scholarly journals P.234 “Inappropriate” spinal ultrasounds for suspected occult spinal dysraphism in northern Alberta

2021 ◽  
Vol 48 (s3) ◽  
pp. S88-S88
Author(s):  
M Keough ◽  
A Thompson ◽  
V Mehta
Keyword(s):  
Imaging System ◽  
Spinal Dysraphism ◽  
Sinus Tract ◽  
Choosing Wisely ◽  
Dermal Sinus ◽  
Mri Imaging ◽  
Occult Spinal Dysraphism ◽  
Cutaneous Manifestations ◽  
Family Doctors ◽  
Dorsal Appendage

Background: Occult spinal dysraphism (OSD) may be associated with visible cutaneous manifestations. A common non-pathological mimic of a dermal sinus tract is an incidental sacrococcygeal dimple. Choosing Wisely Canada Guidelines recommend these dimples not be imaged. Methods: This study assessed the appropriateness of spinal ultrasounds performed for the investigation of an OSD. We interrogated our local imaging system to analyze spinal ultrasounds being performed in babies less than 6 months of age, from 2017-2018. Results: 429 children had spinal ultrasounds ordered by pediatricians (55%), family doctors (21%), and neonatologists (20%). 183 children (43%) had imaging indications that was deemed “inappropriate”. Some of this cohort had further MRI imaging (5/183) or neurosurgical referral (8/183). None of these children underwent neurosurgery. 231 (54%) children had appropriate indications for imaging. Within this cohort MRI imaging (23/231), neurosurgical referral (24/231) and neurosurgical intervention occurred (4/231). All four “surgical children” harboured either a dorsal appendage or a subcutaneous lipoma. We estimated, declining inappropriate scans would save $22, 500 annually. Conclusions: A significant portion of local spinal ultrasound requests for OSD are inappropriate. Collaboration with other sites is ongoing to investigate if the Choosing Wisely guidelines for imaging this patient population are being practiced more efficiently.

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.

Conflicting Diagnosis of Dermal Sinus Tract and Tethered Cord

2013 ◽  
Vol 40 (6) ◽  
pp. 889-891
Author(s):  
Chris J. Hong ◽  
Saleh A. Almenawer ◽  
Boleslaw Lach ◽  
Nina Stein ◽  
Benedicto Baronia ◽  
...  
Keyword(s):  
Spinal Dysraphism ◽  
Tethered Cord ◽  
Sinus Tract ◽  
Neural Tube Closure ◽  
Dermal Sinus ◽  
Lumbar Region ◽  
Occult Spinal Dysraphism ◽  
Developmental Abnormalities ◽  
Skin Tags ◽  
Dermal Sinus Tract

Dermal sinus tracts (DSTs) are an uncommon form of occult spinal dysraphism that is attributed to incomplete neural tube closure during fetal development. Dermal sinus tracts are found along the midline neuroaxis from the nasion to the coccyx, but they most commonly appear in the lumbar region. Dermal sinus tracts are more commonly associated with other developmental abnormalities such as skin tags, naevi, spinal dermoid cysts, meningocoele, lipomas and spinal cord tethering, and can be complicated by cerebrospinal fluid drainage, shedding of keratin from the epithelialized tract, and infection such as meningitis.

Occult Spinal Dysraphism: A Series of 73 Cases

PEDIATRICS ◽  
1975 ◽  
Vol 55 (6) ◽  
pp. 826-835 ◽  
Author(s):  
Frank M. Anderson
Keyword(s):  
Distal Part ◽  
Spinal Dysraphism ◽  
Clinical Manifestations ◽  
Dermal Sinus ◽  
Loss Of Function ◽  
Occult Spinal Dysraphism ◽  
Neural Tissues ◽  
The Subject ◽  
The Many ◽  
Developmental Variants

The subject of occult spinal dysraphism or myelodysplasia is reviewed from standpoints of embryology, clinical manifestations, and treatment, and the management of 73 cases summarized. In general, these concealed lesions arise from developmental variants in the most distal part of the neural tube, a situation which may cause distortion or partial absence of neural tissues and also lead to damage from compression or traction. Lipomyelomeningocele and congenital dermal sinus are two examples of the many types of such lesions, but some are more complicated, and borderline myelomeningocele-like forms occur. Incontinence, deformity or weakness of the feet, impaired gait, and other difficulties may appear late and increase with growth. Surgical treatment is advised to reduce chances of delayed or progressive loss of function.

Spinal Dermal Sinus Tract

2019 ◽  
pp. 47-55
Author(s):  
Nathan R. Selden
Keyword(s):  
Imaging Modality ◽  
Spinal Dysraphism ◽  
Cauda Equina ◽  
Sinus Tract ◽  
Conus Medullaris ◽  
Dermal Sinus ◽  
Dermal Sinus Tract ◽  
Long Term Follow Up ◽  
Operative Assessment ◽  
Spinal Dermal Sinus

Spinal dermal sinus tract is a rare form of spinal dysraphism that presents occasionally with signs of spinal tethering and rarely with repeated bouts of bacterial meningitis or fulminant pyogenic infection of the conus medullaris or cauda equina leading to serious loss of neurologic function. Physical examination is crucial to accurately diagnose cutaneous findings such as the presence of a pit or tract, in order to avoid subsequent neurological sequelae. Spinal MR imaging is the only definitive imaging modality for the diagnosis of spinal dermal sinus tract and surgical planning for its excision. Total removal of all dermoid tract material is necessary to prevent recurrence. Careful peri-operative assessment and long-term follow-up will optimize outcomes and minimize complications.

scholarly journals Temporal Dermoid Cyst with a Partial Dermal Sinus Tract

1999 ◽  
Vol 26 (4) ◽  
pp. 321-324 ◽  
Author(s):  
Joseph A. Shehadi ◽  
Karen M. Johnston ◽  
Ibrahim A. Alorainy
Keyword(s):  
Dermoid Cyst ◽  
Complex Partial Seizure ◽  
Sinus Tract ◽  
Dermal Sinus ◽  
Unique Case ◽  
Cutaneous Manifestations ◽  
Novel Variant ◽  
Dermal Sinus Tract ◽  
Adult Female Patient ◽  
New Onset

Background:Cranial dermal sinuses are rare and occur most frequently in the posterior fossa and along the midline. Likewise, supratentorial dermoid cysts are very uncommon.Method:We report a unique case of an adult female patient with both a supratentorial dermoid cyst and an incomplete dermal sinus tract.Results:The patient is a 31-year-old female, who presented with a new onset complex partial seizure. Neuroimaging and surgery revealed a right superior temporal dermoid cyst with an associated dermal sinus tract. Furthermore, the dermal sinus tract was incomplete and had no cutaneous manifestations.Conclusion:We present a rare patient with an off midline supratentorial dermoid cyst associated with a uniquely incomplete cranial dermal sinus tract. The dermal sinus tract involved the bone, dura and intradural compartment, without involving the overlying skin. This represents a novel variant in the spectrum of cranial dermal sinus abnormalities.

scholarly journals SPINAL DYSRAPHISM;

2017 ◽  
Vol 24 (04) ◽  
pp. 565-573
Author(s):  
Bushra Ujala ◽  
Saeeda Bano ◽  
Asma Mehreen ◽  
Hassan Bukhari
Keyword(s):  
Spinal Dysraphism ◽  
Tethered Cord ◽  
Sinus Tract ◽  
Radiology Department ◽  
Dermal Sinus ◽  
Pediatric Age Group ◽  
First Choice ◽  
Dermal Sinus Tract

Introduction: MRI plays an important role in characterising spinal dysraphisms.The reason behind this is quality of MRI showing very high contrast resolution of soft tissuesand the ability to detect fat in the lesion.T2 weighted images provide excellent contrastbetween the sub-arachnoid spaces and neural tissue while evaluating spinal dysraphisms.Objectives: To determine the frequency of rare disorders of spinal dysraphism in view of MRIfindings of spinal dyspharism patients. Study Design: retrospective. Duration: the study wasconducted from 1st September 2015 to 30th November 2015. Settings: Radiology department,Allied hospital Faisalabad. Methods: A total of 20 consecutive pediatric age group patientspresented with clinical suspicion of spinal dysraphism were included. MRI L/S spine was carriedout on 1.5Tesla Philips and diagnosis of various disorders of spinal dysraphism was made.Conclusion: MRI is the first choice examination for the detection of occult spinal dysraphism.Its timely diagnosis improving surgical & medical outcome as well as better & long term careof patients with spinal dysraphism. Majority of patients in the current study had tethered cord(75%), myelomeningocele (20%), myelocele (10%), lipomyelocele (10%) Dermal sinus tract(10%) & diastematomyelia (10%) followed by associated spinal lipomas (5%), caudal agenesis(5%) & anterior meningocele (5%).

Dorsal dermal sinus and dermoid cysts in occult spinal dysraphism

1999 ◽  
Vol 134 (6) ◽  
pp. 793 ◽  
Author(s):  
Haruo Hattori ◽  
Yoshihisa Higuchi ◽  
Yuzuru Tashiro
Keyword(s):  
Spinal Dysraphism ◽  
Dermal Sinus ◽  
Occult Spinal Dysraphism

scholarly journals Congenital spinal dermal tract: how accurate is clinical and radiological evaluation?

2015 ◽  
Vol 15 (6) ◽  
pp. 651-656 ◽  
Author(s):  
Martin M. Tisdall ◽  
Richard D. Hayward ◽  
Dominic N. P. Thompson
Keyword(s):  
Magnetic Resonance ◽  
Spinal Dysraphism ◽  
Sinus Tract ◽  
Magnetic Resonance Images ◽  
Dermal Sinus ◽  
Inclusion Cyst ◽  
Operative Finding ◽  
Increased Risk ◽  
History Of ◽  
Operative Findings

OBJECT A dermal sinus tract is a common form of occult spinal dysraphism. The presumed etiology relates to a focal failure of disjunction resulting in a persistent adhesion between the neural and cutaneous ectoderm. Clinical and radiological features can appear innocuous, leading to delayed diagnosis and failure to appreciate the implications or extent of the abnormality. If it is left untreated, complications can include meningitis, spinal abscess, and inclusion cyst formation. The authors present their experience in 74 pediatric cases of spinal dermal tract in an attempt to identify which clinical and radiological factors are associated with an infective presentation and to assess the reliability of MRI in evaluating this entity. METHODS Consecutive cases of spinal dermal tract treated with resection between 1998 and 2010 were identified from the departmental surgical database. Demographics, clinical history, and radiological and operative findings were collected from the patient records. The presence or absence of active infection (abscess, meningitis) at the time of neurosurgical presentation and any history of local sinus discharge or infection was assessed. Magnetic resonance images were reviewed to evaluate the extent of the sinus tract and determine the presence of an inclusion cyst. Radiological and operative findings were compared. RESULTS The surgical course was uncomplicated in 90% of 74 cases eligible for analysis. Magnetic resonance imaging underreported the presence of both an intradural tract (MRI 46%, operative finding 86%) and an intraspinal inclusion cyst (MRI 15%, operative finding 24%). A history of sinus discharge (OR 12.8, p = 0.0003) and the intraoperative identification of intraspinal inclusion cysts (OR 5.6, p = 0.023) were associated with an infective presentation. There was no significant association between the presence of an intradural tract discovered at surgery and an infective presentation. CONCLUSIONS Surgery for the treatment of spinal dermal tract carries a low morbidity. While it seems intuitive that tracts without intradural extension carry a low risk of spinal cord tethering, it is not possible to reliably detect these cases using MRI. Similarly, intraspinal dermoid cannot be reliably excluded using MRI and carries an increased risk of infection. These points justify excision together with intradural exploration of all spinal dermal sinus tracts.

scholarly journals Importance of Physical Examination and Imaging in the Detection of Tethered Cord Syndrome

2019 ◽  
Vol 6 ◽  
pp. 2333794X1985141
Author(s):  
Lisa B. E. Shields ◽  
Ian S. Mutchnick ◽  
Dennis S. Peppas ◽  
Eran Rosenberg
Keyword(s):  
Magnetic Resonance Imaging ◽  
Spinal Dysraphism ◽  
Tethered Cord ◽  
Tethered Cord Syndrome ◽  
Resonance Imaging ◽  
Occult Spinal Dysraphism ◽  
Cutaneous Manifestations ◽  
Physical Examinations ◽  
Spinal Ultrasound ◽  
Prompt Diagnosis

Tethered cord syndrome (TCS) is a type of occult spinal dysraphism that may lead to permanent neurologic and orthopedic deficits. Infants with TCS may have lumbosacral cutaneous malformations (LsCMs). We studied 67 infants referred to a single pediatric urology practice for a urological concern unrelated to occult spinal dysraphism with no prior diagnosis of LsCM between March 1, 2015 and September 30, 2018. Each infant underwent a spinal ultrasound. If an abnormality was detected, they were referred to a pediatric neurosurgeon. The most common cutaneous manifestations were duplicated or bifurcated (46%) gluteal folds and gluteal asymmetry (16%). Fourteen (21%) of the 67 patients had an abnormal spinal ultrasound; 5 of the 14 infants underwent a lumbar magnetic resonance imaging. One infant had urodynamics studies and a tethered cord release. Pediatricians should be familiar with TCS and perform lumbar physical examinations for LsCMs suggestive of TCS to ensure prompt diagnosis and management and avoid potentially devastating complications.

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