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Occult spinal dysraphism: neuroradiological study
P Tortori-Donati1, A Cama, M L Rosa
1Department of Neuroradiology, Ospedale San Martino, Genova, Italy.
Insights
Magnetic resonance imaging (MRI) is the primary diagnostic tool for occult spinal dysraphism in children. Computed tomography (CT) and myelography are reserved for complex cases where MRI is insufficient.
Area of Science:
- Pediatric Radiology
- Neurosurgery
- Developmental Biology
Background:
- Occult spinal dysraphism comprises a spectrum of congenital vertebral anomalies.
- Accurate diagnosis is crucial for timely surgical intervention and improved outcomes.
- Traditional imaging modalities have limitations in fully characterizing these complex malformations.
Purpose of the Study:
- To evaluate the diagnostic utility of various imaging techniques for occult spinal dysraphism.
- To refine classification and surgical indications based on neuroradiological findings.
- To introduce a new term for complex conus medullaris and filum terminale abnormalities.
Main Methods:
- Retrospective analysis of 47 pediatric patients (0-14 years) with occult spinal dysraphism.
- Utilized plain X-rays, computed tomography (CT), CT myelography, and magnetic resonance (MR) imaging.
- Correlated imaging findings with clinical presentation and surgical outcomes.
Main Results:
- Magnetic resonance (MR) imaging proved to be the most effective modality for diagnosis.
- CT and CT myelography were necessary only in select cases of significant anatomical complexity.
- A novel term, "neurofibrous structure," is proposed for the indistinguishable conus-filum terminale unit.
Conclusions:
- MR imaging is the gold standard for evaluating occult spinal dysraphism in children.
- CT and CT myelography play a supplementary role in complex anatomical scenarios.
- The proposed "neurofibrous structure" term aids in describing complex conus-filum terminale malformations.
Abstract:
We present a retrospective study of occult spinal dysraphism in 47 children aged 0 to 14 years, all studied with plain X-rays, 60% with CT and myelo-CT, and 40% with MR. We consider the classification and grading of these malformations, clinical, neuroradiological patterns, and indications for surgery. In the light of our findings and of the published data MR emerges as the key investigation. Only in a few cases of great anatomical complexity is it now necessary to perform CT and myelo-CT as well. A case in point is when the conus and thickened filum terminale are inextricably bound together and can no longer be considered separate structures. We propose the term "neurofibrous structure" to define the conus-thickened-filum-terminale unit when these structure are no longer distinguishable.