A Type II Split Cord Malformation in an Adult Patient: An Operative Case Report

2020 ◽  
Author(s):  
Taemin Oh ◽  
Lauro Nathaniel Avalos ◽  
John Frederick Burke ◽  
Nikhil Mummaneni ◽  
Michael Safaee ◽  
...  
Keyword(s):  
Adult Patient ◽  
Tethered Cord ◽  
Wound Dehiscence ◽  
Bladder Function ◽  
Split Cord Malformation ◽  
Type Ii ◽  
Fibrous Septum ◽  
Lumbar Drain ◽  
First Case ◽  
Uncommon Presentation

Abstract BACKGROUND AND IMPORTANCE Split cord malformations (SCMs) are rare conditions in which the spinal cord is split into two hemicords within either a single thecal sac or two separate thecal sacs. The hemicords are typically split by a bony or fibrous structure. We present an adult patient who presented with a type II SCM with tethered cord. This is the first case of such a presentation with an accompanying intraoperative video. Unusual features of the case were the presence of an incomplete fibrous septum and lack of a discrete filum terminale. CLINICAL PRESENTATION A 50-yr-old woman presented with back pain, radiculopathy, urinary urgency, and episodic fecal incontinence. Her exam was notable for weakness of the right extensor hallicus longus. Imaging showed an SCM extending from L3 to S1, a fibrous septum located at L4-5, and a low-lying conus at S4. She was treated with a decompressive L3-S4 laminectomy and disconnection of all the dural attachment points. She required lumbar drain placement postoperatively and reoperation for wound dehiscence and persistent pseudomeningocele. At the time of last follow-up, she was neurologically intact with improvement in bowel/bladder function. CONCLUSION SCM is an uncommon presentation in adults and is often accompanied by findings of skin stigmata, tethered cord, and other central nervous system/skeletal anomalies. Obtaining full multimodal imaging is critical to understanding subtle anatomic variations that can pose operative challenges. We report the treatment of an adult patient with type II SCM, and provide an intraoperative video demonstrating the removal of an incomplete midline fibrous septum.

scholarly journals Clinical and surgical management of a congenital Type II split cord malformation presenting with progressive cranial neuropathies: case report

2017 ◽  
Vol 19 (3) ◽  
pp. 349-353
Author(s):  
Patrick R. Maloney ◽  
Meghan E. Murphy ◽  
Molly J. Sullan ◽  
Kathryn M. Van Abel ◽  
Shelagh A. Cofer ◽  
...  
Keyword(s):  
Case Report ◽  
Surgical Management ◽  
Clinical Impact ◽  
Split Cord Malformation ◽  
Cervical Cord ◽  
Clinical Scenario ◽  
Type Ii ◽  
First Case ◽  
Thoracolumbar Region ◽  
Cranial Neuropathies

Split cord malformation (SCM) is a rare abnormality of notochord development. The majority of cases occur in the thoracolumbar region, with more than 30 cases of cervical SCM reported. The clinical impact of SCMs involving the cervical cord is therefore largely unknown. In addition, the concomitant finding of brainstem involvement is presumably incompatible with life in the majority of patients, resulting in a paucity of data regarding this clinical scenario. In this paper the authors present the first case, to their knowledge, of an incomplete cervical SCM involving the brainstem and discuss its clinical impact, diagnosis, and management.

Surgical management of tethered cord syndrome in adults: indications, techniques, and long-term outcomes in 60 patients

2006 ◽  
Vol 4 (2) ◽  
pp. 123-131 ◽  
Author(s):  
Gabriel Y. F. Lee ◽  
Guillermo Paradiso ◽  
Charles H. Tator ◽  
Fred Gentili ◽  
Eric M. Massicotte ◽  
...  
Keyword(s):  
Bladder Dysfunction ◽  
Tethered Cord ◽  
Neurological Status ◽  
Tethered Cord Syndrome ◽  
Neurological Dysfunction ◽  
Bladder Function ◽  
Split Cord Malformation ◽  
Cerebrospinal Fluid Leakage

Object The adult presentation of tethered cord syndrome (TCS) is well recognized but continues to pose significant diagnostic and management challenges. The authors performed a retrospective study of clinical outcomes after neurosurgical intervention in 60 adults with TCS. Methods All patients who underwent detethering surgery for caudal cord tethering at Toronto Western Hospital between August 1993 and 2004 were identified. Their clinical charts, operative records, and follow-up data were reviewed. Detethering procedures were performed in 62 patients (age range 17–72 years) for TCS of various origins. Long-term (mean 41.5 months) follow-up data were obtained in 60 patients. The tethering lesions were tight terminal filum in 29 patients, postrepair myelomeningocele in 15, lipomyelomeningocele/lipoma in nine, split cord malformation in four, and arachnoidal adhesions in three. Fifty-nine patients presented with progressive pain and/or neurological dysfunction. One patient underwent prophylactic sectioning of the terminal filum. Most patients (71%) had bladder dysfunction at presentation. Microsurgical release of the tethered cord was performed in each case while using multimodality intraoperative neurophysiological monitoring. The most common complication was cerebrospinal fluid leakage, which occurred in nine patients and was managed by reinforcement sutures in four patients, temporary external drainage in three, and the placement of a lumboperitoneal shunt in two. Infective complications included superficial wound infection in three patients, meningitis in one, and urinary tract infection in one. One patient who had undergone multiple previous intradural procedures experienced worsened foot weakness postoperatively. Another patient experienced temporary unilateral lower-limb numbness. At follow up, improvement was noted in the majority of patients presenting with back (78%) and leg (83%) pain. Improvement was more likely in patients with preoperative motor weakness than in those with sensory deficits. Overall, neurological status was improved or stabilized in 90% of patients. Subjective improvement in bladder function was noted in 50% of patients with bladder dysfunction at presentation. Conclusions Surgery in adult patients with TCS is safe and effective for improving pain and neurological status in the majority of patients; however, patients who have undergone previous intradural detethering procedures in general fare less well, and considerable judgment is required in their management.

scholarly journals A Knowledge-Based Algorithm for Automatic Monitoring of Orthodontic Treatment: The Dental Monitoring System. Two Cases

Sensors ◽  
2021 ◽  
Vol 21 (5) ◽  
pp. 1856
Author(s):  
Silvia Caruso ◽  
Sara Caruso ◽  
Marianna Pellegrino ◽  
Rayan Skafi ◽  
Alessandro Nota ◽  
...  
Keyword(s):  
Adult Patient ◽  
Remote Monitoring ◽  
Digital Technology ◽  
Orthodontic Treatment ◽  
Dental Treatment ◽  
Automatic Monitoring ◽  
Software As A Service ◽  
Knowledge Based ◽  
First Case ◽  
Service Application

Background: In the dental field, digital technology has created new opportunities for orthodontists to integrate their clinical practice, and for patients to collect information about orthodontics and their treatment, which is called “teledentistry.” Dental monitoring (DM) is a recently introduced orthodontic application that combines safe teledentistry with artificial intelligence (AI) using a knowledge-based algorithm, allowing an accurate semi-automatic monitoring of the treatment. Dental Monitoring is the world’s first SaaS (Software as a Service) application designed for remote monitoring of dental treatment, developed in Paris, France, with Philippe Salah as the Co-founder and CEO. Cases presentation: This report describes two cases in which DM system was essential to achieve the control of certain movements: it was possible to follow the movement, even if complex, such as the anterior cross of an adult patient and a lack of space in the canine of the growing patient. The software analyzed the fit and retention of the aligner, thus ensuring correct biomechanics. They were treated during the COVID-19 pandemic lockdown with aligners. The first case is a growing patient who was monitored during an interceptive orthodontic treatment to manage a retained upper canine. The second case is an adult patient forced to finalize his treatment of upper lateral incisor crossbite. The software analyzed the fit and retention of the aligner, thus ensuring correct biomechanics. Conclusions: DM system appears to be a promising method, useful for improving the interaction between doctor and patient, generally acceptable and useful to patients, even in critical clinical situations, at least in cases with optimal compliance and ability to use the tool properly.

scholarly journals Acute Cholecystitis Caused by Ceftriaxone Stones in an Adult

2009 ◽  
Vol 2009 ◽  
pp. 1-2 ◽  
Author(s):  
Christian D. Becker ◽  
Robert A. Fischer
Keyword(s):  
Adult Patient ◽  
Acute Cholecystitis ◽  
Health Problem ◽  
Medical Literature ◽  
Early Recognition ◽  
Gallstone Formation ◽  
Sludge Formation ◽  
Major Health Problem ◽  
Major Health ◽  
First Case

Acute cholecystitis is a major health problem. There are multiple etiologies to be considered and early recognition of the condition is important to optimize management and outcome. We report the first case in the medical literature of symptomatic acute cholecystitis triggered by ceftriaxone-associated gallbladder sludge formation and, importantly, solid ceftriaxone gallstone formation in an adult patient with underlying mineral and pigment cholecystolithiasis, necessitating cholecystectomy. This case serves as a reminder for physicians to keep this uncommon cause of cholecystolithiasis and cholecystitis in mind in patients who receive prolonged ceftriaxone therapy. These patients should be cautioned to promptly report to their physicians any signs or symptoms of cholecystitis in order to ensure timely and appropriate evaluation.

scholarly journals The use of a handmade balloon-expandable covered stent for native coarctation of the aorta in an adult patient: A report of a first case in Japan

2010 ◽  
Vol 56 (3) ◽  
pp. 287-290
Author(s):  
Takashi Higaki ◽  
Eiichi Yamamoto ◽  
Masahiro Ryugo ◽  
Hiroshi Imagawa ◽  
Fumiaki Shikata ◽  
...  
Keyword(s):  
Adult Patient ◽  
Coarctation Of The Aorta ◽  
Covered Stent ◽  
First Case

Intradural spinal endoscopy in children

2011 ◽  
Vol 8 (1) ◽  
pp. 107-111 ◽  
Author(s):  
Joshua J. Chern ◽  
Amber S. Gordon ◽  
Robert P. Naftel ◽  
R. Shane Tubbs ◽  
W. Jerry Oakes ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Brain Tumors ◽  
Arachnoid Cyst ◽  
Spinal Cord Tumor ◽  
Split Cord Malformation ◽  
Type Ii ◽  
Pediatric Spine ◽  
Spinal Cord Malformation ◽  
Wide Acceptance ◽  
Surgical Adjunct

Intracranial endoscopy in the treatment of hydrocephalus, arachnoid cysts, or brain tumors has gained wide acceptance, but the use of endoscopy for intradural navigation in the pediatric spine has received much less attention. The aim of the authors' present study was to analyze their experience in using spinal endoscopy to treat various pathologies of the spinal canal. The authors performed a retrospective review of intradural spinal endoscopic cases at their institution. They describe 4 representative cases, including an arachnoid cyst, intrinsic spinal cord tumor, holocord syrinx, and split cord malformation. Intradural spinal endoscopy was useful in treating the aforementioned lesions. It resulted in a more limited laminectomy and myelotomy, and it assisted in identifying a residual spinal cord tumor. It was also useful in the fenestration of a multilevel arachnoid cyst and in confirming communication of fluid spaces in the setting of a complex holocord syrinx. Endoscopy aided in the visualization of the spinal cord to ensure the absence of tethering in the case of a long-length Type II split spinal cord malformation. Conclusions Based on their experience, the authors found intradural endoscopy to be a useful surgical adjunct and one that helped to decrease morbidity through reduced laminectomy and myelotomy. With advances in technology, the authors believe that intradural endoscopy will begin to be used by more neurosurgeons for treating diseases of this anatomical region.

scholarly journals Type II hereditary angioedema: The first case report in Taiwan

2016 ◽  
Vol 115 (8) ◽  
pp. 680-681 ◽  
Author(s):  
Ying-Juang Chen ◽  
Shyh-Dar Shyur ◽  
Wei Te Lei ◽  
Yu-Hsuan Kao
Keyword(s):  
Case Report ◽  
Hereditary Angioedema ◽  
Type Ii ◽  
First Case

scholarly journals Traumatic lumbar spondylolisthesis resulting in complete thoracic spinal cord avulsion: an unusual presentation

2018 ◽  
Vol 29 (6) ◽  
pp. 635-638
Author(s):  
Jamie Toms ◽  
David L. Boyer ◽  
Craig R. Kelman ◽  
Rafael A. Vega
Keyword(s):  
Soft Tissues ◽  
Unusual Presentation ◽  
Thoracic Spinal Cord ◽  
Lumbar Drain ◽  
First Case ◽  
Thoracic Spinal ◽  
Initial Imaging ◽  
Lumbar Spondylolisthesis ◽  
A Site ◽  
Traumatic Spondylolisthesis

Traumatic spondylolisthesis is a known occurrence in trauma, but complete cord transection is relatively rare. Moreover, complete cord transection at a site distant from the traumatic spondylolisthesis without spondyloptosis is exceedingly rare. In this report, authors describe the first case of thoracic cord avulsion following a traumatic grade II lumbar spondylolisthesis. The unusual presentation of this case highlights the importance of further evaluating patients with neurological symptoms out of proportion with the injuries seen on initial imaging. Magnetic resonance imaging performed after initial imaging studies demonstrated T11 cord transection with the distal cord herniating into the lumbar paraspinal soft tissues, thus allowing for preoperative planning to prepare for a more significant intervention including complex dural repair and lumbar drain placement, in addition to instrumented fusion to stabilize the traumatic spondylolisthesis.

scholarly journals Complex regional pain syndrome type II arising from a gunshot wound (GSW) associated with infective endocarditis and aortic valve replacement

2018 ◽  
pp. bcr-2018-224702
Author(s):  
Vinicius Tieppo Francio ◽  
Brandon Barndt ◽  
Chris Towery ◽  
Travis Allen ◽  
Saeid Davani
Keyword(s):  
Aortic Valve ◽  
Complex Regional Pain Syndrome ◽  
Gunshot Wound ◽  
Pain Syndrome ◽  
Syndrome Type ◽  
Type Ii ◽  
Thoracic Sympathectomy ◽  
Arm Pain ◽  
First Case ◽  
Pain Status

A 34-year-old man with a history of gunshot wound (GSW) to the right upper chest developed secondary aortic valve endocarditis (AVE) and was treated with an artificial valve placement (AVP). Three months after, he presented to an outpatient pain management clinic right arm pain and was diagnosed with complex regional pain syndrome type II (CRPS II). The patient underwent a diagnostic sympathetic ganglion block, before undergoing endoscopic thoracic sympathectomy surgery. Successful outcomes revealed decreased pain, opioid utilisation and improved tolerance to therapy and activities of daily living. To our knowledge, this is the first case reporting CRPS II arising from a GSW complicated by AVE followed by AVP, which emphasises how unforeseen syndromes can arise from the management of seemingly unrelated pathology. This case demonstrates the importance of timely and proper diagnosis of uncharacterised residual pain status post-trauma and differential diagnosis and management of chronic pain syndromes.

Tethering Elements in the “ Type II ” Split Cord Malformation (SCM) Complex

Neurosurgery ◽  
1996 ◽  
Vol 39 (3) ◽  
pp. 644-644
Author(s):  
André Turmel ◽  
Claude Mercier
Keyword(s):  
Split Cord Malformation ◽  
Type Ii
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