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Silent neurenteric cyst with split cord malformation at conus medullaris: Case report and literature review.

Srinivas H, Kumar A - J Pediatr Neurosci (2014 Sep-Dec)

Bottom Line: Split cord malformations (SCM) are a common pediatric abnormality where children present with features of tethering and backache along with varying neurological deficits.Multiple spinal neural tube defects in children need more attention and precise microneurosurgical skills as management differs in each of them.Co-existence of such pathologies detected intra-operatively may need modifications in preoperative planning to achieve the best possible outcomes.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India.

ABSTRACT
Split cord malformations (SCM) are a common pediatric abnormality where children present with features of tethering and backache along with varying neurological deficits. Multiple neural tube defects may co-exist in children having defects of primary and/or secondary neurulation. Co-existent neurenteric cysts along with type 1 SCM have been described very rarely in the literature. We report a case of silent neurenteric cyst at conus medullaris with SCM type 1 where the cyst was missed in the preoperative imaging. Until date, only 8 such cases of neurenteric cysts with SCM at lumbar region have been reported. We review the literature regarding co-existing dual pathologies of neurenteric cysts and type 1 SCMs in light of limited capacity of imaging modalities to detect small neurenteric cysts in presence of co-existent neural tube defects. Multiple spinal neural tube defects in children need more attention and precise microneurosurgical skills as management differs in each of them. Co-existence of such pathologies detected intra-operatively may need modifications in preoperative planning to achieve the best possible outcomes.

No MeSH data available.


Related in: MedlinePlus

Magnetic resonance imaging lumbar spine showing split cord malformation with low lying cord and terminal syrinx. Retrospective analysis shows a possible cystic lesion dorsal to the cord having a cerebrospinal fluid like intensity
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Figure 1: Magnetic resonance imaging lumbar spine showing split cord malformation with low lying cord and terminal syrinx. Retrospective analysis shows a possible cystic lesion dorsal to the cord having a cerebrospinal fluid like intensity

Mentions: A 12-year-old girl presented with complaints of low backache and difficulty in walking since childhood and pain radiating to both lower limbs. On examination, right plantar and dorsiflexion were mildly weak (Grade IV) and sensations of touch and pinprick were decreased by 20% in right L4 and L5 dermatomes. Magnetic resonance imaging (MRI) showed low lying cord with split cord malformation (SCM) type 1 from D12 to L3 with terminal syrinx. No other abnormality was evident [Figure 1]. Computed tomography scan showed bony septum at L1 region [Figure 2]. She was planned for D12 to L3 laminectomy and excision of bony cartilaginous spur at L1 level. Intraoperatively on opening the dura, a 2 cm × 2 cm small whitish globular lesion was identified. Whitish cheesy material came out of it once the wall was excised. Complete excision was performed, and dural tubes were repaired into one thecal sac subsequently. Postoperative recovery was uneventful. Histopathological examination revealed a cyst lined by cuboidal to ciliated columnar epithelium with focal stratification and occasional goblet cells with components of bone, cartilage, collagen, skeletal muscle tissue suggestive of type B neurenteric cysts.


Silent neurenteric cyst with split cord malformation at conus medullaris: Case report and literature review.

Srinivas H, Kumar A - J Pediatr Neurosci (2014 Sep-Dec)

Magnetic resonance imaging lumbar spine showing split cord malformation with low lying cord and terminal syrinx. Retrospective analysis shows a possible cystic lesion dorsal to the cord having a cerebrospinal fluid like intensity
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4302545&req=5

Figure 1: Magnetic resonance imaging lumbar spine showing split cord malformation with low lying cord and terminal syrinx. Retrospective analysis shows a possible cystic lesion dorsal to the cord having a cerebrospinal fluid like intensity
Mentions: A 12-year-old girl presented with complaints of low backache and difficulty in walking since childhood and pain radiating to both lower limbs. On examination, right plantar and dorsiflexion were mildly weak (Grade IV) and sensations of touch and pinprick were decreased by 20% in right L4 and L5 dermatomes. Magnetic resonance imaging (MRI) showed low lying cord with split cord malformation (SCM) type 1 from D12 to L3 with terminal syrinx. No other abnormality was evident [Figure 1]. Computed tomography scan showed bony septum at L1 region [Figure 2]. She was planned for D12 to L3 laminectomy and excision of bony cartilaginous spur at L1 level. Intraoperatively on opening the dura, a 2 cm × 2 cm small whitish globular lesion was identified. Whitish cheesy material came out of it once the wall was excised. Complete excision was performed, and dural tubes were repaired into one thecal sac subsequently. Postoperative recovery was uneventful. Histopathological examination revealed a cyst lined by cuboidal to ciliated columnar epithelium with focal stratification and occasional goblet cells with components of bone, cartilage, collagen, skeletal muscle tissue suggestive of type B neurenteric cysts.

Bottom Line: Split cord malformations (SCM) are a common pediatric abnormality where children present with features of tethering and backache along with varying neurological deficits.Multiple spinal neural tube defects in children need more attention and precise microneurosurgical skills as management differs in each of them.Co-existence of such pathologies detected intra-operatively may need modifications in preoperative planning to achieve the best possible outcomes.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India.

ABSTRACT
Split cord malformations (SCM) are a common pediatric abnormality where children present with features of tethering and backache along with varying neurological deficits. Multiple neural tube defects may co-exist in children having defects of primary and/or secondary neurulation. Co-existent neurenteric cysts along with type 1 SCM have been described very rarely in the literature. We report a case of silent neurenteric cyst at conus medullaris with SCM type 1 where the cyst was missed in the preoperative imaging. Until date, only 8 such cases of neurenteric cysts with SCM at lumbar region have been reported. We review the literature regarding co-existing dual pathologies of neurenteric cysts and type 1 SCMs in light of limited capacity of imaging modalities to detect small neurenteric cysts in presence of co-existent neural tube defects. Multiple spinal neural tube defects in children need more attention and precise microneurosurgical skills as management differs in each of them. Co-existence of such pathologies detected intra-operatively may need modifications in preoperative planning to achieve the best possible outcomes.

No MeSH data available.


Related in: MedlinePlus