◽  
...  
Keyword(s):  
Voiding Dysfunction ◽  
Spinal Dysraphism ◽  
Occult Spinal Dysraphism

Cutaneous stigmata of occult spinal dysraphism

1994 ◽  
Vol 31 (5) ◽  
pp. 892-896 ◽  
Author(s):  
David A. Davis ◽  
Philip R. Cohen ◽  
Richard E. George
Keyword(s):  
Spinal Dysraphism ◽  
Occult Spinal Dysraphism

scholarly journals Occult Spinal Dysraphism: A Challenge in Pain Management

2015 ◽  
Vol 2;18 (2;3) ◽  
pp. E225-E228
Author(s):  
Frederic J Gerges
Keyword(s):  
Pain Management ◽  
Spina Bifida ◽  
Spinal Dysraphism ◽  
Lumbar Radiculopathy ◽  
Occult Spinal Dysraphism ◽  
Case Scenario ◽  
Vascular Abnormalities ◽  
The Central Nervous System ◽  
Radicular Symptoms ◽  
Clinical Dilemma

Spina bifida is a common birth defect affecting the central nervous system and represents a group of neural tube defects caused by congenital dysraphic malformations of the vertebral column and/or spinal cord. The anatomy in these patients is challenging and includes structural and vascular abnormalities including arteriovenous malformation or fistulae, and fatty substitution of paravertebral tissues. A magnetic resonance image (MRI) is needed for management of patients with lumbar radiculopathy and clinical features suspicious of occult spinal dysraphism. Risks and benefits of lumbar epidural steroids should be discussed comprehensively with those patients and in the best case scenario be avoided. Occult spinal dysraphism poses a clinical dilemma for interventional pain specialists managing those patients with lumbar radiculopathy. We report a case of occult spinal dysraphism discovered following the development of post-traumatic radicular symptoms. Key words: Occult spinal dysraphism, spina bifida, lumbar radiculopathy, pain, pain management, physical findings

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