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Complex Split Cord Complex Split Cord Malformations- The Untold StoryMalformations- The Untold Story
Deepak AgrawalDeepak AgrawalDepartment of Neurosurgery,Department of Neurosurgery,
Neurosciences & Gamma Knife centre,Neurosciences & Gamma Knife centre,
All India Institute of Medical Sciences, New All India Institute of Medical Sciences, New DelhiDelhi
COMPLEX SPLIT CORD MALFORMATIONS
DEFINITIONDEFINITION
Complex SCM are SCM associated Complex SCM are SCM associated with other intraspinal anomalies like with other intraspinal anomalies like lipomeningocele, myelomeningocele, lipomeningocele, myelomeningocele, neuroenteric cyst and/or tumors neuroenteric cyst and/or tumors (such as dermoids).(such as dermoids).
COMPLEX SPLIT CORD MALFORMATIONS
CURRENT STATUSCURRENT STATUS
The literature is sparse regarding the The literature is sparse regarding the epidemiology of complex SCM.epidemiology of complex SCM.
Pubmed search reveals only 15 papersPubmed search reveals only 15 papers
Most are case reportsMost are case reports
COMPLEX SPLIT CORD MALFORMATIONS
INDIAN EXPERIENCEINDIAN EXPERIENCE
Easy availability of 1.5T MRIEasy availability of 1.5T MRI
MR costs USD 50/ptMR costs USD 50/pt
MR feasible in infants & neonates MR feasible in infants & neonates with minimal sedationwith minimal sedation
COMPLEX SPLIT CORD MALFORMATIONS
AIMS & OBJECTIVESAIMS & OBJECTIVES
To assess the incidence and clinico-To assess the incidence and clinico-radiological findings of complex SCM radiological findings of complex SCM in a tertiary level pediatric in a tertiary level pediatric neurosurgery unitneurosurgery unit
COMPLEX SPLIT CORD MALFORMATIONS
STUDY DESIGNSTUDY DESIGN
Retrospective chart reviewRetrospective chart review
24 month period (Jan 2005- Dec 24 month period (Jan 2005- Dec
2006)2006)
COMPLEX SPLIT CORD MALFORMATIONS
MATERIALS & METHODSMATERIALS & METHODS
Operative and clinical-Operative and clinical-radiological records of all radiological records of all patients patients (age<21yrs) (age<21yrs) with spinal with spinal dysraphism who underwent dysraphism who underwent surgery in our department were surgery in our department were reviewed.reviewed.
COMPLEX SPLIT CORD MALFORMATIONS
MRI PROTOCOLMRI PROTOCOL
MRI whole spine with screening MRI MRI whole spine with screening MRI Brain on a 1.5T MachineBrain on a 1.5T Machine
Picks up assoc Spinal & Brain Picks up assoc Spinal & Brain abnormalitiesabnormalities
Helps in prognosticatingHelps in prognosticating
COMPLEX SPLIT CORD MALFORMATIONS
RESULTSRESULTS
PatientsPatients
Spinal DysraphismSpinal Dysraphism 107 pts107 pts
SCMSCM 53 pts53 pts
(49.5%)(49.5%)
Spinal Dysraphism
SCM
Patients
COMPLEX SPLIT CORD MALFORMATIONS
RESULTSRESULTS
SCMSCM
SCMSCM 5353 Complex SCMComplex SCM 2323
(43.4%)(43.4%)
SCM,
Complex SCM,
COMPLEX SPLIT CORD MALFORMATIONS
RESULTSRESULTS
Demographics (Complex SCM)Demographics (Complex SCM)
Mean age 4.7yrs (1 mth-20yrs)Mean age 4.7yrs (1 mth-20yrs)
M: F 2.2:1M: F 2.2:1
COMPLEX SPLIT CORD MALFORMATIONS
RESULTSRESULTS
SCMSCM
SCM ISCM I 12 pts (52.2%)12 pts (52.2%)
SCM IISCM II 11 pts (47.8%)11 pts (47.8%)
SCM I
SCM II
Patients
COMPLEX SPLIT CORD MALFORMATIONS
COMPLEX SCM(23 PTS)
MMC(n=17)
Conus Lipoma(n=4)
Spinal Tumor(n=2)
Pure MMC(n=10)(59%)
LMMC(n=7)(41%)
Hydrocephalus(n=5)(50%)
Assoc Tumor(n=3)
No Tumor(n=4)
Hydrocephalus(n=2)(29%)
Assoc Tumor(n=3)
COMPLEX SPLIT CORD MALFORMATIONS
COMPLEX SPLIT CORD MALFORMATIONS
COMPLEX SPLIT CORD MALFORMATIONS
COMPLEX SPLIT CORD MALFORMATIONS
SCM I & SCM IISCM I & SCM II
5 5
2
5
4
0 0
2
0
1
2
3
4
5
6
No o
f Pts
Pure MMC LMMC Conus Lipoma Tumor
SCM I SCM II
COMPLEX SPLIT CORD MALFORMATIONS
IMPORTANT FINDINGSIMPORTANT FINDINGS
Very high incidence of SCM in patients Very high incidence of SCM in patients with spinal dysraphism with spinal dysraphism (49.5% in this (49.5% in this study).study).
Very high incidence of Complex SCM in Very high incidence of Complex SCM in patients with SCM patients with SCM (43% in this study).(43% in this study).
Incidence of hydrocephalus different (Incidence of hydrocephalus different (50% 50% of MMC & 30% of LMMCof MMC & 30% of LMMC))
COMPLEX SPLIT CORD MALFORMATIONS
CONCLUSIONSCONCLUSIONS
Very high incidence of complex SCM in Very high incidence of complex SCM in patients with spinal dysraphism.patients with spinal dysraphism.
Preoperative MRI can be extremely useful in Preoperative MRI can be extremely useful in operative planning and management of such operative planning and management of such patients and should be done in all casespatients and should be done in all cases
Our is the largest study in literature till dateOur is the largest study in literature till date
COMPLEX SPLIT CORD MALFORMATIONSTHANK YOUTHANK YOU