ABSTRACT
We review and describe the neurological presentation and long-term outcome of patients with meningocele manqué, and describe the dysraphic features associated with this entity. Our series of patients was collected over a 25-year period with a mean follow-up of 11.5 years. The mean age of presentation was 10.4 years and 72% of the patients presented with an abnormal neurological examination. At most recent follow-up, symptoms were stable, improved, and progressed in 47, 37 and 16%, respectively. Meningocele manqué was associated with focal hirsutism in 37% of the cases. These bands were primarily found in the lumbar spine and involved two sequential vertebral levels in 42% of cases. Sectioning of meningocele manqué has good long-term results in the majority of patients. These bands should be sought in the evaluation of patients with spinal dysraphism and surgically transected.
Subject(s)
Meningocele/surgery , Adolescent , Adult , Child , Child, Preschool , Colonic Diseases/etiology , Female , Follow-Up Studies , Humans , Infant , Infant, Newborn , Laminectomy/methods , Male , Meningocele/pathology , Motor Neuron Disease/etiology , Neurologic Examination , Pain/etiology , Paresthesia/etiology , Retrospective Studies , Spinal Dysraphism/pathology , Urinary Bladder Diseases/etiologyABSTRACT
Tethered cord syndrome is a progressive form of neurological deterioration that results from spinal cord tethering by various dysraphic spinal abnormalities. The syndrome, treatments, outcomes, and current controversies are reviewed.
Subject(s)
Neural Tube Defects/pathology , Spinal Dysraphism/pathology , Humans , Neural Tube Defects/diagnosis , Neural Tube Defects/embryology , Neural Tube Defects/surgery , Spinal Dysraphism/diagnosis , Spinal Dysraphism/embryology , Spinal Dysraphism/surgeryABSTRACT
Pneumosinus dilatans is a rare condition of unknown etiology in which there is enlargement of the paranasal sinuses by air, with extension beyond the normal boundaries of bone. The authors present a case of pneumosinus dilatans of the frontal sinus and review the literature.
Subject(s)
Frontal Sinus/pathology , Paranasal Sinus Diseases/surgery , Adolescent , Dilatation, Pathologic/diagnosis , Dilatation, Pathologic/surgery , Frontal Sinus/surgery , Humans , Male , Paranasal Sinus Diseases/diagnosis , Plastic Surgery Procedures/methods , Tomography, X-Ray ComputedABSTRACT
We have previously proposed the existence of the tethered cord syndrome in the presence of a conus medullaris in the normal position. Our 12-year series of 73 patients with the tethered cord syndrome included 13 patients in whom the spinal cord terminated at or above the L1-L2 disc space. We compare the characteristics of these 13 with those of the 60 patients whose spinal cord terminated below the L1-L2 disc space. The parameters for comparison included neurological status at presentation and follow-up, the presence of cutaneous stigmata of occult spinal dysraphism, vertebral anomalies, and others. The frequency of occurrence of each parameter in the normally positioned group was essentially the same as its occurrence in the low-lying group.
Subject(s)
Spina Bifida Occulta/surgery , Adolescent , Adult , Child , Child, Preschool , Diagnosis, Differential , Diagnostic Imaging , Female , Follow-Up Studies , Humans , Infant , Infant, Newborn , Lipoma/classification , Lipoma/diagnosis , Lipoma/surgery , Lumbar Vertebrae/abnormalities , Lumbar Vertebrae/surgery , Male , Neurologic Examination , Spina Bifida Occulta/classification , Spina Bifida Occulta/diagnosis , Spinal Neoplasms/classification , Spinal Neoplasms/diagnosis , Spinal Neoplasms/surgeryABSTRACT
The intent of this article is to propose the existence of the tethered cord syndrome in patients whose conus is in a normal position. The tethered cord syndrome has been a well-recognized entity, occurring in the pediatric and adult population. A central tenet to this syndrome is that the conus medullaris must be "abnormally" low, regardless of the tethering lesion. Our 12-year series of 73 patients with tethered cord syndrome included 13 patients in whom the cord terminated at or above the L1-L2 space. These patients otherwise displayed characteristics usually associated with the patient with an abnormally low conus. Most patients with progressive neurological deterioration responded to surgery. The preoperative radiographic evaluation and the operative findings usually demonstrated a thickened filum. Tethered cord syndrome may occur in the patient who has a conus in the "normal" position.
Subject(s)
Spina Bifida Occulta/surgery , Adolescent , Adult , Child , Child, Preschool , Female , Follow-Up Studies , Humans , Infant , Infant, Newborn , Lipoma/diagnosis , Lipoma/surgery , Lumbar Vertebrae/pathology , Lumbar Vertebrae/surgery , Male , Middle Aged , Neurologic Examination , Postoperative Complications/diagnosis , Retrospective Studies , Spina Bifida Occulta/diagnosis , Spinal Dysraphism/diagnosis , Spinal Dysraphism/surgery , Spinal Neoplasms/diagnosis , Spinal Neoplasms/surgeryABSTRACT
The normal src protein (pp60c-src) is localized principally in the nerve growth cone of developing neurons and declines to low levels with synaptic maturation. To determine whether pp60c-src is reexpressed in regenerating axons, its expression was studied by immunoblotting and immunocytochemical analyses in adult chicken sciatic nerve following nerve crush injury. pp60c-src expression was found to increase during nerve repair with a temporal and spatial pattern consistent with a localization in regenerating axons. At the crush site, pp60c-src increased to maximal levels 7 days postinjury, increasing fivefold relative to 0 day nerve. In the nerve segment distal to the injury, the maximal increase in pp60c-src was sevenfold and occurred between 11 and 21 days postinjury. Immunoperoxidase staining revealed pp60c-src in regenerating axons and certain nonneuronal cells at the site of nerve repair. pp60c-src was induced in both motor and sensory neurons, as shown by increased pp60c-src immunoreactivity in their cell bodies located in the spinal cord and dorsal root ganglion. Phosphotyrosine-modified proteins that were potential targets of pp60c-src increased following nerve crush, and were localized to outgrowing neurites as well as to nonneuronal cells. These results suggest that pp60c-src is a common component of cellular mechanisms regulating growth cone migration in both regenerating and developing axons.
