Spinal cord deformity with aggravation of tethering in saccular limited dorsal myeloschisis during the first 2 months of life

Takafumi Shimogawa, Nobutaka Mukae, Akiko Kanata, Haruhisa Tsukamoto, Nobuya Murakami, Ai Kurogi, Tadahisa Shono, Satoshi O. Suzuki, Takato Morioka

研究成果: Contribution to journalArticle査読

抄録

Background: Although the optimal timing of prophylactic untethering surgery for limited dorsal myeloschisis (LDM) with intact or subtle neurological findings diagnosed at birth remains undetermined, intentional delayed surgery is commonly used for flat and tail-like LDM. Conversely, for saccular LDM, early surgery is indicated during the postnatal period because it prevents rupture of the sac. We treated a saccular LDM patient, in whom intentional delayed surgery was selected because the sac was thickly covered with normal skin. We describe the clinical course of the case and discuss the optimal timing of the surgery. Case Description: The patient had a dorsal midline sac in the upper lumbar region. Initial magnetic resonance imaging (MRI) after birth revealed a tethering tract that began at the dome of the sac and joined the lumbar cord. Dorsal bending of the cord at the stalk-cord union and invagination of the cord into the sac were noted. At 2 months, he was neurologically normal; however, the second MRI examination revealed that the cord tethering was aggravated. The cord was markedly displaced dorsally and to the left, with deviation of the cord to the sac out of the spinal canal. Following untethering surgery, the spinal cord deformity markedly improved. Conclusion: Early surgery may be recommended for saccular LDM when tethering is present, including dorsal bending of the cord at the stalk-cord union and invagination of the cord into the sac observed on detailed MRI examination, even if the sac has no risk of rupture.

本文言語英語
論文番号476
ジャーナルSurgical Neurology International
12
DOI
出版ステータス出版済み - 2021

All Science Journal Classification (ASJC) codes

  • 外科
  • 臨床神経学

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