Type 1.5 Split Cord Malformation : A New Theory of Pathogenesis

To report two cases of type 1.5 split cord malformation (SCM), a subtype of SCM with combined characteristics of types I and II and to review the relevant literature and propose a new possible pathogenetic theory for type 1.5 SCM. A 52-year-old woman had hemicords within a single dural sac with a dorsal bony septum at the L5 level. A 9-year-old boy had hemicords within a single dural sac with a ventral bony septum and fibrous extension at the L3 level. Both patients underwent microsurgical treatments for removing the bony septum, detethering the spinal cord, and sectioning the filum terminale. The surgical procedure revealed an extradural partial bony septum and hemicords within an intact single dural sac in each patient. Both patients were discharged from the hospital without de novo nerve dysfunction. Published cases have validated that types I and II SCM can overlap. We recommend recent type 1.5 SCM as a normative terminology for this overlapping SCM and report two rare cases of this SCM. We propose an associated pathogenesis consisting of uneven distribution and regression to explain type 1.5 SCM. Furthermore, we postulate that the amount of condensing meninx primitiva might determine whether the left bony septum has fibrous extensions to the opposite dura in type 1.5 SCM.

Ruptured Spinal Dermoid Cysts with Lipid Droplets into the Syrinx Cavity : Reports of Fourteen Cases

Objective@#: Dermoid cysts are uncommon in spinal cord tumors, and the phenomenon of their spontaneous rupture into the syrinx cavity is quite rare. We aimed to analyze the imaging characteristics and etiologies, and propose some surgical strategies, for this uncommon phenomenon. @*Methods@#: We retrospectively reviewed 14 cases with spinal dermoid cysts that ruptured into the cervical and thoracic syrinx cavity. There were six male and eight female cases, aged 21 to 46 years, who had lipid droplets in the syrinx cavity from C1 to L3. The dermoid cysts were always located at the conus. Based on patients’ complaints, clinical manifestations, and imaging results, we adopted tumor excision and/or syrinx cavity aspiration in one stage or multiple stages. @*Results@#: Three patients had only a syrinx cavity aspiration surgery due to a history of dermoid cyst excision. Eight patients had dermoid cyst resection and syrinx cavity aspiration in one stage. One patient was operated upon in two stages due to the development of new symptoms at nine months follow-up. Two patients underwent only tumor resection since they did not show similar symptoms or signs caused by the cervicothoracic syrinx. The axial magnetic resonance imaging indicated that the lipid droplets were always not at the center but were eccentric. The clinical effect was satisfactory during the follow-up period in this group. @*Conclusion@#: The lipid droplets filled the spinal syrinx cavity, not entirely confined to the central canal. Based on the chief complaints and associated signs, we adopted different surgical strategies and had satisfactory clinical results.

Intraoperative lumbar cathetering for prevention of postoperative cerebrospinal fluid leakage in lumbosacral vertebral canal / 局解手术学杂志

Objective To study the technique of lumbar cathetering in lumbosacral vertebral canal operation and its effect on prevention of postoperative cerebrospinal fluid leakage.Methods Retrospectively analyzed the clinical data of patients who underwent lumbosacral ver-tebral canal surgery and suffered from difficult dural repair during the operation in Department of Neurosurgery from August 2015 to October 2015.These patients were divided into the observation group (11 cases)and the control group (12 cases)according to whether lumbar cathe-ter were placed during the operation or not.Volume of drainage was strictly controlled after surgery.Remove the epidural drainage after primi-tive healing of the dura mater.The lumbar catheter was removed after 7 to 10 days.The indwelling time of each patient was collected and sta-tistical analyzed.Results The observation group got obvious shorter epidural drainage indwelling time than the control group(P <0.05). Short-term postoperative complications did occur in some cases in observation group,however,there was no obvious increase of infection rate in patients with lumbar continuous drainage indwelling.Conclusion Lumbar cathetering during the operation could be an effective method to solve difficult problem of placeing a lumbar drainage after lumbar puncture and to prevent cerebrospinal fluid leakage after operations of lum-bosacral vertebral canal.But it can not replace the delicate operation and tight dural suture.Drainage should be used only as a remedial measure of dural repair failure.

Diagnosis and treatment of calcifying pseudoneoplasm of thoracic spine / 局解手术学杂志

Objective To explore the characteristics of calcifying pseudoneoplasm of the neuraxis ( CAPNON) , and to improve the di-agnostic level and standard of treatment. Methods The clinical traits, imaging features and curative effect of one case of CAPNON who were treated in our departmen were analyzed combined with the pathological analysis and literature review. Results Transient back pain was the only clinical presentation of the patient. CT images showed obvious calcification. MRI showed low signal in T1-weigthed images and T2-weighted images. Examined with the contrast-enhanced MR images, the lesion showed inhomogeneous enhancement. No nervous symptom newly occurred in the 6-month follow-up. Conclusion Symptoms of patients with CAPNON are generally related to local compression or irri-tation of the adjacent tissue. CAPNON should be highly suspected in patients with dense calcification in the CT combined with low signal in T1-weigthed images and T2-weighted images and rim or internal inhomogeneous linear enhancement in the MRI. The final diagnosis depends on the histopathological analysis, and surgical resection is the major therapy.