Minor skin lesions as markers of occult spinal dysraphisms—prospective study

Henriques, José Gilberto de Brito; Pianetti, Geraldo; Henriques, Karina Santos Wandeck; Costa, P.U; Gusmão, Sebastião

doi:10.1016/j.surneu.2004.09.017

Cited by 51 publications

(60 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…10,16 In clinical practice, however, it is important to distinguish between dermal sinus tracts and sacrococcygeal dimples, as they are treated differently. The dural sac ends at S-2, 8 and sacrococcygeal dimples do not extend into the intradural space.…”

Section: 19mentioning

confidence: 99%

Intraspinal lesions associated with sacrococcygeal dimples

Harada¹,

Nishiyama²,

Yoshimura³

et al. 2014

PED

View full text Add to dashboard Cite

Object Sacrococcygeal dimples in the gluteal fold, also known as coccygeal pits, are observed in 2%–4% of newborns. Sacrococcygeal dimples are not generally considered to be associated with a significant risk of intraspinal anomalies and therefore are not thought to require further radiographic evaluation. Accordingly, the precise incidence and nature of intraspinal lesions that may be associated with sacrococcygeal dimples is unclear. This study was conducted to determine the incidence of intraspinal lesions in patients with intergluteal dimples. Methods In this study, the authors used MRI to evaluate 103 children who were seen at the Niigata University Medical and Dental Hospital between 2006 and 2011 because of skin abnormalities in the lumbosacral region. Of these children, 14 were excluded as having a subcutaneous fatty mass, and 5 were excluded because the dimples were above the gluteal fold or did not end at the coccyx. The remaining 84 patients were classified according to whether the bottom of the dimple was visible (shallow) or not (deep). The authors also retrospectively examined other skin abnormalities and coexisting anomalies. Results The mean age at the time of MRI evaluation was 11.7 months. Magnetic resonance imaging led to the identification of fibrolipoma of the terminal filum (FTF) in 14 cases (16.7%); 6 of these patients also had a low conus. Classified by depth, there were 58 cases with shallow and 26 with deep dimples. Fibrolipoma of the terminal filum was found in significantly more patients with deep dimples (9 [34.6%]) than in those with shallow dimples (5 [8.6%]). The frequency of other congenital anomalies was significantly higher in patients with FTF-associated dimples (6 [42.9%] of 14) than in those with dimples that were not associated with FTF (9 [12.9%] of 70). Conclusions Fibrolipoma of the terminal filum was identified by MRI in 16.7% of patients with sacrococcygeal dimples. The risk of FTF increased when the dimples were deeply excavated or were accompanied by congenital anomalies. Magnetic resonance imaging should be performed to identify intraspinal lesions when there are high risk factors for intraspinal abnormalities, or when an ultrasound screening suggests intraspinal abnormalities.

show abstract

Section: 19mentioning

confidence: 99%

Intraspinal lesions associated with sacrococcygeal dimples

Harada¹,

Nishiyama²,

Yoshimura³

et al. 2014

PED

View full text Add to dashboard Cite

show abstract

“…The rate of spinal-dysraphism-related nervous system abnormalities in neonates with a single and small lesions is low [26]; however, the study of 171 neonates who had spinal dysraphism abnormalities showed that multiple skin lesions, large subcutaneous masses and cutaneous sinuses over the sacrum were correlated with an increase in the rate of spinal dysraphism disorders. Henriques et al [10] also prospectively studied minor skin lesions as signs of spinal dysraphism by spinal USG. If the ultrasound study was abnormal or inconclusive, it was complemented with MRI.…”

Section: Discussionmentioning

confidence: 99%

“…Symptoms leading to the diagnosis are upper motor neuron dysfunction, lower motor neuron dysfunction and their associated malformations [4]. There are 6 cutaneous manifestations of congenital neuroectodermal anomalies which are possible indicators of spinal dysraphism [5,6,7]; these include the presence of a dermal sinus (dimple), focal hypertrichosis, midline or paraspinal subcutaneous masses (low-lying lipomas) which cause gluteal cleft asymmetry, strawberry nevus or telangiectasia, cutaneous appendage or rudimentary tail, and atretic meningocele associated with abnormal gait and lower limb posture changes [2,8,9,10,11]. About 50% of these lesions are associated with spinal dysraphism disorders and therefore are of great diagnostic value [12].…”

Section: Introductionmentioning

confidence: 99%

Correlation of Cutaneous Lesions with Clinical Radiological and Urodynamic Findings in the Prognosis of Underlying Spinal Dysraphism Disorders

Sasani

Asghari²,

Asghari

et al. 2008

Pediatr Neurosurg

View full text Add to dashboard Cite

Spinal dysraphism is characterized by a lack of fusion of the vertebral arches that occurs in the absence of spinous processes with variable amounts of lamina. Here, we retrospectively present the importance of cutaneous lesions and their correlation with clinical presentation, radiological examination and urodynamic assessment. We retrospectively reviewed 612 (6.12%) cases with skin lesions from 10,000 consecutive live-born children seen at two institutions between January 1998 and March 2005. We divided all children into a control group and three groups based on clinical assessment, radiological examination and urodynamic evaluation results. Neurological deficits were identified in 113 (18.46%) children, while spinal dysraphism disorders, tethered cord syndrome and associated orthopedic malformations were found in 171 (27.94%), 119 (19.45%) and 28 (4.57%) patients, respectively. The incidence of tethered cord with lumbosacral dimple lesions over the sacrum (32/119, 26.65% of patients) was 3.5-fold higher than that of lesions found over the coccyx (9/119, 7.5% of patients). Uroneurological symptoms were found in 207/612 (33.82%) children. Urodynamic assessment revealed decreased bladder capacity in 10% of patients, detrusor hyperflexia during filling in 47% and a low-compliance detrusor in 71%. Discordance between ultra- sonography and MRI was found in 16.58% of patients. Spinal cord untethering was performed for 109 patients. Nearly all children with resolution were at the end of their follow-up period (24 months). Retethering occurred in 21 (19.26%) patients, and a second untethering surgery was performed in 12 patients. When spina bifida was associated with lumbar skin lesions, there may have been an increased incidence of tethered cord and other spinal cord disorders. MRI scans are more reliable and give an exact diagnosis of tethered cord. Neurological and uroneurological instability are ultimately a clinical diagnosis, and there is controversy about their indications for surgery. However, the correlation between urodynamic assessment and cutaneous lesions with a tethered cord found by MRI examination allow for an early diagnosis and the possibility of prompt treatment.

show abstract

“…Extraspinal lesions have no direct relationship with neurological deficits and they are not markers of spinal dysraphism [21], but they can hint at the possibility of existing neurological deficits and provide cues to diagnose and evaluate the disease.…”

Section: Discussionmentioning

confidence: 99%

Study on the Pathomorphology of Myelodysplasia

et al. 2008

View full text Add to dashboard Cite

Objective: To study the clinical pathomorphology of myelodysplasia and research its relationship with the neurological defect of myelodysplasia. Methods: 184 patients with myelodysplasia were diagnosed and evaluated depending on patient history, physical examination, imaging, voiding cystourethrogram and urodynamic tests. 182 patients underwent surgical management. The intraspinal anomalies and their relationships with the spinal cords were observed and recorded during operations. The pathological tissues which were resected during the operations were examined postoperatively. Results: Myelodysplasia was divided into 6 types depending on the intraspinal pathomorphology: type I (tethered spinal cord with morbid terminal filum), type II (tethered spinal cord with fibrous adhesion), type III (lipoma on the spinal cord), type IV (intraspinal cyst), type V (split cord malformations), and type VI (defect of spinal cords and/or nerve roots). Conclusions: Theneurological defect of myelodysplasia results from its intraspinal anomaly and the morphological change of the spinal cord. It should be actively diagnosed and surgically treated to improve the prognosis.

show abstract

Minor skin lesions as markers of occult spinal dysraphisms—prospective study

Cited by 51 publications

References 11 publications

Intraspinal lesions associated with sacrococcygeal dimples

Intraspinal lesions associated with sacrococcygeal dimples

Correlation of Cutaneous Lesions with Clinical Radiological and Urodynamic Findings in the Prognosis of Underlying Spinal Dysraphism Disorders

Study on the Pathomorphology of Myelodysplasia

Contact Info

Product

Resources

About