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[PMID]:29390297
[Au] Autor:Theofanakis C; Theodora M; Sindos M; Daskalakis G
[Ti] Título:Prenatal diagnosis of sirenomelia with anencephaly and craniorachischisis totalis: A case report study.
[So] Source:Medicine (Baltimore);96(50):e9020, 2017 Dec.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:RATIONALE: Sirenomelia and anencephaly are well-defined congenital malformations that usually occur independently. PATIENT CONCERNS: We report a case of combined sirenomelia, anencephaly and complete rachischisis, diagnosed in the 16th week of gestation. DIAGNOSES: To our knowledge, this is the 7th case in the literature and the first that is diagnosed so early in pregnancy. INTERVENTIONS: The final diagnosis is confirmed with radiological examination after the termination of pregnancy. OUTCOMES: Prenatal diagnosis of sirenomelia is difficult due to the presence of kidney agenesis and severe oligohydramnios. LESSONS: The combination of sirenomelia and craniorachischisis totalis is extremely rare and prenatal ultrasound scan are a challenge, even for experts in the field.
[Mh] Termos MeSH primário: Anencefalia/diagnóstico por imagem
Ectromelia/diagnóstico por imagem
Defeitos do Tubo Neural/diagnóstico por imagem
Ultrassonografia Pré-Natal
[Mh] Termos MeSH secundário: Aborto Eugênico
Feminino
Seres Humanos
Gravidez
Adulto Jovem
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180301
[Lr] Data última revisão:
180301
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180203
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009020


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[PMID]:29339865
[Au] Autor:Altiok H; Riordan A; Graf A; Krzak J; Hassani S
[Ad] Endereço:Shriners Hospitals for Children Chicago.
[Ti] Título:Response of Scoliosis in Children with Myelomeningocele to Surgical Release of Tethered Spinal Cord.
[So] Source:Top Spinal Cord Inj Rehabil;22(4):247-252, 2016.
[Is] ISSN:1945-5763
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:To examine the effect of surgical tethered cord release (TCR) on scoliosis in children with myelomeningocele. A retrospective review of 65 pediatric patients with myelomeningocele and TCR. The final sample consisted of 20 patients with scoliosis who were managed conservatively after TCR. Average age at TCR was 6.2 years with average follow-up of 3.8 years. Scoliosis of 1 (5%) patient improved, 7 (35%) were stable, and 12 (60%) worsened (≥10°). Fifty percent of patients ultimately required definitive spinal surgery. TCR release delayed definitive spine surgery for an average of 3.2 years. Sixty-four percent of patients with curves less than or equal to 45° had progression of their curves compared to 50% with curves greater than 45°. For patients with curves less than or equal to 45°, curves progressed in 80% of those younger than 10 years as compared to 25% of those older than 10 years. For patients with curves less than or equal to 45°, 43% required definitive spine surgery as opposed to 83% with curves greater than 45°. Level of neurological involvement (ie, lumbar versus thoracic) and age at untethering emerged as factors influencing the effects of TCR for patients with curves less than or equal to 45°. Lumbar curves had more favorable results. Pediatric patients with myelomeningocele and scoliosis should be closely assessed and monitored. A selective approach for youth with lumbosacral level myelomeningocele and progressive curves less than or equal to 45° may result in scoliosis stabilization and avoidance of definitive surgery.
[Mh] Termos MeSH primário: Meningomielocele/cirurgia
Escoliose/cirurgia
[Mh] Termos MeSH secundário: Criança
Feminino
Seres Humanos
Masculino
Defeitos do Tubo Neural
Estudos Retrospectivos
Vértebras Torácicas
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180220
[Lr] Data última revisão:
180220
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180118
[St] Status:MEDLINE
[do] DOI:10.1310/sci2204-247


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[PMID]:29215383
[Au] Autor:Patel N; Viguera AC; Baldessarini RJ
[Ti] Título:Mood-Stabilizing Anticonvulsants, Spina Bifida, and Folate Supplementation: Commentary.
[So] Source:J Clin Psychopharmacol;38(1):7-10, 2018 Feb.
[Is] ISSN:1533-712X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:PURPOSE/BACKGROUND: High risks of neural tube defects and other teratogenic effects are associated with exposure in early pregnancy to some anticonvulsants, including in women with bipolar disorder. METHODS/PROCEDURES: Based on a semistructured review of recent literature, we summarized findings pertaining to this topic. FINDINGS/RESULTS: Valproate and carbamazepine are commonly used empirically (off-label) for putative long-term mood-stabilizing effects. Both anticonvulsants have high risks of teratogenic effects during pregnancy. Risks of neural tube defects (especially spina bifida) and other major malformations are especially great with valproate and can arise even before pregnancy is diagnosed. Standard supplementation of folic acid during pregnancy can reduce risk of spontaneous spina bifida, but not that associated with valproate or carbamazepine. In contrast, lamotrigine has regulatory approval for long-term use in bipolar disorder and appears not to have teratogenic effects in humans. IMPLICATIONS/CONCLUSIONS: Lack of protective effects against anticonvulsant-associated neural tube defects by folic acid supplements in anticipation of and during pregnancy is not widely recognized. This limitation and high risks of neural tube and other major teratogenic effects, especially of valproate, indicate the need for great caution in the use of valproate and carbamazepine to treat bipolar disorder in women of child-bearing age.
[Mh] Termos MeSH primário: Antimaníacos/efeitos adversos
Ácido Fólico/administração & dosagem
Defeitos do Tubo Neural/prevenção & controle
Disrafismo Espinal/prevenção & controle
[Mh] Termos MeSH secundário: Anticonvulsivantes/administração & dosagem
Anticonvulsivantes/efeitos adversos
Antimaníacos/administração & dosagem
Transtorno Bipolar/tratamento farmacológico
Carbamazepina/administração & dosagem
Carbamazepina/efeitos adversos
Suplementos Nutricionais
Feminino
Seres Humanos
Defeitos do Tubo Neural/induzido quimicamente
Gravidez
Complicações na Gravidez/tratamento farmacológico
Disrafismo Espinal/induzido quimicamente
Triazinas/administração & dosagem
Triazinas/efeitos adversos
Ácido Valproico/administração & dosagem
Ácido Valproico/efeitos adversos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anticonvulsants); 0 (Antimanic Agents); 0 (Triazines); 33CM23913M (Carbamazepine); 614OI1Z5WI (Valproic Acid); 935E97BOY8 (Folic Acid); U3H27498KS (lamotrigine)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180201
[Lr] Data última revisão:
180201
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171208
[St] Status:MEDLINE
[do] DOI:10.1097/JCP.0000000000000813


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[PMID]:29189693
[Au] Autor:Committee on Practice Bulletins-Obstetrics
[Ti] Título:Practice Bulletin No. 187: Neural Tube Defects.
[So] Source:Obstet Gynecol;130(6):e279-e290, 2017 12.
[Is] ISSN:1873-233X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Neural tube defects (NTDs) are congenital structural abnormalities of the central nervous system and vertebral column. Neural tube defects may occur as an isolated malformation, in combination with other malformations, as part of a genetic syndrome, or as a result of teratogenic exposure (1). Neural tube defects are the second-most-common major congenital anomaly (2) after cardiac malformations, and their prevalence varies by geographic region, race, and environmental factors (3). Outcomes and disabilities depend on level and extent of lesion; for instance, anencephaly is incompatible with life but most infants with spina bifida will survive after surgical repair (4). Importantly, and in contrast to many other congenital abnormalities, primary prevention of NTDs is possible with folic acid. In addition, prenatal screening and diagnosis are widely available, and fetal surgery has improved outcomes for some newborns. The purpose of this document is to provide information about NTDs and make management recommendations for the pregnancy complicated by a fetal NTD.
[Mh] Termos MeSH primário: Parto Obstétrico/métodos
Terapias Fetais/métodos
Ácido Fólico/uso terapêutico
Testes para Triagem do Soro Materno/métodos
Defeitos do Tubo Neural
Complicações na Gravidez
Ultrassonografia Pré-Natal/métodos
[Mh] Termos MeSH secundário: Sistema Nervoso Central/anormalidades
Sistema Nervoso Central/diagnóstico por imagem
Feminino
Seres Humanos
Recém-Nascido
Masculino
Defeitos do Tubo Neural/diagnóstico
Defeitos do Tubo Neural/terapia
Gravidez
Complicações na Gravidez/diagnóstico
Complicações na Gravidez/terapia
Coluna Vertebral/anormalidades
Coluna Vertebral/diagnóstico por imagem
Estados Unidos
Complexo Vitamínico B/uso terapêutico
alfa-Fetoproteínas/análise
[Pt] Tipo de publicação:JOURNAL ARTICLE; PRACTICE GUIDELINE
[Nm] Nome de substância:
0 (alpha-Fetoproteins); 12001-76-2 (Vitamin B Complex); 935E97BOY8 (Folic Acid)
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171206
[Lr] Data última revisão:
171206
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171201
[St] Status:MEDLINE
[do] DOI:10.1097/AOG.0000000000002412


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[PMID]:29029903
[Au] Autor:Zhang M; Goyert G; Lim HW
[Ad] Endereço:Department of Dermatology, Henry Ford Hospital, Detroit, Michigan.
[Ti] Título:Folate and phototherapy: What should we inform our patients?
[So] Source:J Am Acad Dermatol;77(5):958-964, 2017 Nov.
[Is] ISSN:1097-6787
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Ultraviolet (UV) degradation of folate has been studied in vitro and in vivo, but comprehensive reviews of the subject and recommendations for supplementing folate are lacking, especially for women of childbearing age, in whom decreases in folate predisposes newborns to neural tube defects. OBJECTIVE: We reviewed the effects of phototherapy on folate and provide a recommendation for women of childbearing age on phototherapy. METHODS: PubMed was searched for in vivo studies comparing folate levels before and after phototherapy. RESULTS: There is no evidence of decreased folate levels after UVA exposure. Decreased folate levels after sun exposure were limited to subjects taking folate supplements. Studies using narrowband UVB showed mixed results, potentially explained by dose-dependent degradation of folate; exposure >40 J/cm cumulatively and >2 J/cm per treatment were associated with 19%-27% decreases in serum folate levels, while lower doses did not affect folate levels. LIMITATIONS: Extensive variability in results from studies and lack of considering confounders. CONCLUSIONS: We recommend all women of childbearing age on phototherapy take 0.8 mg/day of folate supplements, as suggested by current guidelines for women of childbearing age, to reduce the risk of neural tube defects in unplanned pregnancy.
[Mh] Termos MeSH primário: Suplementos Nutricionais
Ácido Fólico/metabolismo
Ácido Fólico/efeitos da radiação
Terapia Ultravioleta/efeitos adversos
[Mh] Termos MeSH secundário: Adulto
Feminino
Ácido Fólico/sangue
Seres Humanos
Defeitos do Tubo Neural/prevenção & controle
Fototerapia/métodos
Gravidez
Resultado do Tratamento
Terapia Ultravioleta/métodos
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
935E97BOY8 (Folic Acid)
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171102
[Lr] Data última revisão:
171102
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171015
[St] Status:MEDLINE


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[PMID]:28984782
[Au] Autor:Zhou Y; Zhu L; Lin Y; Cheng H
[Ad] Endereço:Department of Neurosurgery, Jinling Hospital, Jinling School of Clinical Medicine, Nanjing Medical University, Jiangsu, China.
[Ti] Título:Chiari type I malformation with occult tethered cord syndrome in a child: A case report.
[So] Source:Medicine (Baltimore);96(40):e8239, 2017 Oct.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:RATIONALE: Chiari type I malformation (CM1) and occult tethered cord syndrome (OTCS) are considered to be malformations associated with subtle structural abnormalities of the terminal filum. Few studies have reported patients with CM1 and OTCS. Treatment strategy for patients of CM1 associated with OTCS is controversial. PATIENT CONCERNS: A 14-year-old child was admitted with intermittent pain and numbness in the right upper limb. And he had urinary frequency, neck pain, back pain, and numbness simultaneously. The imaging examinations showed CM1, syringomyelia, small fat in the filum at the level of the L2 vertebral body but the conus medullaris at the aspect of the L1 vertebral body. DIAGNOSES: The child was diagnosed with CM1 associated with OTCS. INTERVENTIONS: Patient underwent sectioning of filum terminale (SFT) under electrophysiological monitoring during the first hospital and posterior fossa decompression (PFD) during the second hospital. OUTCOMES: After first discharge pain of the right upper limb was relieved, but he still felt numbness. And his numbness was relieved after second discharge. The imaging examinations also showed corresponding improvement during the 2-year follow-up period. LESSONS: For pediatric patients with CM1 and TCS, treatment trouble is not only to choose the staging operation or simultaneous operation but also staging procedures for treatment of 2 lesions. Detailed preoperative evaluation is essential for development of individualized surgical plan. Staging operation of firstly minimally invasive SFT and later PFD may be helpful for such cases owing to its positive effect on both the symptoms and imaging findings.
[Mh] Termos MeSH primário: Malformação de Arnold-Chiari/complicações
Defeitos do Tubo Neural/complicações
[Mh] Termos MeSH secundário: Adolescente
Dor nas Costas/etiologia
Seres Humanos
Hipestesia/etiologia
Masculino
Cervicalgia/etiologia
Extremidade Superior
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171012
[Lr] Data última revisão:
171012
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171007
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000008239


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[PMID]:28914749
[Au] Autor:Hurtado-Villa P; Puerto AK; Victoria S; Gracia G; Guasmayán L; Arce P; Álvarez G; Blandón E; Rengifo N; Holguín JA; Durán A; Zarante I
[Ad] Endereço:From the *Pontificia Universidad Javeriana Cali; †Congenital Malformations Surveillance Programme of Bogotá, Pontificia Universidad Javeriana Bogotá; ‡Congenital Birth Defects Surveillance Programme of Cali, Pontificia Universidad Javeriana Cali; §Secretaria de Salud de Bogotá, Congenital Malformations Surveillance Programme of Bogotá, Pontificia Universidad Javeriana Bogotá; ¶Secretaria de Salud de Bogotá; ‖Secretaria de Salud Pública Municipal de Cali; and **Hospital Universitario San Ignacio, Pontificia Universidad Javeriana Bogotá.
[Ti] Título:Raised Frequency of Microcephaly Related to Zika Virus Infection in Two Birth Defects Surveillance Systems in Bogotá and Cali, Colombia.
[So] Source:Pediatr Infect Dis J;36(10):1017-1019, 2017 Oct.
[Is] ISSN:1532-0987
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Zika virus infection during pregnancy is now known to cause congenital microcephaly and severe brain defects. In 2016, rates of microcephaly appeared to start increasing around May, peaking in July, and declining through December. The occurrence of microcephaly appears to have increased nearly 4-fold in 2 large cities in Colombia, concurrently with the reported Zika virus epidemic in the country.
[Mh] Termos MeSH primário: Microcefalia/epidemiologia
Microcefalia/virologia
Infecção pelo Zika virus/complicações
Infecção pelo Zika virus/epidemiologia
[Mh] Termos MeSH secundário: Colômbia/epidemiologia
Estudos Transversais
Feminino
Seres Humanos
Recém-Nascido
Defeitos do Tubo Neural/epidemiologia
Gravidez
Prevalência
Vigilância em Saúde Pública
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170929
[Lr] Data última revisão:
170929
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170916
[St] Status:MEDLINE
[do] DOI:10.1097/INF.0000000000001670


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[PMID]:28862518
[Au] Autor:Hwang H; Wang KC; Bang MS; Shin HI; Kim SK; Phi JH; Lee JY; Choi J; Cha S; Kim K
[Ad] Endereço:Departments of 1 Rehabilitation Medicine.
[Ti] Título:Optimal stimulation parameters for intraoperative bulbocavernosus reflex in infants.
[So] Source:J Neurosurg Pediatr;20(5):464-470, 2017 Nov.
[Is] ISSN:1933-0715
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE The aim of this study was to establish optimal electric stimulation parameters for intraoperatively monitoring the bulbocavernosus reflexes (BCRs) in infants. METHODS The authors retrospectively reviewed the medical records of all infants (age < 24 months) who had undergone an untethering operation for tethered cord syndrome between May 2013 and February 2014 at a single institution and whose baseline BCR had been elicited during surgery. Using different combinations of stimulation parameters-number of stimulation pulses: 4 or 8 pulses, interpulse interval: 1, 2, or 5 msec, and polarity of stimulation: biphasic or monophasic-the authors compared the relative mean amplitude of 10 BCR responses (rmaBCRs) to each combination of parameters. RESULTS The rmaBCRs were larger with the 8-pulse stimulations than with the 4-pulse stimulations (p < 0.0001). There was a tendency, though not statistically significant, for larger rmaBCRs to be obtained with the longer interpulse interval in the 8-pulse stimulation (p = 0.1289). The biphasic stimulation produced larger rmaBCRs than the monophasic stimulation (p = 0.0005). CONCLUSIONS Biphasic 8-pulse stimulations with 5-msec or 2-msec intervals yield the largest BCR responses. Considering that an 8-pulse stimulation with 5-msec intervals may overlap the onset of the BCR, a biphasic 8-pulse stimulation with 2-msec intervals is recommended as the optimal stimulation paradigm to monitor intraoperative BCRs in infants.
[Mh] Termos MeSH primário: Estimulação Elétrica/métodos
Eletrodiagnóstico/métodos
Reflexo
[Mh] Termos MeSH secundário: Feminino
Seres Humanos
Lactente
Masculino
Defeitos do Tubo Neural/diagnóstico
Defeitos do Tubo Neural/fisiopatologia
Defeitos do Tubo Neural/cirurgia
Reflexo/fisiologia
Estudos Retrospectivos
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171102
[Lr] Data última revisão:
171102
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170902
[St] Status:MEDLINE
[do] DOI:10.3171/2017.6.PEDS16664


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[PMID]:28797054
[Au] Autor:Noor RA; Abioye AI; Ulenga N; Msham S; Kaishozi G; Gunaratna NS; Mwiru R; Smith E; Dhillon CN; Spiegelman D; Fawzi W
[Ad] Endereço:Africa Academy for Public Health (AAPH), Dar es Salaam, Tanzania.
[Ti] Título:Large -scale wheat flour folic acid fortification program increases plasma folate levels among women of reproductive age in urban Tanzania.
[So] Source:PLoS One;12(8):e0182099, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:There is widespread vitamin and mineral deficiency problem in Tanzania with known deficiencies of at least vitamin A, iron, folate and zinc, resulting in lasting negative consequences especially on maternal health, cognitive development and thus the nation's economic potential. Folate deficiency is associated with significant adverse health effects among women of reproductive age, including a higher risk of neural tube defects. Several countries, including Tanzania, have implemented mandatory fortification of wheat and maize flour but evidence on the effectiveness of these programs in developing countries remains limited. We evaluated the effectiveness of Tanzania's food fortification program by examining folate levels for women of reproductive age, 18-49 years. A prospective cohort study with 600 non-pregnant women enrolled concurrent with the initiation of food fortification and followed up for 1 year thereafter. Blood samples, dietary intake and fortified foods consumption data were collected at baseline, and at 6 and 12 months. Plasma folate levels were determined using a competitive assay with folate binding protein. Using univariate and multivariate linear regression, we compared the change in plasma folate levels at six and twelve months of the program from baseline. We also assessed the relative risk of folate deficiency during follow-up using log-binomial regression. The mean (±SE) pre-fortification plasma folate level for the women was 5.44-ng/ml (±2.30) at baseline. These levels improved significantly at six months [difference: 4.57ng/ml (±2.89)] and 12 months [difference: 4.27ng/ml (±4.18)]. Based on plasma folate cut-off level of 4 ng/ml, the prevalence of folate deficiency was 26.9% at baseline, and 5% at twelve months. One ng/ml increase in plasma folate from baseline was associated with a 25% decreased risk of folate deficiency at 12 months [(RR = 0.75; 95% CI = 0.67-0.85, P<0.001]. In a setting where folate deficiency is high, food fortification program with folic acid resulted in significant improvements in folate status among women of reproductive age.
[Mh] Termos MeSH primário: Farinha
Deficiência de Ácido Fólico/sangue
Ácido Fólico/administração & dosagem
Ácido Fólico/sangue
Alimentos Fortificados
Defeitos do Tubo Neural/prevenção & controle
[Mh] Termos MeSH secundário: Adolescente
Adulto
Feminino
Seres Humanos
Meia-Idade
Tanzânia
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
935E97BOY8 (Folic Acid)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171009
[Lr] Data última revisão:
171009
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170811
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0182099


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[PMID]:28686126
[Au] Autor:Tamura G; Morota N; Ihara S
[Ad] Endereço:Division of Neurosurgery, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan.
[Ti] Título:Impact of magnetic resonance imaging and urodynamic studies on the management of sacrococcygeal dimples.
[So] Source:J Neurosurg Pediatr;20(3):289-297, 2017 Sep.
[Is] ISSN:1933-0715
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE Sacrococcygeal dimples in neonates and infants are of uncertain pathological import. Previously they were believed to be rarely associated with intraspinal anomalies. Recent studies using MRI, however, revealed that 6%-7% of pediatric cases of sacrococcygeal dimples were associated with anatomical tethered spinal cord (TSC). Because the prevalence of tethered cord syndrome is still unclear, there is no consensus among pediatric neurosurgeons on the management of children with sacrococcygeal dimples. The authors performed an analysis of MRI and urodynamic studies to validate their management strategy for pediatric cases of sacrococcygeal dimples. METHODS A total of 103 Japanese children (49 male and 54 female, median age 4 months, range 8 days-83 months) with sacrococcygeal dimples who were referred to the Division of Pediatric Neurosurgery between 2013 and 2015 were included in this study. The lumbosacral region of all the patients was investigated using MRI. Anatomical TSC was defined as a condition in which the caudal end of the conus medullaris is lower than the inferior border of the L2-3 intervertebral disc. Patients with minor spinal anomalies (e.g., anatomical TSC, filum lipoma, thickened filum, or filar cyst) underwent further urodynamic studies to ascertain the presence of neurogenic bladder (NGB). In this study, the presence of NGB without anatomical TSC but with other minor spinal anomalies was defined as "functional TSC." The prevalence of anatomical and functional TSC was investigated. The association of the following cutaneous findings with spinal anomalies was also assessed: 1) depth of the dimple, 2) deviation of the gluteal fold, and 3) other skin abnormalities (e.g., discoloration, angioma, or abnormal hair). RESULTS The children were classified into 4 groups: Group 1, patients with anatomical TSC; Group 2, patients with functional TSC; Group 3, patients without anatomical or functional TSC but with other minor spinal anomalies; and Group 4, patients with no spinal anomaly. There were 6 patients (5.8%) in Group 1, 8 patients (7.8%) in Group 2, 10 patients (9.7%) in Group 3, and 79 patients (76.7%) in Group 4. Twenty-four patients (23.3%; Groups 1, 2, and 3) showed MRI abnormalities, including filum lipoma (14 cases), filar cysts (5 cases), thickened filum (2 cases), and anatomical TSC without other spinal anomalies (3 cases). Untethering of the spinal cord was indicated for 14 patients (13.6%; Groups 1 and 2) with anatomical and functional TSCs. Preoperative NGB was found in 12 patients and improved postoperatively in 7 (58.3%). None of the associated lumbosacral skin findings predicted the presence of underlying spinal anomalies. CONCLUSIONS The prevalence of tethered cord syndrome among children with sacrococcygeal dimples was, for the first time, revealed to be higher than previously thought. MRI and supplemental urodynamic studies may be indicated for children with sacrococcygeal dimples to identify patients with symptomatic TSC.
[Mh] Termos MeSH primário: Imagem por Ressonância Magnética
Região Sacrococcígea/anormalidades
Anormalidades da Pele
Urodinâmica
[Mh] Termos MeSH secundário: Pré-Escolar
Estudos de Coortes
Feminino
Seres Humanos
Lactente
Recém-Nascido
Masculino
Defeitos do Tubo Neural/diagnóstico por imagem
Defeitos do Tubo Neural/epidemiologia
Defeitos do Tubo Neural/fisiopatologia
Defeitos do Tubo Neural/cirurgia
Prevalência
Região Sacrococcígea/diagnóstico por imagem
Região Sacrococcígea/patologia
Região Sacrococcígea/cirurgia
Anormalidades da Pele/patologia
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170919
[Lr] Data última revisão:
170919
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170708
[St] Status:MEDLINE
[do] DOI:10.3171/2017.5.PEDS16719



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