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 Diffusion-Weighted Magnetic Resonance Imaging of an Intramedullary Epidermoid Cyst with Dorsal Dermal Sinus Tract in a Toddler

2013 ◽  
Vol 2013 ◽  
pp. 1-3 ◽  
Author(s):  
Michael G. Fazio ◽  
Alyson M. Kil ◽  
Veronica J. Rooks ◽  
Timothy J. Biega
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Epidermoid Cyst ◽  
Sinus Tract ◽  
Magnetic Resonance Images ◽  
Dermal Sinus ◽  
Resonance Imaging ◽  
Diffusion Weighted ◽  
Dermal Sinus Tract ◽  
Weighted Magnetic Resonance Imaging

We report the use of diffusion-weighted magnetic resonance imaging to diagnose and manage a rare case of a symptomatic thoracic intramedullary congenital epidermoid cyst with associated dermal sinus in a girl. Congenital intramedullary epidermoid cysts with associated dermal sinuses are very rare occurrences and seldom present symptomatically in very young children. We present a case of a 32-month old with a draining dimpled skin lesion. Magnetic resonance images demonstrated an intramedullary epidermoid with a dorsal dermal sinus tract opening to the skin surface which was confirmed surgically. The patient was treated with debulking to prevent recurrent infection and progression of neurological symptoms. This case demonstrates the use of diffuse-weighted MRI to assist in the diagnosis and surgical management of an atypical presentation of a rare developmental abnormality, which is not well documented in the pediatric radiological literature. Failure to diagnosis may have significant neurological permanent debilitating consequences.

scholarly journals Isolated extramedullary intradural thoracic epidermoid cyst: A rare case report

2021 ◽  
Vol 7 (3) ◽  
pp. 81-84
Author(s):  
Anuj Kumar Tripathi ◽  
Zahwa Rizwan ◽  
Shagufta Tahir Mufti ◽  
Saurabh Patahak ◽  
Om Prakash Gupta ◽  
...  
Keyword(s):  
Epidermoid Cyst ◽  
Spinal Dysraphism ◽  
Young Male ◽  
Sinus Tract ◽  
Interesting Case ◽  
Dermal Sinus ◽  
Rare Case Report ◽  
Dermal Sinus Tract ◽  
History Of ◽  
Or History

Spinal epidermoid cyst is a rare entity. It may be congenital with associated spinal dysraphism such asspina bifida ,dermal sinus tract and other neural tube defects or acquired due to repeated lumbar puncture and trauma. Congenital spinal epidermoid cysts without spinal dysraphism are rare. Here we are reporting a rare and interesting case of thoracic extramedullary intradural epidermoid cyst with no associated features of spinal dysraphism or history of iatrogenic trauma in a young male patient.

scholarly journals A Case of Bilateral Permanent Subluxation of the Lateral Meniscus

2016 ◽  
Vol 2016 ◽  
pp. 1-4
Author(s):  
Jun Suganuma ◽  
Tadashi Sugiki ◽  
Yutaka Inoue
Keyword(s):  
Magnetic Resonance ◽  
Knee Joint ◽  
Lateral Meniscus ◽  
Detailed Examination ◽  
Magnetic Resonance Images ◽  
Posterior Segment ◽  
Anterior Dislocation ◽  
Normal Position ◽  
Straight Position ◽  
History Of

We report a case of bilateral, permanent subluxation of the lateral meniscus. To our knowledge, the present case is the first reported description of bilateral irreducible anterior dislocation of the posterior segment of the lateral meniscus. This disorder is characterized by a flipped meniscus sign of the lateral meniscus on sagittal magnetic resonance images of the knee joint, with no history of trauma or locking symptoms. A detailed examination of serial magnetic resonance images of the lateral meniscus can help differentiate this condition from malformation of the lateral meniscus, that is, a double-layered meniscus. We recommend two-stage treatment for this disorder. First, the knee joint is kept in straight position for 3 weeks after the lateral meniscus is reduced to the normal position. Second, if subluxation of the lateral meniscus recurs, meniscocapsular suture is then performed. Although subluxation of the lateral meniscus without locking symptoms is rare, it is important to be familiar with this condition to diagnose and treat it correctly.

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.

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 Measurement of Posterior Tibial Slope in Turkish Population Groups with Magnetic Resonance İmaging

2020 ◽  
Author(s):  
Musab Ümeyir Karakanlı ◽  
Ferdanur Deniz ◽  
İlkin Celilov ◽  
Ömer Sofulu ◽  
Fatih Küçükdurmaz
Keyword(s):  
Magnetic Resonance ◽  
Tibial Slope ◽  
Turkish Population ◽  
Magnetic Resonance Images ◽  
Posterior Tibial Slope ◽  
Slice Thickness ◽  
Posterior Tibial ◽  
Significant Difference ◽  
History Of ◽  
The Mean

Abstract Background The posterior tibial slope (PTS) has great importance on the balance and the stability of the knee and has to be taken into account during the reconstruction and replacement procedure. However, the anthropometric measurements are not universal and show population-based variations. The purpose of this study is to find features of PTS in the Turkish population in regards to the medial and lateral compartment. Methods Magnetic resonance images (MRIs) were retrieved from the Picture Archiving and Communication System (PACS). Subjects from 25 to 45 years old were included from the MRIs taken between July 2015 to July 2017. Any MRI with radiological signs of osteoarthritis, chondral and meniscus (grade 3 & 4) lesions was excluded as well as a deformity in the lower extremity, patients with a history of fracture and/or history of knee surgery. The measurements were made using T1-weighted coronal and sagittal MRI planes with a slice thickness of 4 mm. The PTS of the medial, lateral plateau were recorded with gender and age of the subjects. Non-parametric Spearman's Correlation tests and Student T tests were used to calculate the relationship between medial-lateral PTS and ages and also to evaluate PTS differences between genders. Results Two-hundred thirty-two subjects (122 female, 110 male) were included in the study. The mean medial and lateral PTS were 7.7°±1.3° and 7.5°±1.3° respectively, and there was a significant correlation (p < 0.001). However, no significant difference was found in the mean medial PTS (p = 0.45) and lateral PTS (p = 0.73) between genders and matched age groups. Conclusions Our results showed that there is no gender-based variation in the Turkish population. Although we do not make a systematic comparison, the measurements of PTS in the Turkish population were different from other populations.

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%).

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