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Occult spinal dysraphism: neuroradiological study

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Summary

We present a retrospective study of occult spinal dysraphism in 47 children aged 0 to 14 years, all studied with plain X-rays, 60% with CT and myelo-CT, and 40% with MR. We consider the classification and grading of these malformations, clinical, neuroradiological patterns, and indications for surgery. In the light of our findings and of the published data MR emerges as the key investigation. Only in a few cases of great anatomical complexity is it now necessary to perform CT and myelo-CT as well. A case in point is when the conus and thickened filum terminale are inextricably bound together and can no longer be considered separate structures. We propose the term “neurofibrous structure” to define the conus-thickened-filum-terminale unit when these structure are no longer distinguishable.

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References

  1. Naidich TP, McLone DG, Harwood-Nash (1983) Spinal dysraphysm. In: Newton TH, Potts DG (eds) Computed tomography of the spine and spinal cord. Clavadel Press, San Anselmo, Calif., p 299

    Google Scholar 

  2. Harwood-Nash DC (1981) Computed tomography of the pediatric spine: a protocol for the 1980's. Radiol Clin North Am 19:479–494

    Google Scholar 

  3. Rejo IM, Harwood-Nash (1978) Computed tomography metrizamide myelography in spina dysraphism in infants and children J Comput Assist Tomogr 2:549

    Google Scholar 

  4. Naidich TP, Harwood-Nash DC, McLone DG (1982) Radiology of spinal dysraphism. Clin Neurosurg 30:341–365

    Google Scholar 

  5. Haughton VM (1988) Spinal cord diseases. Presented at the 74th Scientific Assembly and Annual Meeting of RSNA, November 27–December 2, 1988. Radiology 169 [Suppl]:127

    Google Scholar 

  6. Williams AL, Quencer RM (1988) The abnormal spinal cord: current imaging status. Presented at the 74th Scientific Assembly and Annual Meeting of RSNA, November 27–December 2, 1988. Radiology 169 [Suppl]:284

    Google Scholar 

  7. Zimmermann RA (1988) Pediatric central nervous system. Presented at the 74th Scientific Assembly and Annual Meeting of RSNA, November 27–December 2, 1988. Radiology 169 [Suppl]:127

    Google Scholar 

  8. Naidich TP, Barrovich AJ (1988) Pediatric neuroradiology: the maturing central nervous system. Presented at the 74th Scientific Assembly and Annual Meeting of RSNA, November 27–December 2, 1988. Radiology 169 [Suppl]:295

    Google Scholar 

  9. Han JS, Benson JE, Kaufman B et al. (1983) NMR imaging of the spine, AJNR 4:1151

    Google Scholar 

  10. Modic MT, Weinstein MA, Pavlicek W et al. (1983) Nuclear magnetic resonance imaging of the spine. Radiology 148:757

    Google Scholar 

  11. Barnes PD, Lester PD, Iamanashy WS, Prince GR (1986) Magnetic resonance imaging in infants and children with spinal dysraphism. AJNR 7:465

    Google Scholar 

  12. Norman D, Mills CM, Brant Zawadzky M et al. (1984) Magnetic resonance imaging of the spinal cord and canal. Potentials and limitations. AJNR 5:9

    Google Scholar 

  13. Roos RAC, Vielvoye GJ, Voormolen JHC, Peters ACB (1986) Magnetic resonance imaging in occult spinal dysraphism. Pediatr Radiol 16:412–416

    Google Scholar 

  14. Altman NR, Altman DH (1986) MR imaging of spinal dysraphism. AJNR 8:533–538

    Google Scholar 

  15. Flanningan-Sprague BD, Modic MT (1988) The pediatric spine: normal anatomy and spinal dysraphism. In: Modic MT, Masarik TJ, Ross JS (eds). Magnetic resonance imaging of the spine. Year Book Medical Publishers, Chicago London Boca Rathon, pp 240–256

    Google Scholar 

  16. Norman D (1986) The spine In: Brant-Zawatzky M, Norma D (eds) Magnetic resonance imaging of the central nervous system. Raven Press, New York, pp 289–328

    Google Scholar 

  17. Davis PC, Hoffman JC, Turner JR et al. (1988) Spinal abnormalities in pediatric patients: MR imaging findings compared with clinical myelographic and surgical findings. Radiology 166:679–685

    Google Scholar 

  18. French BN (1982) Midline fusion defects of formation. Neurol Surg 2:1236

    Google Scholar 

  19. Creissard P, Redondo A (1974) Spina bifida. Neurologie 4:39

    Google Scholar 

  20. Anderson FM (1975) Occult spinal dysraphism: a series of 73 cases. Pediatrics 55:826

    Google Scholar 

  21. O'Railly R, Muller F (1986) The normal and abnormal development of the nervous system in the early human embryo. J Pediatr Neuroscience 2:89

    Google Scholar 

  22. French BN (1982) The embryology of spinal dysraphism. Clin Neurosurg 30:295–340

    Google Scholar 

  23. McLone DG, Mutluer S, Naidich TP (1983) Lipomeningoceles of the conus medullaris. Concepts Pediatr Neurosurg 3:170

    Google Scholar 

  24. Matson DD (1969) Neurosurgery in infancy and childhood, 2nd edn. Complete revision of monograph by Ingraham FD, Matson DD. Thomas, Springfield

    Google Scholar 

  25. Humphreys RP (1985) Spinal dysraphism. In: Wilkins RH, Rengachary SS (eds) Neurosurgery. McGraw-Hill, New York, pp 2041–2052

    Google Scholar 

  26. Page LK (1985) Occult spinal dysraphism and related disorders. In: Wilkins RH, Rengachary SS (eds) Neurosurgery. McGraw-Hill, New York, pp 2053–2058

    Google Scholar 

  27. Hoffman HJ, Taecholarn C, Hendrick, EB, Humphreys RP (1985) Management of lipomyelomeningoceles: experience at the hospital for sick children Toronto. J Pediatr Neurosciences 1:3

    Google Scholar 

  28. Giuffrè R (1966) Intradural spinal lipomas. Acta Neurol Chir 14:69–95

    Google Scholar 

  29. Emery JL, Lendon RG (1969) Lipomas of the caude equina and other fatty tumours related to neurospinal dysraphism. Dev Med Child Neurol [Suppl] 11:62–70

    Google Scholar 

  30. Chapman PH (1982) Congenital intraspinal lipomas. Anatomic considerations and surgical treatment. Child's Brain 9: 37–47

    Google Scholar 

  31. Cotroneo E, Floris R (1987) MRI of lumbosacral lipoma. In: Calabro A, Leonardi M (eds) Computer Aided Neuroradiology. XI Vth Congress of the European Society of Neuroradiology, Udine, Italy, September 8–12. Ed. Internazionali, Rome

    Google Scholar 

  32. Bruce DA, Schut L (1979) Spinal lipomas in infancy and childhood. Child's Brain 5:192–203

    Google Scholar 

  33. Dossetor RS, Kaiser M, Veiga-Pires JA (1979) CT scanning in two cases of lipoma of the spinal cord. Clin Radiol 30: 227–331

    Google Scholar 

  34. Walsh JW, Markesbery WR (1980) Histological features of congenital lipomas of the lower spinal canal. J Neurosurg 52: 564–569

    Google Scholar 

  35. Wippold FJ, Citrin C, Barkovich AJ, Sherman (1987) Evaluation of MR in spinal dysraphism with lipoma: comparison with metrizamide computed tomography. Pediatr Radiol 17: 184–188

    Google Scholar 

  36. Sarwar M, Virapongse C, Bhimani S (1984) Primary tethered cord syndrome: a new hypothesis of its orgin. AJNR 5: 235–242

    Google Scholar 

  37. Lapras C, Patet JD, Mottolese C (1988) Le syndrome de traction du cone terminal: Moelle attache et lipomes sacres Neurochirugie 34 [Suppl 1]:91

    Google Scholar 

  38. Hoffman HJ, Hendrick EB, Humphrey RP (1976) The tethered spinal cord: its protean manifestations, diagnosis and surgical correction. Child's Brain 2:145–155

    Google Scholar 

  39. Kaplan JO, Quencer MR (1980) The occult tethered conus syndrome in the adult. Radiology 137:387–391

    Google Scholar 

  40. Fitz CR, Harwood-Nash DC (1975) The tethered conus. AJR 125:515–523

    Google Scholar 

  41. Dachling Pang, Wilberg JE (1982) Tethered cord syndrome in adults. J Neurosurg 57:32–47

    Google Scholar 

  42. Sarwar M, Crelin ES, Kier EL, Virapongse C (1983) Experimental cord stretchability and the tethered cord syndrome. AJNR 4:641–643

    Google Scholar 

  43. Naidich TP, McLone DG, Mutluer S (1983) A new understanding of dorsal dysraphism with lipoma (lipomyeloschisis). AJNR 4:103–116

    Google Scholar 

  44. Naidich TP, Harwood-Nash (1983) Diastematomyelia: Hemicord and meningeal sheaths single and double arachnoid and dural tubes. AJNR 4:633–636

    Google Scholar 

  45. Han JS, Benson JE, Kaufman B et al. (1985). Demonstration of diastematomyelia and associated abnormalities with MR imaging. AJNR 6:215

    Google Scholar 

  46. Scotti G, Musgrave MA, Harwood-Nash DC et al. (1980) Diastematomyelia in children metrizamide and CT metrizamide myelography AJR 135:1225–1232

    Google Scholar 

  47. Guthkelch AN (1985) Diastematomyelia. In: Wilkins RH, Rengachary SS (eds) Neurosurgery. McGraw-Hill, New York, pp 2058–2061

    Google Scholar 

  48. Frerebeau P, Dimeglio A, Gras A, Harbi H (1984) Diastematomyelia. Report of 21 cases surgically trated by a neurological and orthopedic team. Child's Brain 10:328

    Google Scholar 

  49. Naidich TP, Regenbogen V, Limauro D, McLone DG (1988) Presented at 26th Annual Meeting of the American Society of Neuroradiology, Chicago, March 15–20, 1988

  50. Gerlach J (1978) Dermal sinuses and dermoids. In: Vinken PJ, Bruyn GW (eds) Handbook of clinical neurology, vol 32. Elsevier, Amsterdam, New York, pp 449–463

    Google Scholar 

  51. Monajati A, Spitzer RM, Larue Wiley J, Heggeness L (1986) MR imaging of a spinal teratoma. J Comput Assist Tomogr 10: 307–310

    Google Scholar 

  52. Bucy PC, Buchanan DN (1935) Teratoma of spinal cord. Surg Cynecol Obstet 60:1137–1144

    Google Scholar 

  53. Scotti G, Harwood-Nash DC, Hoffman HJ (1980) Congenital thoracic dermal sinus: diagnosis by computer assisted metrizamide myelography. J Comput Assist Tomogr 4:675–677

    Google Scholar 

  54. List CF (1941) Intraspinal epidermoids, dermoids and dermal sinuses. Surg Gynecol Obstet 73:525–538

    Google Scholar 

  55. Dachling Pang, Hoffman HJ (1980) Sacral agenesis with progressive neurological deficit. Neurosurgery 7:118–126

    Google Scholar 

  56. Renshaw TS (1978) Sacral agenesis: a classification and review of 23 cases. J Bone Joint Surg (Am) 60A:373–383

    Google Scholar 

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Tortori-Donati, P., Cama, A., Rosa, M.L. et al. Occult spinal dysraphism: neuroradiological study. Neuroradiology 31, 512–522 (1990). https://doi.org/10.1007/BF00340133

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