1Pediatric Neurosurgery Unit, Hospital Universitario Virgen del Rocío, Seville.
3Neuroscience Applied Group, Institute of Biomedicine of Seville, Spain.
J Neurosurg Pediatr. 2020 Dec 18;27(3):311-316. doi: 10.3171/2020.7.PEDS20161. Print 2021 Mar 1.
Split cord malformation (SCM) is a term used for all double spinal cords. It represents 3.8%-5% of spinal dysraphisms. Pang et al.'s embryological theory proposes the formation of an "accessory neurenteric canal" that communicates with the yolk sac and amnion. To the authors' knowledge, only three cases of diastematobulbia (basicranial SCM) associated with a spur or dermoid have been reported in the literature.The case patient is a newborn girl with an occipitocervical meningocele and dermal sinus associated with an anomaly of notochordal development in the transition between the medulla oblongata and the spinal cord (diastematobulbia) without a bony septum or dermoid cyst. The patient also has agenesis of the atlas and an absence of corticospinal tract decussation. This patient underwent reconstruction of the occipital meningocele and dermal sinus excision.To the authors' knowledge, this is the first described case of type II diastematobulbia (basicranial SCM), without a dermoid cyst. The authors analyzed the embryological errors present in the case patient and considered the option of further surgical treatment depending on the evolution of the patient's condition. At the time of this report, the patient had shown normal psychomotor development. However, this fact may only be due to the patient's young age. Considering that after initial untethering the patient remained clinically asymptomatic, conservative and close surveillance has been and continues to be the proposed treatment.
脊髓纵裂畸形(SCM)是用于所有双脊髓的术语。它占脊髓脊膜膨出的 3.8%-5%。Pang 等人的胚胎学理论提出了形成“副神经肠管”的理论,该管与卵黄囊和羊膜相通。据作者所知,文献中仅报道了三例与脊柱裂(颅底 SCM)相关的齿状突或皮样瘤。该病例患者为一名新生女婴,伴有枕颈脑膜膨出和皮窦,与延髓和脊髓交界处的脊索发育异常相关(脊髓纵裂),无骨隔或皮样囊肿。患者还存在寰椎发育不全和皮质脊髓束交叉缺失。该患者接受了枕骨脑膜膨出重建和皮窦切除术。据作者所知,这是首例无皮样囊肿的 II 型脊髓纵裂(颅底 SCM)描述。作者分析了病例患者存在的胚胎学错误,并考虑了根据患者病情变化进行进一步手术治疗的选择。在本报告时,患者表现出正常的精神运动发育。然而,这一事实可能仅归因于患者年龄较小。考虑到初始松解后患者仍无临床症状,保守治疗和密切监测一直是并将继续是推荐的治疗方法。