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

Pediatric Neurosurgery - Tập 55 Số 6 - Trang 380-387 - 2020
Takato Morioka1,2, Nobuya Murakami3, Masako Ichiyama3, Takeshi Kusuda3, Satoshi Suzuki4,5
1Department of Neurosurgery, Fukuoka Children’s Hospital, Fukuoka, Japan
2Department of Neurosurgery, Harasanshin Hospital, Fukuoka, Japan
3Department of Neonatology, Fukuoka Children’s Hospital, Fukuoka, Japan
4Department of Neuropathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
5Department of Psychiatry, Shourai Hospital, Saga, Japan

Tóm tắt

<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.

Từ khóa


Tài liệu tham khảo

10.1227/NEU.0b013e3181f93e5a

10.1007/s00381-013-2189-2

10.1007/s00381-016-3207-y

10.1111/neup.12382

10.1159/000495810

10.1227/NEU.0b013e31820ee282

10.1007/s00381-017-3644-2

10.1007/s00381-018-3812-z

10.1007/s00381-018-3938-z

10.3171/2016.12.PEDS16171

10.1007/s00381-017-3625-5

10.1007/s00381-018-3870-2

10.1007/s00381-019-04297-8

10.1007/s00381-019-04071-w

10.1159/000494029

Thông tin
Thông tin xuất bản

Pediatric Neurosurgery

Tập 55 Số 6

380-387

Thông tin tác giả