E Ausili1, G Maresca2, L Massimi3, L Morgante2, C Romagnoli2, C Rendeli2. 1. Spina Bifida Center, Women's and Infant Health Sciences, A. Gemelli Policlinic, Catholic University of Sacred Heart, Largo A. Gemelli 8, 00168, Rome, Italy. emanuele.ausili@tin.it. 2. Spina Bifida Center, Women's and Infant Health Sciences, A. Gemelli Policlinic, Catholic University of Sacred Heart, Largo A. Gemelli 8, 00168, Rome, Italy. 3. Neurosurgery Department, Catholic University of Sacred Heart, Largo A. Gemelli 8, 00168, Rome, Italy.
Abstract
PURPOSE: The purpose of this paper is to investigate occult spinal dysraphisms (OSD) using lumbar ultrasonography (LUS) in newborns presenting with specific skin markers or sacrococcygeal dimple. METHOD: From 2012 to 2015, we performed LUS in newborns with cutaneous stigmata and/or sacroccygeal dimple. Magnetic resonance imaging (MRI) was performed in all patients with abnormal ultrasound or features of neurological involvement in order to detect spinal lesions. RESULTS: We prospectively evaluated 475 newborns who presented cutaneous stigmata performing LUS during their 4 weeks of life though 439 completed the study. All patients had a follow-up of almost 12 months. Of these, 39 presented abnormal ultrasonography and underwent MRI. In this group, spinal dysraphism was confirmed in 12 patients. When considering skin markers, dermal sinus correlated with higher risk of spinal cord lesions, on the other hand the presence of simple sacral dimple alone denoted a very low risk of occult spinal dysraphism. The simultaneous presence of more skin markers and/or the presence of lumbar ultrasonography abnormality regarding the level of the conus, pulsatility, and the position of the cord, thickness of the filum terminale, or the presence of an intratecal mass, lipoma, or dermal sinus tract indicated the necessity to perform MRI in order to detect spinal cord abnormalities because of higher risk of spinal lesions. CONCLUSION: LUS in newborns with specific skin markers is a valid method to select patients in which MRI can be performed to detect OSD. The presence of a simple sacral dimple alone is a negligible marker for occult neural pathology while the presence of isolated dermal sinus or more than one cutaneous marker could be considered indicative of higher risk of spinal dysraphism.
PURPOSE: The purpose of this paper is to investigate occult spinal dysraphisms (OSD) using lumbar ultrasonography (LUS) in newborns presenting with specific skin markers or sacrococcygeal dimple. METHOD: From 2012 to 2015, we performed LUS in newborns with cutaneous stigmata and/or sacroccygeal dimple. Magnetic resonance imaging (MRI) was performed in all patients with abnormal ultrasound or features of neurological involvement in order to detect spinal lesions. RESULTS: We prospectively evaluated 475 newborns who presented cutaneous stigmata performing LUS during their 4 weeks of life though 439 completed the study. All patients had a follow-up of almost 12 months. Of these, 39 presented abnormal ultrasonography and underwent MRI. In this group, spinal dysraphism was confirmed in 12 patients. When considering skin markers, dermal sinus correlated with higher risk of spinal cord lesions, on the other hand the presence of simple sacral dimple alone denoted a very low risk of occult spinal dysraphism. The simultaneous presence of more skin markers and/or the presence of lumbar ultrasonography abnormality regarding the level of the conus, pulsatility, and the position of the cord, thickness of the filum terminale, or the presence of an intratecal mass, lipoma, or dermal sinus tract indicated the necessity to perform MRI in order to detect spinal cord abnormalities because of higher risk of spinal lesions. CONCLUSION:LUS in newborns with specific skin markers is a valid method to select patients in which MRI can be performed to detect OSD. The presence of a simple sacral dimple alone is a negligible marker for occult neural pathology while the presence of isolated dermal sinus or more than one cutaneous marker could be considered indicative of higher risk of spinal dysraphism.
Authors: C J Rozzelle; G T Reed; J L Kirkman; C N Shannon; Joshua J Chern; J C Wellons; R S Tubbs Journal: Childs Nerv Syst Date: 2013-11-01 Impact factor: 1.475
Authors: Brent R O'Neill; Danielle Gallegos; Alex Herron; Claire Palmer; Nicholas V Stence; Todd C Hankinson; C Corbett Wilkinson; Michael H Handler Journal: J Neurosurg Pediatr Date: 2016-12-02 Impact factor: 2.375
Authors: C Rendeli; E Ausili; F Tabacco; B Focarelli; L Massimi; M Caldarelli; G Tamburrini; C Di Rocco Journal: J Urol Date: 2007-06 Impact factor: 7.450