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59. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
3. Joint Meeting mit der Italienischen Gesellschaft für Neurochirurgie (SINch)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

01. - 04.06.2008, Würzburg

Occult spinal dysraphism: clinical and surgical management in a series of 66 paediatric cases

Meeting Abstract

  • corresponding author M. Vissani - Department of Neurosurgery, University of Turin, Italy
  • P. Peretta - Department of Paediatric Neurosurgery, Children’s Hospital “Regina Margherita” Turin, Italy
  • A. Ducati - Department of Neurosurgery, University of Turin, Italy
  • P. Gaglini - Department of Paediatric Neurosurgery, Children’s Hospital “Regina Margherita” Turin, Italy
  • P. Ragazzi - Department of Paediatric Neurosurgery, Children’s Hospital “Regina Margherita” Turin, Italy

Deutsche Gesellschaft für Neurochirurgie. Società Italiana di Neurochirurgia. 59. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 3. Joint Meeting mit der Italienischen Gesellschaft für Neurochirurgie (SINch). Würzburg, 01.-04.06.2008. Düsseldorf: German Medical Science GMS Publishing House; 2008. DocMO.05.08

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dgnc2008/08dgnc074.shtml

Veröffentlicht: 30. Mai 2008

© 2008 Vissani et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective: Occult Spinal Dysraphism (OSD) is a group of congenital and pathological changes occurring in the spine and spinal cord characterized by different failure of the neurulation process. Tethered cord syndrome associated causes a progressive form of neurological deterioration. The objective of this study is to analyze our patients evaluating the importance of a precocious untethering surgery.

Methods: We studied retrospectively 66 paediatric patients affected by OSD operated between 1994 and 2006 in the Department of Paediatric Neurosurgery of Children’s Hospital “Regina Margherita” in Turin. 33 male and 33 female, ranging from 1 month to 22 years (mean 3,72 years). 4.6 yrs of follow-up (2 months to 9 yrs). 59 pts were never untethering before: spinal lipoma (34, 57,7%), fatty filum (13, 22%), dermal sinus tract (9, 15.2%), terminal myelocystocele (2, 3,4%) and adhesions/bands (1, 1,7%). The others 7 pts were operated for retethering. We divided the patients in 3 groups (<1 year, 13-36 months and >36 months) and analyzed the neurological evolution considering the dysraphism type.

Results: The mean age of patients without neurological sings at diagnosis was 16,3 months, while if neurological sings were present the average was 62,7 months. Bladder dysfunction was present mainly in older patients (>1 years) and in lipomyelomeningocele. In 9 pts with bladder dysfunction less than 1 year old were presents spinal cord and genito-urinary anomalies. Bladder dysfunction has a poorly chance of improving after surgery in children over 2 years old. Neurological signs, bladder dysfunction and orthopaedic anomalies affected the major part of older patients at diagnosis.

Conclusions: Progressive neurological deterioration with loss of bladder control is the natural history of untreated OSD. Early diagnosis and surgical intervention may prevent significant neurological deterioration and progressive disability. The goal of surgery is to re-establish the normal anatomical plans and obtain the untethering of the spinal cord. Lipomyelomeningocele have poor prognosis in a long time, while fatty filum have high likelihood to improve after surgery and have good prognosis. A long follow-up is mandatory because retethering may appear many years after first surgery. Early surgery may change the natural history of a gradual loss of function obtaining clinical stability.