The Currarino Triad: Neurosurgical Considerations

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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Surgical treatment for intramedullary spinal cord melanocytomas

Journal of Neurosurgery Spine ◽

10.3171/spi/2008/9/7/048 ◽

2008 ◽

Vol 9 (1) ◽

pp. 48-54 ◽

Cited By ~ 21

Author(s):

Eric M. Horn ◽

Peter Nakaji ◽

Stephen W. Coons ◽

Curtis A. Dickman

Keyword(s):

Spinal Cord ◽

Chart Review ◽

Retrospective Chart Review ◽

Complete Resection ◽

Intramedullary Spinal Cord ◽

Local Infiltration ◽

Patients Âgés ◽

Patient Demographics

Spinal meningeal melanocytomas are rare lesions that are histologically benign and can behave aggressively, with local infiltration. The authors present their experience with intramedullary spinal cord melanocytomas consisting of 3 cases, which represents the second largest series in the literature. A retrospective chart review was performed following identification of all spinal melanocytomas treated at the author's institution, based on information obtained from a neuropathology database. The charts were reviewed for patient demographics, surgical procedure, clinical outcome, and long-term tumor progression. Three patients were identified in whom spinal melanocytoma had been diagnosed between 1989 and 2006. The patients' ages were 37, 37, and 48 years, and the location of their tumor was C1–3, T9–10, and T-12, respectively. All 3 had complete resection with no adjuvant radiotherapy during follow-up periods of 16, 38, and 185 months, respectively. One patient demonstrated a recurrence 29 months after resection and the other 2 patients have demonstrated asymptomatic recurrences on imaging studies obtained at 16 and 38 months following resection. With these cases added to the available literature, the evidence strongly suggests that complete resection is the treatment of choice for spinal melanocytomas. Even with complete resection, recurrences are common and close follow-up is needed for the long term in these patients. Radiation therapy should be reserved for those cases in which complete resection is not possible or in which there is recurrence.

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The neurophysiological balance in Chiari type 1 malformation (CM1), tethered cord and related syndromes

Neurological Sciences ◽

10.1007/s10072-011-0692-3 ◽

2011 ◽

Vol 32 (S3) ◽

pp. 311-316 ◽

Cited By ~ 7

Author(s):

Scaioli Vidmer ◽

Curzi Sergio ◽

Saletti Veronica ◽

Tripaldi Flavia ◽

Esposito Silvia ◽

...

Keyword(s):

Tethered Cord ◽

Chiari Type ◽

Chiari Type 1 Malformation

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Participation restriction in childhood phenotype of myotonic dystrophy type 1: a systematic retrospective chart review

Developmental Medicine & Child Neurology ◽

10.1111/dmcn.13282 ◽

2016 ◽

Vol 59 (3) ◽

pp. 291-296 ◽

Cited By ~ 5

Author(s):

Cynthia Gagnon ◽

Marie Kierkegaard ◽

Catherine Blackburn ◽

Nicolas Chrestian ◽

Mélissa Lavoie ◽

...

Keyword(s):

Myotonic Dystrophy ◽

Chart Review ◽

Retrospective Chart Review ◽

Myotonic Dystrophy Type 1 ◽

Myotonic Dystrophy Type ◽

Participation Restriction

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Therapy-Related Explants After Spinal Cord Stimulation: Results of an International Retrospective Chart Review Study

Neuromodulation Technology at the Neural Interface ◽

10.1111/ner.12642 ◽

2017 ◽

Vol 20 (7) ◽

pp. 642-649 ◽

Cited By ~ 45

Author(s):

Jean-Pierre Van Buyten ◽

Frank Wille ◽

Iris Smet ◽

Carin Wensing ◽

Jennifer Breel ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Stimulation ◽

Chart Review ◽

Retrospective Chart Review ◽

Review Study

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Spinal cord detethering in children with tethered cord syndrome and Chiari type 1 malformations

Journal of Clinical Neuroscience ◽

10.1016/j.jocn.2015.05.023 ◽

2015 ◽

Vol 22 (11) ◽

pp. 1749-1752 ◽

Cited By ~ 11

Author(s):

Chad Glenn ◽

Ahmed A. Cheema ◽

Sam Safavi–Abbasi ◽

Naina L. Gross ◽

Michael D. Martin ◽

...

Keyword(s):

Spinal Cord ◽

Tethered Cord ◽

Tethered Cord Syndrome ◽

Chiari Type

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Glaucoma in children with facial port wine stain

European Journal of Ophthalmology ◽

10.1177/1120672118819668 ◽

2018 ◽

Vol 30 (1) ◽

pp. 168-174 ◽

Cited By ~ 5

Author(s):

Nader Hussein Lotfy Bayoumi ◽

Eman Nabil Elsayed

Keyword(s):

Success Rate ◽

Chart Review ◽

Clinical Presentation ◽

Surgical Intervention ◽

Retrospective Chart Review ◽

Port Wine Stain ◽

Port Wine ◽

Intravitreal Gas ◽

Paediatric Ophthalmology

Purpose: To report on the clinical presentation and surgical treatment (procedure and outcome(s)) of glaucoma in children with facial port wine stain. Materials and methods: This is a retrospective chart review of children with facial port wine stain referred to Alexandria University paediatric ophthalmology practice from 2005 to 2016. The charts of 22 children (44 eyes) with facial port wine stain were reviewed. The data extracted included demographics, results of ophthalmic examination findings and treatment(s). The main outcome measures were the number of eyes stratified as glaucoma, glaucoma suspects and no glaucoma at the initial and final presentations. Results: The average age of presentation was 18.2 (±33.9) months. After a follow-up of over 16.1 (±24.8) months, there were 34%, 30% and 36% of the study eyes diagnosed as glaucoma, glaucoma suspects and no glaucoma, respectively with mean ± standard deviation of intraocular pressure of 20.6 ± 5.1, 13.6 ± 5.4 and 7.5 ± 1.7 mmHg. The majority (91%) of eyes presenting with glaucoma had clear corneas. In total, 11 eyes were operated upon for glaucoma. The recorded success rate was 91%. Two eyes developed a postoperative exudative choroidal detachment, of which one resolved spontaneously and the other was successfully managed by intravitreal gas injection. Conclusion: Glaucoma is a significant ocular hazard in children with facial port wine stain that may not be evident on the initial presentation. The presentation is usually with a clear cornea and surgical intervention is associated with a high success rate and a low rate of complications.

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Management of Recurrent and Delayed Post-Tonsillectomy and Adenoidectomy Hemorrhage in Children

Ear Nose & Throat Journal ◽

10.1177/0145561321999594 ◽

2021 ◽

pp. 014556132199959

Author(s):

Phylannie K. F. Cheung ◽

Joanna Walton ◽

Megan L. Hobson ◽

Piera Taylor ◽

Michael Chin ◽

...

Keyword(s):

Chart Review ◽

Pediatric Patients ◽

Surgical Intervention ◽

Postoperative Bleeding ◽

Retrospective Chart Review ◽

Postoperative Hemorrhage ◽

Recurrent Hemorrhage ◽

Delayed Bleeding ◽

Bleeding Episodes ◽

Preoperative Counseling

Objective: To review our experience on post-tonsillectomy and/or adenoidectomy hemorrhage (PTAH) at a tertiary pediatric referral hospital and to evaluate the management and risk factors for recurrent postoperative hemorrhage and for delayed bleeding after day 14. Methods: A retrospective chart review was performed for all pediatric patients admitted to The Children’s Hospital at Westmead for PTAH between July 01, 2014, and June 30, 2019. Patients with recurrent hemorrhage and those with bleeding after day 14 were selected for subanalysis. Results: Of the 291 patients admitted for PTAH, 31 (11%) patients had recurrent postoperative hemorrhage, and 11 (4%) patients had delayed bleeding after day 14. Surgical intervention for cessation of hemorrhage was required in 88 (30%) patients, including 2 patients who required return to the theater more than once. Nine (3%) patients received blood transfusions. The average number of days between bleeding episodes was 4 days. Recurrent postoperative hemorrhage occurred in 8.5% of patients who were managed operatively at their first presentation compared to 11.4% of patients who were managed nonoperatively (odds ratio: 1.1; 95% confidence interval 0.43-2.8). No association was found between abnormal coagulation profile, surgical indication, and risk of delayed postoperative hemorrhage. Conclusions: Recurrent or delayed postoperative hemorrhage represents a small proportion of children with postoperative bleeding and cannot be reliably predicted. Management of first presentations with either a conservative or a surgical approach is reasonable since the risk of recurrent of PTAH may be unrelated to the choice of management at initial presentation. Careful preoperative counseling of patients and their families is important to help set expectations in the event of PTAH.

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Eosinophilic Polymyositis: A Rare Cause of Atraumatic Compartment Syndrome of the Forearm

Journal of Hand and Microsurgery ◽

10.1055/s-0039-1694288 ◽

2019 ◽

Vol 12 (S 01) ◽

pp. S67-S69

Author(s):

Michael K. Boyajian ◽

Lauren O. Roussel ◽

Galam Khan ◽

Edward Stopa ◽

Reena Bhatt

Keyword(s):

Case Report ◽

Connective Tissue ◽

Compartment Syndrome ◽

Rare Case ◽

Chart Review ◽

Surgical Intervention ◽

Retrospective Chart Review ◽

Definitive Diagnosis ◽

Pertinent Literature ◽

Case Summary

Abstract Background Eosinophilic polymyositis is a rare disorder in which eosinophils infiltrate muscle and supporting connective tissue structures, resembling autoimmune or immunologically mediated disease. This disorder can be associated with muscle inflammation and death, and can be a cause of atraumatic compartment syndrome. Methods This is a retrospective chart review of a case report as well as review of pertinent literature. Results This report presents a rare case of atraumatic compartment syndrome of the forearm caused by eosinophilic polymyositis. It provides a case summary and histological examination of this patient. Conclusion This is an important case to report because it highlights eosinophilic polymyositis as a unique etiology of compartment syndrome. In appropriate clinical situations where patients do not improve despite standard interventions, one should consider the rare and unusual etiology of compartment syndrome due to eosinophilic polymyositis. Furthermore, primary surgical intervention should not be delayed while waiting to ascertain a definitive diagnosis.

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