Myelomeningocele in one neonate from a fraternal triplet birth: Two case reports on neurosurgical and multidisciplinary treatment during the perinatal period

Murakami, Nobuya; Kanata, Akiko; Kurogi, Ai; Mukae, Nobutaka; Shimogawa, Takafumi; Nakanami, Naoyuki; Ichiyama, Masako; Morioka, Takato

doi:10.1016/j.inat.2021.101372

Cited by 1 publication

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“…Subsequently, multiple-layer closure, including the dura mater and muscle layer, subcutaneous tissue, and skin, with skin flap when required, was performed as described previously. [ 12 , 16 ] For intraoperative neurophysiological monitoring (IONM), we recorded evoked compound muscle action potentials from the external anal sphincter, hamstrings, and gastrocnemius muscles by direct electrical stimulation of the NP, CM, and nerve roots as described previously. [ 12 ] Pre- and postnatal magnetic resonance imaging (MRI), including 3D-heavily T2-weighted image (3D-hT2WI), was performed as described in the previous reports.…”

Section: Methodsmentioning

confidence: 99%

Histopathological presence of dermal elements in resected margins of neural structures obtained from initial repair surgery for myelomeningocele

Murakami

Kurogi

Suzuki³

et al. 2023

Surgical Neurology International

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Background: Development of dermoid or epidermoid cysts in myelomeningocele (MMC) sites is generally thought to occur in a delayed fashion due to implantation of dermal elements during initial repair surgery. Another theory is that dermal and dermoid elements may already be present within dysplastic neural structures at birth. Methods: We experienced histopathological presence of dermal elements in resected tissues at initial repair surgery in four out of 18 cases with MMC who required resection of parts or margins of the neural structures to perform cord untethering. Since one of these cases has already been reported, we describe the clinicopathological findings for the remaining three cases. Results: In Case1, cryptic dermoid elements were discovered in the terminal filum-like structure (FT-LS) caudal to the open neural placode (NP). The FT-LS had histopathological characteristics similar to the retained medullary cord. In Case 2, dermoid elements were discovered in the caudal margin of the dysplastic conus medullaris. In Case 3, a thin squamous epithelial layer overlapped the rostral margin of the NP where the NP was located near the skin. Case 1 developed an epidermoid cyst at 1 year and 2 months of age, which was totally resected. Conclusion: Prenatally existing cryptic dermoid elements in the caudal portion of neural structures and remnants of dermal elements overlapping the rostral margin of the NP are associated with delayed occurrence of dermoid/ epidermoid cysts. Postoperative histopathological investigation of the resected specimens is recommended. Once dermal elements are revealed, repeated imaging examination and additional surgery should be considered.

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Section: Methodsmentioning

confidence: 99%