Occult spinal dysraphism in children: the time and the surgical treatment of 50 children

OCCULT SPINAL DYSRAPHISM IN CHILDREN: THE TIME AND THE SURGICAL TREATMENT OF 50 CHILDREN (ABSTRACT)^*. THESIS. CAMPINAS, 1994.

DONIZETI CESAR HONORATO^**

The diagnosis and the surgical treatment of 50 children with occult spinal dysraphism followed from 1982 to 1992 are analyzed. The ages at the time of the surgery ranged from 9 days to 16 years. Sixty per cent (60%) were less than two years old, and neither sex was predominant.

In 92% of the cases there were cutaneous anomalies in the lumbosacral area (semifluctuant mass, dimple, skin tag, hairy pathy or hemangiomas). Additionally, back pain and progressive neurological deficits in the lower limbs were present in 42% of the cases. Sphincter disturbance and orthopedic deformities were present in 34% of the series, and trophic disorders in 12% of the children.

Physical and neurological exam, urodynamic evaluation and neuroradiological study (X-ray, myelography, myelo-CT and magnetic resonance image) were considered essential components of the pre-operative studies.

Lipomas and thickened filum were the more frequent operative findings. The surgical aim is to free intra to extradural adhesions and to release the tethered spinal cord, responsible for ischemia of the lumbosacral cord neurons.

The results showed the pain always disappear. The motor weakness and sensory loss in the lower limbs decreased in most and certainly got no worse in any. Several children were able to cancel proposed orthopedic corrective procedures on their lower limbs. The sphincter disturbance responded least of all, but even this improved.

Surgical treatment was gratifying. In 80% of the cases, there were complete cure or improvement of the deficits. The symptoms have not increased in another 10% of the cases.

Early identification of the illness permitted the realization of prophylactic surgeries in the case of lipomas, and in other pathologies the patients would have to be operated on at the onset sign of a tethered cord.

KEY WORDS: spinal dysraphism occult, surgical treatment, lipoma.

** Address: Rua Giuseppe Maximo Scolfaro 501, Cidade Universitária, 13083-360. Campinas SP, Brasil. E-mail: [e-mail]

*

Disrafismo espinhal oculto com comprometimento medular na infância: da identificação ao momento exato do tratamento cirúrgico (Resumo).Tese de Doutorado, Faculdade de Ciências Médicas da Universidade Estadual de Campinas - UNICAMP (Área: Neurociências). Orientador: José Jorge Facure.

Publication Dates

• Publication in this collection
  06 Dec 2000
• Date of issue
  Sept 1999