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1.
World Neurosurg ; 133: 185-187, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31606509

RESUMO

We report a rare case of bony diastematomyelia associated with intraspinal teratoma. The patient was surgically treated with bony diastematomyelia and intradural teratoma resection, followed by lumbar duroplasty, and posterior fusion from L2-L4 in order to maintain the spinal stability of the approached segments. Despite the risks, it was necessary to perform early surgical treatment because of rapid neurologic deterioration. The patient had a good postoperative outcome.


Assuntos
Vértebras Lombares/cirurgia , Defeitos do Tubo Neural/cirurgia , Neoplasias da Medula Espinal/cirurgia , Fusão Vertebral/métodos , Teratoma/cirurgia , Vértebras Torácicas/cirurgia , Adulto , Humanos , Vértebras Lombares/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino , Defeitos do Tubo Neural/complicações , Defeitos do Tubo Neural/diagnóstico por imagem , Neoplasias da Medula Espinal/complicações , Neoplasias da Medula Espinal/diagnóstico por imagem , Teratoma/complicações , Teratoma/diagnóstico por imagem , Vértebras Torácicas/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Resultado do Tratamento
2.
BMC Surg ; 19(1): 164, 2019 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-31694612

RESUMO

BACKGROUND: Triple neural tube defects are rare. To the author's knowledge, there are only four reported cases available in the literature up to date. Controversies exist with regards to the development of neural tube defects. We revisit the multisite closure theory and try to explain the mechanism of neural tube defects in our case. CASE PRESENTATION: We report a case of one-month-old baby boy who presented to us with three distinct neural tube defects. He had occipital and cervical encephaloceles along with thoracolumbar myelomeningocele accompanied by syrinx and mild hydrocephalus. All the three defects were surgically corrected with good neurological outcome. CONCLUSION: In the multisite model of human neural tube closure, there are only two fusion sites and two neuropores unlike in mouse. This can explain the origin of open neural tube defects including anencephaly and myelomeningocele (as in our case) but cannot account for the development of encephalocele, which appears to be a post neurulation defect.


Assuntos
Encefalocele/cirurgia , Meningomielocele/cirurgia , Defeitos do Tubo Neural/cirurgia , Humanos , Lactente , Masculino , Pescoço
3.
Bratisl Lek Listy ; 120(9): 680-685, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31475554

RESUMO

OBJECTIVES: Neurenteric cysts (NCs) of the central nervous system (CNS) are cystic congenital lesions that may occur anywhere along the neural tube. They are most common in the spinal region, in the lower part of the cervical and upper thoracic spine. Intracranial NCs occur rarely and there are only small series of patients published in literature worldwide. Microsurgical resection is the treatment of choice. We present our experience in treatment of NCs and review of literature. METHODS: Seven patients with NC of CNS who were operated at the Department of Neurosurgery of Comenius University at University Hospital Bratislava within nine years (2010-2018) were included in the study. The series was retrospectively evaluated with an emphasis on symptomatology, surgery and postoperative course. RESULTS: In three of the seven patients, NC was localized intracranially, in the other four, NC was in the spinal canal. In three patients, a complete removal of NC was achieved (2 intracranial NC, 1 spinal NC). In other patients, a portion of the cyst wall was left to prevent the development of a postoperative neurological deficit. After surgery, the neurological symptoms were completely resolved in six patients, while in one patient, they were alleviated. In one patient, a complication occurred during the postoperatove course. There was no recurrence during the follow-up (3-111 months, mean duration 39 months). CONCLUSION: In our series of patients with intracranial and intraspinal tumors, the incidence of NC was higher than presented in the published data. Our own surgical experience has shown that complete tumor resection is not always possible for intimate adherence to the surrounding structures. Leaving a tiny portion of the cyst wall allowed us to achieve good clinical results with no recurrence. Long-term follow-up of patients is required due to the risk of recurrence. However, it can already be stated that an adequate extent of resection leads to good clinical results (Tab. 1, Fig. 4, Ref. 33).


Assuntos
Defeitos do Tubo Neural/epidemiologia , Defeitos do Tubo Neural/cirurgia , Humanos , Incidência , Procedimentos Neurocirúrgicos , Estudos Retrospectivos
4.
World Neurosurg ; 129: 140-142, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31426248

RESUMO

Supratentorial neurenteric cyst is a rare entity. They are usually isointense to slightly hyperintense on T1W images and hyperintense on T2-weighted/fluid attenuated inversion recovery images. There was a diagnostic dilemma in this case due to the cerebrospinal fluid intensity of the cyst on magnetic resonance imaging. Postoperative residual lesion predisposes to hemorrhage and seizures.


Assuntos
Encefalopatias/patologia , Lobo Frontal/patologia , Defeitos do Tubo Neural/patologia , Adulto , Encefalopatias/cirurgia , Feminino , Lobo Frontal/cirurgia , Humanos , Defeitos do Tubo Neural/cirurgia
7.
J Clin Neurosci ; 68: 346-348, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31301928

RESUMO

Neurenteric cysts are rare, benign congenital lesions of the central nervous system. We present a case of a 59-year-old woman with intractable daily nausea and vomiting with a fourth ventricular cyst adjacent to the area postrema. This was surgically resected leading to complete symptom resolution.


Assuntos
Área Postrema/patologia , Náusea/etiologia , Defeitos do Tubo Neural/complicações , Vômito/etiologia , Área Postrema/cirurgia , Feminino , Humanos , Pessoa de Meia-Idade , Defeitos do Tubo Neural/patologia , Defeitos do Tubo Neural/cirurgia
8.
World Neurosurg ; 129: 105-109, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31150861

RESUMO

BACKGROUND: Iniencephaly is an extremely rare congenital neural tube defect (NTD) involving the occipital region with rachischisis of the cervicothoracic spine and fixed retroflexion deformity of the head. It affects an estimated 0.1-10 out of 10,000 pregnancies and carries a dismal prognosis. Most affected children are either stillborn or perish within a few hours of delivery. Pathological and postmortem studies of iniencephaly significantly outnumber the limited amount of literature available on patients surviving with this disorder. To date, surgical repair has been attempted in only 3 of the 8 patients with iniencephaly who have survived long-term. Thus, a huge knowledge gap remains regarding the neurosurgical nuances and postsurgical outcomes in iniencephaly. CASE DESCRIPTION: A 4-year-old girl presented with soft, fluctuant swelling in the suboccipital region and was subsequently diagnosed with iniencephaly. She underwent a successful surgical repair of the encephalocele with dural plication. No recurrence of swelling or new neurologic deficits were noted at a 1-year follow-up. CONCLUSION: Iniencephaly is a complex NTD associated with high perinatal mortality that requires a vigilant antenatal diagnosis. Surgical repair may be attempted in the lucky few survivors after a thorough evaluation of the anomaly.


Assuntos
Defeitos do Tubo Neural/cirurgia , Procedimentos Neurocirúrgicos/métodos , Pré-Escolar , Feminino , Humanos , Sobreviventes , Resultado do Tratamento
9.
Ann R Coll Surg Engl ; 101(6): e142-e146, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31155903

RESUMO

The intraspinal enterogenous cyst, also called an neurenteric cyst, is a rare congenital disease. It was reported to be local to the C1 to L2 spinal segments, with the majority located in the cervicothoracic region. Most patients present with symptoms of progressive focal pain, myelopathic signs or radicular symptoms. We report a rare case of thoracic spinal intradural extramedullary enterogenous cyst with rapidly progressive weakness of both lower extremities. Additionally, we analysed the literature concerning the clinical features, diagnosis and prognosis of this disease.


Assuntos
Defeitos do Tubo Neural/diagnóstico , Adulto , Feminino , Humanos , Defeitos do Tubo Neural/diagnóstico por imagem , Defeitos do Tubo Neural/patologia , Defeitos do Tubo Neural/cirurgia , Radiografia Torácica , Vértebras Torácicas , Tomografia Computadorizada por Raios X
10.
World Neurosurg ; 128: e912-e917, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31096033

RESUMO

BACKGROUND: Tethered cord syndrome (TCS) refers to a clinical constellation of signs and symptoms associated with tension in the spinal cord and associated with pathologies related to abnormally low-lying conus medullaris. As minimally invasive spinal operations have become more prevalent in the past decade, we applied expanding indications to selected intradural procedures, such as tethered cord release (TCR). We present the first series of minimally invasive muscle-sparing TCR in the pediatric population. METHODS: A retrospective review of the Texas Children's Hospital, Houston, neurosurgical database was conducted for patients who underwent TCR between 2010 and 2017. Charts were reviewed to determine the source of TCS and whether surgery was conducted in a minimally invasive fashion. To establish a cohort of control population, age-matched cases of open TCR were selected in the same. Exclusion criterion was non-fatty filum sources of TCS. The length of stay, operative time, estimated blood loss, and postoperative complications were recorded. RESULTS: Eleven patients underwent minimally invasive TCR. Mean age of the patients was 10.1 years. All patients underwent L4-5 tubular laminotomy and cord detethering by 2 pediatric neurosurgeons at Texas Children's Hospital. The average length of stay in the hospital was 2.6 days. The average operative time was 167 minutes and average estimated blood loss was 8.2 mL. Ten patients reported clinical improvement and 1 patient was lost to follow-up. CONCLUSIONS: Minimally invasive TCR is a safe and represents a viable alternative to the open approach with advantages such as minimal estimated blood loss, shortened length of stay, and postoperative pain control.


Assuntos
Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Defeitos do Tubo Neural/cirurgia , Procedimentos Neurocirúrgicos/métodos , Adolescente , Perda Sanguínea Cirúrgica , Criança , Pré-Escolar , Estudos de Coortes , Bases de Dados Factuais , Feminino , Humanos , Laminectomia/métodos , Tempo de Internação , Masculino , Duração da Cirurgia , Dor Pós-Operatória/epidemiologia , Dor Pós-Operatória/terapia , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Resultado do Tratamento
11.
World Neurosurg ; 127: e517-e522, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30928585

RESUMO

OBJECTIVE: Tethered cord syndrome is a rare and intractable disease. The aim of this study was to investigate surgical outcome of homogeneous spinal-shortening axial decompression (HSAD) for tethered cord syndrome through a minimum 3-year follow-up. METHODS: Patients who underwent HSAD for tethered cord syndrome in our institution between May 2011 and July 2015 were included in this study. After a minimum 3-year follow-up, radiologic and clinical data were collected. Surgical outcome was evaluated with Japanese Orthopaedic Association, visual analog scale, International Consultation on Incontinence Questionnaire-Short Form, and Rintala scores and urodynamics. RESULTS: The study included 64 patients (28 men and 36 women) with a mean age of 35.7 ± 18.1 years. Significant improvement of visual analog scale and Japanese Orthopaedic Association scores was noted postoperatively and at a minimum 3-year follow-up. At the final follow-up, Japanese Orthopaedic Association and visual analog scale scores in all patients were improved compared with preoperatively. The International Consultation on Incontinence Questionnaire-Short Form score was decreased from 14.94 ± 4.15 preoperatively to 7.63 ± 4.40 at final follow-up (P < 0.01). Rintala score was improved from 5.26 ± 3.45 preoperatively to 12.32 ± 3.43 at final follow-up (P < 0.01). All urodynamic parameters improved compared with preoperatively. CONCLUSIONS: HSAD was effective and safe. The results were satisfactory with a minimum 3-year follow-up. HSAD could be an alternative surgical treatment of TCS.


Assuntos
Descompressão Cirúrgica , Defeitos do Tubo Neural/cirurgia , Osteotomia , Coluna Vertebral/cirurgia , Adolescente , Adulto , Idoso , Criança , Descompressão Cirúrgica/métodos , Feminino , Humanos , Laminectomia/métodos , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/métodos , Osteotomia/métodos , Resultado do Tratamento , Adulto Jovem
12.
Ultrasound Obstet Gynecol ; 53(3): 287-289, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30835370

RESUMO

Linked Comment: Ultrasound Obstet Gynecol 2018; 53: 293-301 Linked Comment: Ultrasound Obstet Gynecol 2018; 53: 302-308 Linked Comment: Ultrasound Obstet Gynecol 2018; 53: 309-313.


Assuntos
Terapias Fetais/métodos , Diagnóstico Pré-Natal/métodos , Disrafismo Espinal/cirurgia , Feminino , Humanos , Defeitos do Tubo Neural/diagnóstico , Defeitos do Tubo Neural/cirurgia , Gravidez , Disrafismo Espinal/diagnóstico
13.
World Neurosurg ; 125: e1151-e1159, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30790730

RESUMO

OBJECTIVE: To compare bony spur resection (BR) with bony spur nonresection (BN) treatment in patients with congenital scoliosis and type I split cord malformation. METHODS: Patients with congenital scoliosis and type I split cord malformation who underwent corrective surgery in a single institution from 2008 to 2015 were retrospectively evaluated. Patients were divided into 2 groups according to whether BR was performed or not: the BR group included 12 patients, and the BN group included 20 patients. Complications and perioperative and radiographic data were recorded and compared. RESULTS: The study included 32 patients. Mean age at surgery was 14.3 years, and average follow-up period was 2.8 years. There were no statistically significant differences in correction rate of the major curve or other radiographic parameters at final follow-up. Preoperative concerns (6.8 vs. 5.8, P = 0.006), operative times (508.5 minutes vs. 311.3 minutes, P = 0.009), blood loss (1433.3 mL vs. 1015.8 mL, P = 0.064), and hospital charges ($22,387.80 vs. $15,706.8, P = 0.032) were lower in the BN group than in the BR group. Total and major complication rates were higher in the BR group than in the BN group, even though there were no statistically significant differences (58.3% vs. 30.0% and 8.3% vs. 5.0%, respectively). CONCLUSIONS: In patients with congenital scoliosis and type I split cord malformation, not resecting the bony spur can achieve satisfactory radiographic and clinical outcomes with potentially fewer complications.


Assuntos
Defeitos do Tubo Neural/cirurgia , Osteófito/cirurgia , Escoliose/cirurgia , Adolescente , Criança , Feminino , Humanos , Masculino , Defeitos do Tubo Neural/complicações , Defeitos do Tubo Neural/diagnóstico por imagem , Procedimentos Neurocirúrgicos/métodos , Procedimentos Ortopédicos/métodos , Osteófito/complicações , Osteófito/diagnóstico por imagem , Estudos Retrospectivos , Escoliose/complicações , Escoliose/congênito , Escoliose/diagnóstico por imagem , Resultado do Tratamento
14.
Pediatr Neurosurg ; 54(2): 121-124, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30783063

RESUMO

A spinal neurenteric cyst is a rare entity. It commonly presents already at 5 weeks of age up to the 6th decade of life. The most common location is the cervical region followed by thoracic and lumbosacral regions. We report a 9-month-old male infant with sudden onset of weakness in both lower limbs. MRI revealed 2 cystic lesions at cervical and thoracic level with spinal cord compression. He underwent laminectomy and excision of the cervical lesion. The child improved significantly. The postoperative MRI shows complete excision of a dorsal lesion and presence of a cervical lesion. Later, he underwent cervical laminotomy and partial wall excision followed by shunt placement. The histopathological report revealed a neurenteric cyst. Two neurenteric cysts presented in the neuroaxis of the same patient: one was located ventral (thoracic) and the other dorsal (cervical). At the 2-year follow-up, the child was active and walking without support. Multiple cystic lesions in the neuroaxis can be neurenteric cysts.


Assuntos
Vértebras Cervicais/cirurgia , Defeitos do Tubo Neural/cirurgia , Compressão da Medula Espinal/cirurgia , Vértebras Torácicas/cirurgia , Vértebras Cervicais/diagnóstico por imagem , Pré-Escolar , Descompressão Cirúrgica/métodos , Humanos , Lactente , Laminectomia/métodos , Masculino , Defeitos do Tubo Neural/complicações , Defeitos do Tubo Neural/diagnóstico por imagem , Compressão da Medula Espinal/complicações , Compressão da Medula Espinal/diagnóstico por imagem , Vértebras Torácicas/diagnóstico por imagem
15.
World Neurosurg ; 125: 257-260, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30703605

RESUMO

BACKGROUND: Neurenteric cysts (NCs) are rare, non-neoplastic lesions arising from a failure of dissolution of the transient neurenteric canal between the foregut and the notochord. They are most frequently seen in the intradural extramedullary space in the lower cervical and upper thoracic spine. The authors describe a rare case of NC arising from the ventral cervicomedullary junction that was totally resected via a posterior approach. CASE DESCRIPTION: A 24-year-old woman presented with a 4-week history of neck pain and progressive left hemiparesis. Admission magnetic resonance imaging scans demonstrated an intradural extramedullary cystic mass lesion ventral to the upper spinal cord from medulla to C2. We performed a posterior approach and the lesion was totally removed. Surgical treatment resulted in resolution of the neurologic impairments. The histological results were consistent with NC. Postoperative course was uneventful. At the 6-month follow-up, the patient is asymptomatic and magnetic resonance imaging scan shows no residual lesion. CONCLUSIONS: NC is a rare lesion of the craniospinal junction and should be considered among differential diagnoses. Complete excision is the treatment of choice. In most instances a dorsal surgical approach will be satisfactory.


Assuntos
Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Bulbo/diagnóstico por imagem , Bulbo/cirurgia , Defeitos do Tubo Neural/diagnóstico por imagem , Defeitos do Tubo Neural/cirurgia , Feminino , Humanos , Cervicalgia/diagnóstico por imagem , Cervicalgia/etiologia , Cervicalgia/cirurgia , Defeitos do Tubo Neural/complicações , Crânio , Adulto Jovem
16.
J Vet Diagn Invest ; 31(2): 294-297, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30734666

RESUMO

A 4-mo-old French bulldog was presented with acute onset pain and reluctance to move. A tubular structure arising in the dorsal thoracic midline and extending from a cutaneous orifice into deeper tissues was palpated on physical examination. Computed tomography with sinography revealed a dermoid sinus associated with spina bifida at the level of T3-T4. On surgical exploration, the dermoid sinus was found to communicate with the dura. Histology confirmed the diagnosis and classification as a type VI dermoid sinus. The pain response and hyperesthesia were suspected to be the result of tethered cord syndrome. Complete resolution of clinical signs was appreciated post-surgery, with the patient still free of clinical signs 3 mo later.


Assuntos
Doenças do Cão/diagnóstico , Defeitos do Tubo Neural/veterinária , Espinha Bífida Oculta/veterinária , Animais , Doenças do Cão/congênito , Doenças do Cão/patologia , Doenças do Cão/cirurgia , Cães , Hiperestesia/etiologia , Hiperestesia/fisiopatologia , Hiperestesia/veterinária , Masculino , Defeitos do Tubo Neural/diagnóstico , Defeitos do Tubo Neural/patologia , Defeitos do Tubo Neural/cirurgia , Dor/etiologia , Dor/fisiopatologia , Dor/veterinária , Espinha Bífida Oculta/diagnóstico , Espinha Bífida Oculta/patologia , Espinha Bífida Oculta/cirurgia , Tomografia Computadorizada por Raios X/veterinária
17.
Ultrasound Obstet Gynecol ; 53(3): 314-323, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30672627

RESUMO

OBJECTIVE: The effect of fetoscopic myelomeningocele (MMC) repair on fetal growth is unknown. Fetal surgery itself and/or exposure to a carbon dioxide (CO2 ) environment during spina bifida repair may affect placental function and impair fetal growth. Our aim was to assess and compare growth in fetuses, neonates and infants who underwent prenatal fetoscopic or open MMC repair. METHODS: Fetal biometrics were obtained serially using ultrasound after fetoscopic (n = 32) or open hysterotomy (n = 34) MMC repair in utero at a single institution between November 2011 and July 2017. Measurements obtained during growth scans on initial evaluation prior to surgery, and those taken at 6 weeks post-surgery, were transformed into percentiles and compared between groups. Additional neonatal and infant anthropometric measurements, including weight, length/height and head circumference, were also transformed into percentiles and compared between the groups. The proportions of cases in each group with estimated fetal weight (EFW) or postnatal weight < 10th and < 3rd percentiles were calculated and compared. A linear mixed model was used to analyze the serial fetal growth measurements of each parameter, and random intercepts and slopes were used to compare study variables between the study groups. The duration of surgery (skin-to-skin time at fetoscopic and open MMC repair) and duration of CO2 exposure (fetoscopic repair) were evaluated for any effect on the fetal, neonatal or infant biometric percentiles. RESULTS: Fetuses which underwent fetoscopic repair had a larger abdominal circumference percentile at referral (57 ± 21 vs 46 ± 23; P = 0.04). There were no other differences between the two groups in fetal biometric percentiles at the time of referral, 6 weeks post-surgery or at birth. There were no differences between groups in EFW percentile or in proportions of cases with birth weight < 10th and < 3rd percentiles. Linear mixed-model analysis did not show any significant differences in any fetal growth parameter between the groups over time. There were no significant correlations between duration of surgery or duration of CO2 exposure and any of the biometric percentiles evaluated. Postnatal growth showed no significant differences between the groups in weight, height or head circumference percentiles, at 6-18, 18-30 or > 30 months of age. CONCLUSIONS: Babies exposed to fetoscopic or open MMC repair in-utero did not show significant differences in fetal or postnatal growth parameters. These results support the safety of the use of CO2 gas for fetoscopic surgery. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.


Assuntos
Desenvolvimento Fetal/fisiologia , Peso Fetal/fisiologia , Fetoscopia/efeitos adversos , Meningomielocele/cirurgia , Disrafismo Espinal/cirurgia , Peso ao Nascer/fisiologia , Dióxido de Carbono/efeitos adversos , Dióxido de Carbono/metabolismo , Feminino , Fetoscopia/métodos , Feto , Humanos , Histerotomia/métodos , Recém-Nascido , Meningomielocele/epidemiologia , Defeitos do Tubo Neural/diagnóstico por imagem , Defeitos do Tubo Neural/cirurgia , Gravidez , Cuidado Pré-Natal/métodos , Estudos Retrospectivos , Disrafismo Espinal/diagnóstico por imagem
18.
Ultrasound Obstet Gynecol ; 53(3): 324-334, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30620440

RESUMO

OBJECTIVE: To determine if brain imaging in fetuses that underwent prenatal repair of neural tube defect (NTD) can predict the need for postnatal hydrocephalus treatment (HT) in the first year postpartum. METHODS: This was a retrospective study of fetuses diagnosed with open NTD that had in-utero myelomeningocele repair between April 2014 and April 2016. Independent variables were collected from four chronological sets of fetal images: presurgery ultrasound, presurgery magnetic resonance imaging (MRI), 6-week postsurgery MRI and predelivery ultrasound. The following independent variables were collected from all image sets unless otherwise noted: gestational age, head circumference, mean ventricular width, ventricular volume (MRI only), hindbrain herniation (HBH) score (MRI only), and level of lesion (LOL), defined as the upper bony spinal defect (presurgery ultrasound only). Based on these measurements, additional variables were defined and calculated including change in degree of HBH, ventricular width growth (mm/week) and ventricular volume growth (mL/week). The need for HT (by either ventriculoperitoneal shunt or endoscopic third ventriculostomy with choroid plexus cauterization) was determined by a pediatric neurosurgeon using clinical and radiographic criteria; a secondary analysis was performed using the MOMS trial criteria for hydrocephalus. The predictive value of each parameter was assessed by receiver-operating characteristics curve and logistic regression analyses. RESULTS: Fifty affected fetuses were included in the study, of which 32 underwent open hysterotomy and 18 fetoscopic repair. Two neonates from the open hysterotomy group died and were excluded from the analysis. The mean gestational ages for the presurgery ultrasound, presurgery MRI, postsurgery MRI and predelivery ultrasound were 21.8 ± 2.1, 22.0 ± 1.8, 30.4 ± 1.6 and 31.0 ± 4.9 weeks, respectively. A total of 16 subjects required HT. The area under the curve (AUC) of predictive accuracy for HT showed that HBH grading on postsurgery MRI had the strongest predictive value (0.86; P < 0.01), outperforming other predictors such as postsurgery MRI ventricular volume (0.73; P = 0.03), MRI ventricular volume growth (0.79; P = 0.01), change in HBH (0.82; P = 0.01), and mean ventricular width on predelivery ultrasound (0.73; P = 0.01). Other variables, such as LOL, mean ventricular width on presurgery ultrasound, mean ventricular width on presurgery and postsurgery MRI, and ventricular growth assessment by MRI or ultrasound, had AUCs < 0.7. Optimal cut-offs of the variables with the highest AUC were evaluated to improve prediction. A combination of ventricular volume growth ≥ 2.02 mL/week and/or HBH of 3 on postsurgery MRI were the optimal cut-offs for the best prediction (odds ratio (OR), 42 (95% CI, 4-431); accuracy, 84%). Logistic regression analyses showed that persistence of severe HBH 6 weeks after surgery by MRI is one of the best predictors for HT (OR, 39 (95% CI, 4-369); accuracy, 84%). There was no significant change in the results when the MOMS trial criteria for hydrocephalus were used as the dependent variable. CONCLUSIONS: Persistence of HBH on MRI 6 weeks after prenatal NTD repair independently predicted the need for postnatal HT better than any ultrasound- or other MRI-derived measurements of ventricular characteristics. These results should aid in prenatal counseling and add support to the hypothesis that HBH is a significant driver of hydrocephalus in myelomeningocele patients. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.


Assuntos
Encéfalo/diagnóstico por imagem , Hidrocefalia/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Defeitos do Tubo Neural/cirurgia , Neuroimagem/métodos , Encéfalo/patologia , Plexo Corióideo , Endoscopia , Feminino , Feto , Idade Gestacional , Humanos , Hidrocefalia/cirurgia , Recém-Nascido , Meningomielocele/diagnóstico por imagem , Meningomielocele/cirurgia , Defeitos do Tubo Neural/diagnóstico por imagem , Cuidado Pós-Natal , Valor Preditivo dos Testes , Gravidez , Cuidado Pré-Natal , Estudos Retrospectivos , Derivação Ventriculoperitoneal , Ventriculostomia/métodos
19.
Turk Neurosurg ; 29(5): 789-792, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-29757450

RESUMO

Intradural spinal cord abscesses are rare infections in early childhood and usually result from pre-existing congenital anomalies of the spinal column. The formation of abscess may be the result of hematogenous spread. It is treated by surgical and parenteral antibiotic treatment, but some special cases may require additional treatments. This article presents a 4-year-old male patient who was previously operated on for spina bifida (meningocele and tethered cord syndrome) at another hospital. Upon complaints of not being able to walk after one month, he was operated on with the diagnosis of spinal intradural abscess and referred to our clinic to continue his treatment. The patient underwent an emergency operation when his new spinal magnetic resonance imaging (MRI) at our hospital showed progression of intradural abscess. Due to no regression of neurological deficits in the follow-up and the risk of another operation, antimicrobial treatment as well as hyperbaric oxygen therapy (HBOT) was planned. At the end of 20 HBOT treatment sessions, the patient started to walk with support and the antibiotic treatment was completed in six weeks. In cases where surgical and antimicrobial treatments have failed, HBOT should be considered as an additional treatment method in children with spinal abscess.


Assuntos
Abscesso/terapia , Oxigenação Hiperbárica/métodos , Complicações Pós-Operatórias/terapia , Doenças da Medula Espinal/terapia , Abscesso/etiologia , Pré-Escolar , Humanos , Masculino , Meningomielocele/cirurgia , Defeitos do Tubo Neural/cirurgia , Procedimentos Neurocirúrgicos/efeitos adversos , Complicações Pós-Operatórias/etiologia , Doenças da Medula Espinal/etiologia
20.
World Neurosurg ; 121: e493-e499, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30268549

RESUMO

BACKGROUND: Neural tube defects are a large health burden for East African countries. Health strategies in the prevention of this disease include nutritional prophylaxis, prenatal diagnosis, and availability of early neonatal neurosurgery. The main objective of this study is to describe our experience in the early surgical management of neural tube defects in the Zanzibar archipelago. METHODS: From December 2016 to December 2017, we prospectively collected data on all patients admitted with the diagnosis of myelomeningocele. We collected variables regarding demographics, maternal health, preoperative imaging, surgical procedures, and complications at follow-up. RESULTS: We collected data on 19 patients. Mean age was 9.8 ± 18.7 days. Of these patients, 52.6% were male and 47.3% were female; 47.3% patients were from Unguja, 42.0% from Pemba, and 5.2% from mainland Tanzania; 68.4% of all mothers were found to have undergone prenatal ultrasonography and 89.5% of all patients received surgery. Surgical wound infection was present in 29.4% of all surgical patients and 52.9% developed secondary hydrocephalus. CONCLUSIONS: Neural tube defects are a prevailing condition in East Africa. We believe that more health initiatives should address its prevention, mainly through maternal nutrition. On the basis of our findings, we consider early neonatal neurosurgery as the most important factor in reducing immediate morbidity and mortality.


Assuntos
Meningomielocele/epidemiologia , Meningomielocele/cirurgia , Procedimentos Neurocirúrgicos/métodos , Derivação Ventriculoperitoneal/métodos , Feminino , Humanos , Recém-Nascido , Masculino , Defeitos do Tubo Neural/cirurgia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Tanzânia/epidemiologia
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