Cystic spinal dysraphism of the cervical and upper thoracic region.

BACKGROUND: Cystic dysraphic lesions of the cervical and upper thoracic region are rare and only a few series have been published about the topic. These malformations can be divided into categories that include both myelocystoceles and the so-called cervical meningoceles or myelomeningoceles. METHODS: A retrospective study of 18 patients was conducted. RESULTS: In 17 patients a squamous or a cicatricial epithelium of variable thickness covered the dome of the lesions, while the base was covered with full-thickness skin. In one case the skin was entirely normal. Four patients displayed associated CNS malformations and three more had systemic congenital anomalies. All patients underwent surgical exploration and the length of time between birth and surgery ranged from 6 h to 9 months. The most frequent surgical finding, seen in 14 patients, was a stalk connecting the dorsal surface of the spinal cord to the cyst. In three patients the findings were consistent with myelocystocele. Only in one case was a true meningocele found. Hydrocephalus and Chiari II malformation were not as consistently associated as in myelomeningoceles. Neurological signs and symptoms were not so marked as in myelomeningoceles and were found in the follow-up of four patients. In two of them there was a non-progressive deficit, probably expressing an imperceptible involvement of the nervous system in the first year of life. The histopathological findings were of three types: neuroglial stalks, fibrovascular stalks and myelocystoceles. CONCLUSIONS: Cystic dysraphisms of the cervical and upper thoracic region differ clinically and structurally from meningomyelocele and have a more favorable outcome. We believe that these malformations have not been properly labeled and propose a classification based on the structures found inside the cyst.

Tomografia computadorizada das cavidades naso-sinusais: Algumas ocorrências interessantes / Comouterized tomography of the nasal & paranasal cavities: some intersting ocurrences

No estudo das cavidades naso-sinusais por tomografia computadorizada, o especialista pode encontrar ocorrências interessantes por sua raridade ou por seu valor especial como ilustração de uma determinada patologia ou peculiaridade anatômica. Em ambos os casos, o especialista sente a compulsão de exibilas aos colegas, principalmente àqueles que se iniciam no assunto, quer radiologistas, quer otorrinos. Na presente comunicação são apresentadas nove de tais ocorrências, das quais cinco por terem sido consideradas raras (mucocele gigante da concha nasal média, pneumatização da concha nasal inferior, encefalomeningocele basal transetmoidal (intranasal) congênita, pneumatização do septo nasal pelo seio frontal, peumatização extensa do assoalho da órbita