gms | German Medical Science

58. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

26. bis 29.04.2007, Leipzig

Occult spinal dysraphism – differences between pediatric and adult patients

Okkulte spinale Dysraphie – Unterschiede zwischen pädiatrischen und adulten Patienten

Meeting Abstract

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  • corresponding author M. Messing-Jünger - Neurochirurgische Klinik, Universitätsklinik Düsseldorf
  • S. Persits - Neurochirurgische Klinik, Universitätsklinik Düsseldorf
  • M. Reed - Neurochirurgische Klinik, Universitätsklinik Düsseldorf

Deutsche Gesellschaft für Neurochirurgie. 58. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC). Leipzig, 26.-29.04.2007. Düsseldorf: German Medical Science GMS Publishing House; 2007. DocDO.06.03

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Veröffentlicht: 11. April 2007

© 2007 Messing-Jünger et al.
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Objective: Occult spinal dysraphism (OSD) usually becomes symptomatic in childhood, but there are also cases of newly dignosed dysraphic disorders in adult patients.

Methods: A retrospective analysis of pre and postoperative clinical and radiological findings of patients with OSD was performed. Pediatric and adult patients have been compared in order to define age related factors.

Results: A total of 42 patients with OSD have been treated in our department since 2000. Mean age was 16.6 yrs (1 month – 68 yrs), male:female ratio was 18:24. The following dysraphic entities were found: lipomeningocele 24, filum pathologies 11, dermoid cysts 2, syringomyelia and low conus 1, dorsal band 1, diplomyelia 1, diastematomyelia 2. Reintervention rate was 20% due to retethering in 5 cases of lipomeningocele and recurrence of dermoid cyst in one case. Complication rate was 17% (CSF fistula/accumulation 4, healing disorder 1). The mean age in the adult group (n=15) was 39 yrs. Diagoses were lipomeningoceles in 9, filum pathologies in 4 cases and diastematomyelia in 2 patient. The predominant symptoms were pain (70%) and peripheral sensomotor deficits (70%). Syringomyelia was present in only 20%. 50% conus position lower than L3. Outcome was deteriorated in 1, unchanged in 6 and improved in 8 patients. The mean pediatric age was 4.1 yrs. OSD entities were lipomeningocele in 13, filum pathologies in 9, dermoids in 2 and diplomyelia, low conus/syrinx and dorsal band in 1 each. Pain was present in only 20% and syringomyelia (45%) and lower extrimity asymmetry (35%) were predominant clinical findings. 65% conus position lower than L3. Outcome was deteriorated in 3, unchanged in 13 and improved in 10 patients. 3 (4) deteriorations were in lipomeningocele patients. 1 LOF.

Conclusions: Adult OSD patients develop late neurological deficits and pain is the predominant symptom. In children pain is uncommon. Syringomyelia is more common in pediatric patients, which could be related to lower conus position compared to the adult group. Lipomeningoceles can have an unfavourable prognosis and tend to deteriorate despite reinterventions. CSF fistula/accumulation is the major surgical complication.