Spinal dysraphism controversies: AIIMS experiences and contribution

 

PDF Download Buy Article Permissions and Reprints

Abstract

A large series of split cord malformation (SCM). Over the last 22 years, we have operated more than 1500 patients of SD, of which over 450 are (SCM), and 300 are with various lipomatus malformations. About 55% type II and 45% type I SCM. A separate sub-classification of type I SCM (a,b,c and d), is presented which alter the surgical approach and influence the results. Overall improvement following surgery in patients with SCM was observed in 94%. Fifty percent patients improved and 44% remained stable. However, deterioration was noticed in 6%, mostly with composite type of SCM. A paradigm for management of SCM is provided taking into consideration also the author’s large experience.

• References

• 1 Pang D. Split cord malformation part II clinical syndrome. Neurosurg 1992; 31: 481-500
  CrossrefPubMedGoogle Scholar
• 2 Dorward NL, Seatliff JH, Hayward RD. Congenital lumbosacral lipoma: Pitfalls in analyzing the results of prophylactic surgery. Childs NervSyst 2002; 18: 326-332
  PubMedGoogle Scholar
• 3 Mahapatra AK. Split Cord malformation. A study of 300 cases at AIIMS 1996-2006. JPediatrNeurosci 2011; 6: 541-545
  PubMedGoogle Scholar
• 4 Mahapatra AK, Gupta DK. Split cord malformation: A clinical study of 254 patients and proposal for new clinical imaging classification. J Neurosurg 2005; 103: 531-536
  PubMedGoogle Scholar
• 5 Kasliwal MK, Mahapatra AK. Surgery for spinal cord lipoma. Ind J Pediatrics 2007; 74: 39-44
  PubMedGoogle Scholar
• 6 Agrawal D, Mahaptra AK. Complex split cord malformation associated with situsinversustotalis. JPedNeurosci 2007; 2: 39-40
  PubMedGoogle Scholar
• 7 Dwarkanath S, Suri A, Mahapatra AK, Mehta VS. Adult Complex Spinal Dyraphism with situsinversustotalis. A rare case and reviewer Spine 2005; 30 (Suppl. 08) E225-E228
  PubMedGoogle Scholar
• 8 Suri A, Ahmad FU, Mahapatra AK, Mehta VS, Sharma MC, Gupta V. Mediastinal extension of an intraduralteratoma in a patient with split cord malformation: A case report and review of literature. Childs NervSyst 2006; 22: 440-444
  PubMedGoogle Scholar
• 9 Gupta DK, Mahaptra AK. Proposal for new clinoradiological classification of type I split cord malformation. A prospective study of 25 cases. PediatrNeurosurg 2006; 42: 341-346
  PubMedGoogle Scholar
• 10 Tunguria A, Srivasatava A, Mahapatra AK. Rajkumar Multiple neural tube defect in the same patient with no neurological deficit. J Pediatr Neurosci 2010; 5: 52-56
  CrossrefPubMedGoogle Scholar
• 11 RajKumar Garg P, Kalra SK, Mahapatra AK. Management of multiple tethering in spinal dysraphism. Childs NervSyst 2010; 26: 1743-1747
  PubMedGoogle Scholar
• 12 Pang D, Zovickianf Oviedo A. Long term outcome of total and near total excision of spinal cord lipoma and radical reconstruction of the neural placode. Part II. Outcome analysis and preoperative profiling. Neurosurgery 2010; 66: 253-272
  PubMedGoogle Scholar
• 13 Kang HS, Wang KC, Kim KM, Kim SK, Cho BK. Prognostic factors affecting urologic outcome after untethering surgery for lumbosacral lipoma. Childs NervSyst 2006; 22: 1111-1121
  PubMedGoogle Scholar
• 14 Ansari S, Nejt F, Yazdari S, Dadmer M. Split cord malformation associated with meningomyelocele. JNeurosurg 2007; 107: 284-285
  PubMedGoogle Scholar
• 15 Proctor MR, Scott MR. Long term outcome for patients with split cord malformation. Neurosurg Focus 2001; 15: 10-15
  PubMedGoogle Scholar
• 16 Arai H, Sato K, Okuda O, Miyajima M, Hishii M, Nakanishi H. et al Surgical experience of 120 patients with lumbosacral lipomas. ActaNeurochirg (wien) 2001; 143: 857-864
  PubMedGoogle Scholar
• 17 Jindal A, Mahapatra AK. Spinal congenital dermal sinus. An experience 23 cases in 7 years. Neurol India 2001; 49: 243-246
  PubMedGoogle Scholar
• 18 Jindal A, Mahapatra AK. Spinal Lipomatus malformation. Indian JPediatr 2000; 67: 342-346
  PubMedGoogle Scholar
• 19 Kasliwal MK, Dwarkanath S, Mahapatra AK. Cervical meningomyelocele -an institutional experiences. Childs NervSyst 2007; 23: 1291-1293
  PubMedGoogle Scholar
• 20 Agarwal D, Suri A, Mahapatra AK, Sharma MC. Intramedullary neuroenteric cyst presenting infantile paraplegia. A case report. PediatrNeurosurg 2002; 27: 93-96
  PubMedGoogle Scholar
• 21 Satyarthee GD, Mahapatra AK. Presacralneuroenteric cyst in an infant. PediatrNeurosurg 2003; 39: 222-224
  PubMedGoogle Scholar
• 22 Pierre AKahn, Zerah M, Renier D, Clinalli G. Congenital lumbosacral lipoma. Childs NervSyst 1997; 13: 298-334
  PubMedGoogle Scholar
• 23 Champman PH. Congenital intraspinallipomas anatomic consideration and surgical treatment. Childs Brain 1982; 9: 37-47
  PubMedGoogle Scholar
• 24 Kulkarni AV, Pierre AKahn, Zerah M. Conservative management of asymptomatic spinal lipoma of the conus. Neurosurgery 2004; 54: 868-873
  CrossrefPubMedGoogle Scholar
• 25 Sinha S, Agrawal D, Mahapatra AK. Split cord malformations: An experience of 203 cases. Childs NervSyst 2006; 22: 3-7
  PubMedGoogle Scholar
• 26 Chandra PS, Kamal R, Mahapatra AK. An unusual case of dorsally situated spur in lumar split cord malformation. PediatrNeurosurg 1997; 31: 49-52
  PubMedGoogle Scholar
• 27 Khandelwal A, Tandon V, Mahapatra AK. An unusual case of 4 level spinal dysraphism multiple composite type I, type II split cord malformation, dorsal myelocystocele and hydrocephalus. JPaedtrNeurosci 2011; 6: 58-61
  PubMedGoogle Scholar
• 28 Ahmed FU, Dwarkanath S, Sharma BS, Mahapatra AK. Multiple neural tube defect: A clinical series of seven cases and their embryological basis. PediatrNeurosurg 2008; 44: 280-287
  PubMedGoogle Scholar
• 29 Chapman P, Stieg PE, Magge S, Barnes P, Feany M. Spinal lipoma controversies Neurosurgery 1999; 44: 186-192
  PubMed
• 30 Koyanagi I, Iwasaki Y, Hida K, Abe H, Isu T, Akino M. et al Factors in neurological deterioration and role of surgical treatment in lumbosacral spinal lipoma. Childs NervSyst 2006; 16: 143-149
  PubMedGoogle Scholar
• 31 Koyanagi I, Hida K, Iwasaki Y, Isu T, Yoshino M, Murakami T. et al Radiological finding and clinical course of conuslipoma: Implications for surgical treatment. Neurosurgery 2008; 63: 546-551
  CrossrefPubMedGoogle Scholar
• 32 Dwarkanath S, Sharma BS, Mahapatra AK. Triple neural tube defect and multisite closure theory for neural tube defect. Is this an additional site?. JPediatrNeurosurg 2008; 1: 160-163
  PubMedGoogle Scholar
• 33 Ahmed FU, Mahapatra AK. Neural tube defect at separate sites: Further evidence in support of multisite closures of the neural tube in human. SurgNeurol 2009; 71: 353-356
  PubMedGoogle Scholar
• 34 Maiti TK, Bhat DI, Devi BI, Sampath S, Mahadevan A, Shankar SK. Teratoma in split cord malformation, an unusual association: Areport of two cases and review of the literature. PediatrNeurosurg 2010; 46: 238-241
  PubMedGoogle Scholar
• 35 Naik V, Mahapatra AK, Gupta D, Suri V. Spinal teratoma associated with a split cord malformation. A case report. PediatrNeurosurg 2010; 46: 368-372
  PubMedGoogle Scholar
• 36 Gupta DK, Ahmed S, Garg K, Mahapatra AK. Regrowth of septal spur in split cord malformation. PediatrNeurosurg 2010; 46: 242-244
  PubMedGoogle Scholar