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Unveiling the tale of the tail: an illustration of spinal dysraphisms
Anjuna Reghunath1, Rohini Gupta Ghasi2, Ankita Aggarwal1
1Department of Radiodiagnosis, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, 110029, India.
Abstract:
Spinal dysraphism is an umbrella term describing herniation of meninges or neural elements through defective neural arch. They can be broadly categorized into open and closed types. MRI is the investigation of choice to study neural abnormalities and to assess the severity of hydrocephalus and Chiari malformation. Knowledge of the embryology of these disorders is valuable in correctly identifying the type of dysraphism. The aim of surgery is untethering and dural reconstruction. Accurate depiction of the abnormal anatomy in cases of spinal dysraphism is of utmost importance for surgical management of these patients. MRI makes this possible due to its excellent soft tissue contrast resolution and multiplanar capability, allowing the radiologist to evaluate the intricate details in small pediatric spinal structures. Imaging enlightens the surgeons about the status of spinal cord and other associated abnormalities and helps detect re-tethering in operated cases. Besides, antenatal surgery to repair myelomeningoceles has made detection of open dysraphisms on fetal MRI and antenatal ultrasound critical. The purpose of this review is to describe the development of spine, illustrate the myriad imaging features of open and closed spinal dysraphisms, and enlist the reporting points the operating surgeon seeks from the radiologist.
Insights
Spinal dysraphism involves neural elements herniating through a defective spine. MRI is crucial for diagnosing these conditions, guiding surgical management, and monitoring post-operative outcomes in pediatric patients.
Area of Science:
- Developmental biology
- Pediatric radiology
- Neurosurgery
Background:
- Spinal dysraphism encompasses congenital anomalies characterized by defective neural arch closure.
- These conditions are broadly classified into open and closed types, impacting neural elements and meninges.
- Understanding spinal embryology is key to accurate diagnosis and management.
Purpose of the Study:
- To review spinal development and the embryology of spinal dysraphisms.
- To illustrate the diverse imaging features of open and closed spinal dysraphisms using MRI.
- To outline essential reporting points for radiologists to aid surgical decision-making.
Main Methods:
- Review of spinal embryology and developmental processes.
- Illustration of imaging findings from Magnetic Resonance Imaging (MRI) in various spinal dysraphisms.
- Compilation of critical radiological reporting parameters for surgical planning.
Main Results:
- MRI offers superior soft tissue contrast and multiplanar capabilities for detailed pediatric spinal imaging.
- Imaging findings provide crucial information on spinal cord status, associated abnormalities, and re-tethering.
- Accurate anatomical depiction via MRI is vital for effective surgical untethering and dural reconstruction.
Conclusions:
- MRI is the gold standard for evaluating spinal dysraphisms, assessing severity, and guiding surgical intervention.
- Radiological expertise in interpreting pediatric spinal MRI is essential for optimal patient outcomes.
- Antenatal imaging (ultrasound and MRI) is increasingly important for early detection and management of open spinal dysraphisms like myelomeningocele.
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