Intramedullary spinal cord abscess

Intramedullary spinal cord abscess is a treatable cause of paraparesis. Magnetic resonance imaging is an important diagnostic modality. Combination of antimicrobial therapy and surgical intervention can provide good results in patients with subacute presentation.     

Holocord intramedullary abscess

Intramedullary spinal cord abscess secondary to dorsal dermal sinus is a rare entity and involvement of the entire length of spinal cord is even rarer. A thorough history with precise clinical localization, a high index of suspicion, Magnetic Resonance Imaging (MRI) of spine and prompt surgical drainage with appropriate antibiotic therapy are key to the eventual outcome and prognosis.     

椎管内肠源性囊肿

目的：报告6例椎管内肠源性囊肿的临床表现，诊断及治疗，方法：分析6例椎管内肠源性囊肿的病史，临床表现及诊断，治疗情况，结合文献加以分析讨论。结果：6例皆在儿童期发病，5例以神经根性疼痛起病，6例均有脊髓受压表现，2例症状有反复，3例有脊柱畸形。5例手术全切，1例大部切除，均取得较好疗效。结论：椎管内肠源性囊肿是良性先天性发育异常疾病，手术治疗效果好，MRI检查及微创手术的应用是提高诊断和治疗的关键。     

Spinal cord hamartoma with pseudopancreatic cyst

A 2-year-old boy presented with weakness of both lower limbs with bladder and bowel involvement and history of frequent falls. Magnetic resonance imaging of the spine revealed a T2 altered signal intensity enhancing mass lesion seen in the spinal epidural space extending from sixth cervical to fourth thoracic vertebrae, which was compressing the adjacent spinal cord. Histopathology of the lesion was suggestive of hamartoma. A brief review of the literature including its embryogenesis is discussed here. The child subsequently developed pseudopancreatic cysts possibly because of repeated falls leading to blunt trauma abdomen.     

Giant purulent mesenteric cyst

Infected intra-abdominal cystic lymphangiomas are very rare. We report a case of a purulent mesenteric cyst, histologically a cystic lymphangioma, w which developed in a 1-year-old girl who presented with marked abdominal distension and high fever. Magnetic resonance imaging revealed that the huge cystic lesion occupied the entire peritoneal cavity. It originated from the mesocolon. It was removed completely, and contained sticky pus at the base where the right fallopian tube penetrated it, which indicated the focus of infection. This may be the first report of a purulent mesenteric cyst in which the route of infection was suspected.     

Preoperative imaging of a choledochal cyst in children: non-breath-holding magnetic resonance cholangiopancreatography

Magnetic resonance cholangiopancreaticography (MRCP) was used to visualize the biliary tract in two children, aged 7 weeks and 10 years, with a choledochal cyst. MRCP was successful in both cases and the findings were confirmed by intraoperative cholangiography. Accepted: 26 April 1999     

Choledochal cyst and duodenal atresia: a rare combination of malformations

A rare case of congenital duodenal atresia (DA) associated with a choledochal cyst (CC) is reported. At 38 weeks of gestation, a 1,610-g girl was born by cesarean section with a prenatal diagnosis of congenital DA. After the disease was confirmed by radiographs, she underwent a duodenoduodenostomy for complete separation of the duodenum with an annular pancreas. Thirty-two months after the initial operation, she developed upper abdominal pain and acholic stools. Abdominal ultrasonography demonstrated a CC and dilated intrahepatic bile ducts. Magnetic resonane cholangiopancreatography showed an anomalous arrangement of the choledochus and the main pancreatic duct. A diffusely dilated extrahepatic bile duct was resected, and a hepaticoduodenostomy was performed after a cholecystectomy. The patient was discharged without complications. We could not find a similar case report in the English literature. Although it is not reported that there is a close relation of DA and CC in embryologic development, the presence of this combination should be considered.     

儿童椎管内硬脊膜外蛛网膜囊肿的外科治疗

目的 探讨儿童椎管内硬脊膜外蛛网膜囊肿的临床特点及其诊治.方法 回顾性分析2001年1月至2009年8月我科收治的4例儿童椎管内硬脊膜外蛛网膜囊肿.其中颈胸段1例,胸腰段3例.临床表现3例患儿出现运动障碍,1例有感觉障碍,1例有小便失禁,1例有根痛表现.4例患儿均采用外科手术治疗,其中2例囊肿节段小于3个椎体的采用椎板切除+囊肿切除术,2例囊肿节段大于3个椎体的采用椎板成形+囊肿切除术.结果 4例患儿术后均恢复良好,除1例患儿术后随访1年下肢仍有轻度乏力外,其余临床症状均消失,恢复学习.随访1～9年均未见囊肿复发,复查脊柱三维CT未见脊柱畸形的发生.结论 儿童椎管内硬脊膜外蛛网膜囊肿是一种少见疾病,外科手术治疗能获得满意的结果,椎板成形术能够减少囊肿节段过长的患儿术后脊柱畸形的发生.

Abstract：

Objective To review the clinical features and surgical treatment of spinal extradural arachnoid cysts (SEACs) in children. Methods Four children with SEAC from were admitted to our department between January,2001 to August,2009. One SEAC was located at the cervicothoracic spine whereas the other three were found in the thoracolumbar spines. All cases were treated by surgery.Two children underwent the laminectomy for resection of the SEAC, which occupied less than 3 segments. SEAC, spreading more than 3 segments in the remaining cases, were treated by laminoplasty and en bloc resection. Results Postoperatively, the children had good recovery and resumed school. Followup of 1 to 9 years revealed no recurrences. The three-dimensional CT spine did not demonstrate any spine deformity in follow-up study. Conclusions SEACs in children are rarely reported in the literature. Excision of the SEAC result in a favorable outcome. The larninoplasty can reduce spinal deformity in patients with the long segment SEAC.     

Spinal cord injury without radiographic abnormalities

Spinal cord injury without radiographic abnormality (SCIWORA) has a reported rate of incidence varying from 19% to 34% of all spinal cord injuries in children. This acronym refers to the presence of neurological lesion, despite normal plain radiographs, but where magnetic resonance imaging (MRI) shows significant pathology. The clinical evidence of the damage could be delayed in 6–54% of cases, usually within 48 h after the trauma. We report two patients affected by SCIWORA in the pediatric population. The first patient was a child of 22 months who had fallen when attempting to get out of bed. The second patient was an 11-month-old child admitted to the Emergency Service department after a car accident. Spinal cord injury has to be suspected in the presence of neurological signs, despite normal plain radiography. MRI is the appropriate diagnostic examination to identify the presence of SCIWORA.     

Brachytelephalangic chondrodysplasia punctata with severe spinal cord compression: report of four new cases

Brachytelephalangic chondrodysplasia punctata (CDPX1, OMIM: #302950) is a rare congenital skeletal dysplasia caused by arylsulfatase E deficiency (OMIM: #300180). Although the symptoms are usually mild, severe spinal cord compression by dysplastic vertebras may develop. We report four new cases with severe cervical spinal canal narrowing documented by radiography, magnetic resonance imaging (MRI), and autopsy. In all, nine cases of CDPX1 with severe cervical spinal cord compression have now been described. Because these cases account for a large proportion of all reported CDPX1 cases, we believe that an antenatal suspicion of CDPX1 should lead to genetic counseling and to investigations for spinal cord compression. After birth, this complication must be routinely anticipated, and we suggest spinal MRI in all CDPX1 infants. Unless spinal cord compression is confidently ruled out, we recommend that these newborns receive the same care as trauma patients suspected of craniocervical junction disruption. No conflicts of interest occurred for this work.     

Incidence of spinal cord lesions in patients with intractable constipation

Abstract Spinal magnetic resonance imaging of children with intractable constipation was reviewed. Nine percent of patients had spinal cord abnormalities. Tethered cord was the most common lesion in 75% of patients. Magnetic resonance imaging is a useful tool to evaluate children with intractable constipation.     

Epidermoid cyst of the spermatic cord

An epidermoid cyst in the spermatic cord of a child, which was found incidentally at operation for hydrocoele, is reported. Although well described in the testis, epidermoid cyst has not previously been reported as occuring in the spermatic cord. The possible pathological aetiology is discussed. Offprint requests to: A. C. Gordon     

脊髓表皮样囊肿32例临床分析

总结３２例儿童脊髓表皮样囊肿，并结合文献探讨其形成原因。结果表明，脊柱皮毛窦及复发性脑膜炎为其特征性表现，并可作为诊断依据。患儿多合并脊柱的先天性畸形，圆锥马尾为其好发部位。提示手术切除仍为目前有效的治疗方法，有效率为９０．７％。治疗效果与病程、病变部位无关。     

Cardiac hydatid cyst in a child: Diagnostic value of echocardiography and magnetic resonance imaging

Cardiac hydatid cyst is extremely rare in children. We report a case of a cardiac echinococcal cyst in an 11 year old boy, diagnosed by two-dimensional echocardiography and magnetic resonance imaging (MRI). The cyst was located in the posterior wall of the left ventricle and was excised surgically. Echocardiographic and MRI findings are discussed.     

囊肿脑池造瘘治疗儿童中颅窝蛛网膜囊肿

目的 探讨囊肿脑池造瘘术治疗儿童中颅窝蛛网膜囊肿(intracranial arachnoid cyst,IAC)的效果及MRI相位对比电影(phase-contrast cine,PC cine)用于囊肿分型诊断及术后疗效评估的价值.方法 对28例中颅窝IAC患儿行PC cine检查,选择非交通性蛛网膜囊肿(non-communicating intracranial arachnoid cysts,NCIAC)的患儿,行显微镜下囊肿脑池造瘘术.回顾分析术前术后临床表现、术后随访囊肿的缩小情况及PC cine MRI资料,定性评估造瘘口脑脊液流动,测量脑脊液动力学指标(峰值流速、流量及流动波型).结果 28例患儿中有20例行PC cine MRI检查诊断为NCIAC,行囊肿与鞍上池造瘘术.20例患儿术后随访囊肿呈进行性缩小,临床症状均有不同程度缓解.术后20例患儿造瘘口脑脊液流动均为阳性:在一个心动周期内表现为双向运动,与正常导水管流动波形相似,提示造瘘口通畅.28例患儿中有8例PC cine MRI诊断为CIAC,均无临床症状,未手术,经3个月至1年随访囊肿无进行性增大.结论 ①囊肿脑池造瘘是治疗儿童中颅窝IAC的有效方法,其近期疗效较为肯定;②PC cine MRI可以作为诊断非交通性IAC和评价IAC脑池造瘘术疗效的有效方法.     

Choledochal cyst and duodenal atresia: a rare combination

 A rare case of congenital duodenal atresia (DA) associated with a choledochal cyst (CC) is reported.At 38 weeks of gestation, a 1,610-g girl was born by cesarean section with a prenatal diagnosis of DA. After the disorder was confirmed by X-ray, she underwent a duodenoduodenostomy for a complete separation of the duodenum with an annular pancreas. Thirty-two months after the initial operation, she developed upper abdominal pain and acholic stools. Abdominal ultrasonography demonstrated a CC and dilatated intrahepatic bile ducts. Magnetic resonance cholangiopancreatography showed an anomalous arrangement of the choledochus and main pancreatic duct. A diffusely dilatated extrahepatic bile duct was resected, and a hepaticoduodenostomy was performed after cholecystectomy. The patient was discharged without complications. We could not find a similar case report in the English literature. Although it is not reported that there is a close relationship in embryologic development of DA and CC, one should be aware of the possibility of this combination. Accepted: 21 December 2000     

小儿椎管内肠源性囊肿的诊断与治疗

目的探讨小儿椎管内肠源性囊肿的临床表现、MRI影像及显微手术治疗。方法回顾性分析1996年至今8年间5例椎管内肠源性囊肿的临床资料，并结合文献加以分析。结果全部病例采用显微外科手术治疗，其中2例全切，2例次全切除，1例大部切除。无一例死亡，经病理报告证实均为肠源性囊肿，术后神经根痛症状基本消失。随访0．5～2年，无一例复发；格拉斯哥预后评分，良好恢复4例，中残1例；脊髓损伤的Frankel分级，E级4例，D级1例。结论小儿椎管内肠源性囊肿有典型的临床表现和MRI特征，作为一种先天性病变，其最佳治疗方法是早期确诊并采取显微外科手术方法切除。     

Neonatal spinal cord injury

Neonatal spinal cord injury (SCI) is well described in the literature, though its diagnosis is often delayed or missed in the neonatal period. We present a neonate who was referred with upper gastrointestinal bleed and a diagnosis of spinal cord injury was subsequently made clinically and confirmed radiologically.     

Neonatal spinal cord injury

Neonatal Spinal Cord Injury (SCI) is well described in the literature, though its diagnosis is often delayed or missed in the neonatal period. We present a neonate who was referred with upper gastrointestinal bleed and a diagnosis of spinal cord injury was subsequently made clinically and confirmed radiologically.