Ausili E, Maresca G, Massimi L, Morgante L, Romagnoli C, Rendeli C
Spina Bifida Center, Women's and Infant Health Sciences, A. Gemelli Policlinic, Catholic University of Sacred Heart, Largo A. Gemelli 8, 00168, Rome, Italy.
Neurosurgery Department, Catholic University of Sacred Heart, Largo A. Gemelli 8, 00168, Rome, Italy.
Childs Nerv Syst. 2018 Feb;34(2):285-291. doi: 10.1007/s00381-017-3638-0. Epub 2017 Oct 27.
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.
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.
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.
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.
本文旨在利用腰椎超声检查（LUS）对出现特定皮肤标记或骶尾部酒窝的新生儿进行隐性脊柱裂（OSD）的研究。
2012年至2015年期间，我们对患有皮肤胎记和/或骶尾部酒窝的新生儿进行了LUS检查。对所有超声检查异常或有神经受累特征的患者进行了磁共振成像（MRI）检查，以检测脊柱病变。
我们前瞻性评估了475例出现皮肤胎记的新生儿，在其出生4周内进行了LUS检查，其中439例完成了研究。所有患者均接受了近12个月的随访。其中，39例超声检查异常并接受了MRI检查。在这组患者中，12例确诊为脊柱裂。在考虑皮肤标记时，皮样窦与脊髓病变的较高风险相关，另一方面，单纯骶部酒窝的存在表明隐性脊柱裂的风险非常低。同时存在更多皮肤标记和/或在圆锥水平、搏动性、脊髓位置、终丝厚度或鞘内肿块、脂肪瘤或皮样窦道方面存在腰椎超声异常，表明由于脊柱病变风险较高，有必要进行MRI检查以检测脊髓异常。
对有特定皮肤标记的新生儿进行LUS检查是一种有效的方法，可用于选择进行MRI检查以检测OSD的患者。单纯骶部酒窝的存在是隐匿性神经病变的一个可忽略不计的标记，而孤立性皮样窦或多个皮肤标记的存在可被认为表明脊柱裂风险较高。
