Missed limited dorsal myeloschisis: an unfortunate cause for recurrent tethered cord syndrome

Chatterjee, Sandip; Rao, Keerthi

doi:10.1007/s00381-015-2774-7

Cited by 10 publications

(4 citation statements)

References 21 publications

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“…While a myelomeningocele is associated with a poor functional outcome, LDM can have a good outcome [8-10]. When LDM is incorrectly diagnosed as a simple meningocele, the stalk may persist postoperatively, and recurrent or de novo tethered cord syndrome may subsequently develop [11]. The perinatal imaging hallmark of LDM is visualization of a stalk that links the saccular skin lesion to the cord [9, 10].…”

Section: Discussionmentioning

confidence: 99%

Slender Stalk with Combined Features of Saccular Limited Dorsal Myeloschisis and Congenital Dermal Sinus in a Neonate

et al. 2019

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Limited dorsal myeloschisis (LDM) and congenital dermal sinus (CDS) originate from incomplete disjunction between the cutaneous and neural ectoderms. Some LDM stalks have been found to have elements of a CDS or dermoid cyst. We surgically treated a saccular lesion in the lumbosacral region of a 7-day-old male neonate. Although fetal magnetic resonance imaging (MRI) failed to reveal a stalk, postnatal MRI including three-dimensional heavily T2-weighted imaging demonstrated a stalk originating from the lumbar cord and extending caudally to enter the lumbosacral meningocele sac. During untethering surgery, we found that the stalk was slender, with a diameter of 0.7–0.8 mm, but otherwise appeared to be a typical LDM stalk. Histopathological examination revealed that the fibrocollagenous stalk contained glial fibrillary acidic protein-immunopositive neuroglial tissues and stratified squamous epithelium. The present report describes the first documented case of a stalk with combined features of saccular LDM and CDS in a neonate. Since cutaneous ectodermal tissue is likely to remain in the remnant stalk, this patient requires careful monitoring to detect the potential development of a dermoid cyst.

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Section: Discussionmentioning

confidence: 99%

Slender Stalk with Combined Features of Saccular Limited Dorsal Myeloschisis and Congenital Dermal Sinus in a Neonate

et al. 2019

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“…The cause is not clear, but it may involve physiological kyphosis of the thoracic spine. Since both of the remnant thick stalk in patient 1 and the dorsal bending of the cord in patient 2 may cause the re-tethered cord syndrome, 22) close observation with repeated MRI is needed.…”

Section: Discussionmentioning

confidence: 99%

Saccular Limited Dorsal Myeloschisis with Spinal Cord Deviation out of the Spinal Canal to the Sac

Kurogi

Morioka

Murakami

et al. 2021

NMC Case Report Journal

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Saccular limited dorsal myeloschisis (LDM) is characterized by a fibroneural stalk linking the saccular skin lesion to the underlying spinal cord. Since untethering surgery during the early postnatal period is often indicated to prevent sac rupture, saccular LDM should be distinguished from myelomeningocele (MMC) during the perinatal period. We treated two patients with the spinal cord deviation from the spinal canal to the sac, which mimicked a prolapse of the neural placode into the MMC sac. In patient 1, pre-and postnatal magnetic resonance imaging (MRI) revealed that the spinal cord was strongly tethered to the thick stalk. During surgery, the dorsally bent cord and stalk were united, and the border between these two was determined with intraoperative neurophysiological mapping (IONM). In patient 2, the spinal cord was tethered to two slender stalks close to each other, which was visible with the combined use of sagittal and axial postnatal three-dimensional heavily T2-weighted imaging (3D-hT2WI). The preoperative MRI hallmark of saccular LDM is the visualization of a stalk that links the bending cord and sac. Complete untethering surgery to return the cord into the spinal canal and correct its dorsal bending is recommended.

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“…However, with the advent of modern MR imaging and a better understanding of the condition, this is less common. 95…”

Section: Failure Of Primary Dysjunctionmentioning

confidence: 99%

Embryology of Spinal Dysraphism and its Relationship to Surgical Treatment

Eagles

Gupta

2020

Can. J. Neurol. Sci.

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Spinal dysraphism is an umbrella term that encompasses a number of congenital malformations that affect the central nervous system. The etiology of these conditions can be traced back to a specific defect in embryological development, with the more disabling malformations occurring at an earlier gestational age. A thorough understanding of the relevant neuroembryology is imperative for clinicians to select the correct treatment and prevent complications associated with spinal dysraphism. This paper will review the neuroembryology associated with the various forms of spinal dysraphism and provide a clinical-pathological correlation for these congenital malformations.

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Missed limited dorsal myeloschisis: an unfortunate cause for recurrent tethered cord syndrome

Cited by 10 publications

References 21 publications

Slender Stalk with Combined Features of Saccular Limited Dorsal Myeloschisis and Congenital Dermal Sinus in a Neonate

Slender Stalk with Combined Features of Saccular Limited Dorsal Myeloschisis and Congenital Dermal Sinus in a Neonate

Saccular Limited Dorsal Myeloschisis with Spinal Cord Deviation out of the Spinal Canal to the Sac

Embryology of Spinal Dysraphism and its Relationship to Surgical Treatment

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