Giorgia Totonelli1, Raffaella Messina2, Francesco Morini3, Giovanni Mosiello4, Paolo Palma2, Marianna Scuglia3, Barbara D Iacobelli3, Pietro Bagolan3. 1. Neonatal Surgery Unit, Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, IRCCS, Piazza S. Onofrio, 4, 00165, Rome, Italy. gtotonelli@gmail.com. 2. Neurosurgery Unit, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy. 3. Neonatal Surgery Unit, Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, IRCCS, Piazza S. Onofrio, 4, 00165, Rome, Italy. 4. Neuro-Urology Unit, Department of Surgery, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
Abstract
PURPOSE: To describe the association of anorectal malformation (ARM) and spinal dysraphism (SD) in terms of impact on the management of SD and embryogenetic implications. METHODS: Patients with SD associated with (A) or without (B) ARM were included. The two groups were further divided into operated on (A1/B1) or not (A2/B2) for SD. Groups A and B were compared for type of SD (embryogenetic classification) and prevalence of neurosurgery; Groups A1 vs. A2 for type of ARM (Wingspread classification); Groups A1 vs. B1 for age at neurosurgery, neurophysiology, and clinical symptoms. MAIN RESULTS: One hundred twenty-one patients with SD, 83 with and 38 without ARM were consecutively treated (1999-2015). Group A was associated only with SDs developing after primary neurulation, corresponding to the period of cloacal septation and organogenesis (p = 0.0007). Untethering surgery was significantly less frequent in Group A (p < 0.0001 and p = 0.04, respectively). Higher ARMs were not associated with increased risk for neurosurgery. No other significant differences were detected. CONCLUSIONS: In our series, ARMs were associated only with SD developing after primary neurulation, suggesting a single insult leading to both SD and the associated ARM. Neurosurgery is indicated less frequently in patients with ARM-associated SD, despite the similar preoperative clinical features.
PURPOSE: To describe the association of anorectal malformation (ARM) and spinal dysraphism (SD) in terms of impact on the management of SD and embryogenetic implications. METHODS:Patients with SD associated with (A) or without (B) ARM were included. The two groups were further divided into operated on (A1/B1) or not (A2/B2) for SD. Groups A and B were compared for type of SD (embryogenetic classification) and prevalence of neurosurgery; Groups A1 vs. A2 for type of ARM (Wingspread classification); Groups A1 vs. B1 for age at neurosurgery, neurophysiology, and clinical symptoms. MAIN RESULTS: One hundred twenty-one patients with SD, 83 with and 38 without ARM were consecutively treated (1999-2015). Group A was associated only with SDs developing after primary neurulation, corresponding to the period of cloacal septation and organogenesis (p = 0.0007). Untethering surgery was significantly less frequent in Group A (p < 0.0001 and p = 0.04, respectively). Higher ARMs were not associated with increased risk for neurosurgery. No other significant differences were detected. CONCLUSIONS: In our series, ARMs were associated only with SD developing after primary neurulation, suggesting a single insult leading to both SD and the associated ARM. Neurosurgery is indicated less frequently in patients with ARM-associated SD, despite the similar preoperative clinical features.
Authors: Federico Scottoni; Barbara Daniela Iacobelli; Antonio Maria Zaccara; Giorgia Totonelli; Antonio Maria Salvatore Schingo; Pietro Bagolan Journal: Pediatr Surg Int Date: 2014-07-05 Impact factor: 1.827
Authors: Desiree van den Hondel; Cornelius Sloots; T H Rob de Jong; Maarten Lequin; Rene Wijnen Journal: Eur J Pediatr Surg Date: 2015-09-21 Impact factor: 2.191
Authors: K Uchida; M Inoue; T Matsubara; K Otake; Y Koike; Y Okugawa; A Kawamoto; C Miki; M Kusunoki Journal: Eur J Pediatr Surg Date: 2007-12 Impact factor: 2.191
Authors: Giorgia Totonelli; Francesco Morini; Vincenzo Davide Catania; Paolo Maria Schingo; Giovanni Mosiello; Paolo Palma; Barbara Daniela Iacobelli; Pietro Bagolan Journal: Pediatr Surg Int Date: 2016-07-02 Impact factor: 1.827