Spinal Dysraphic Malformations
Science and Surgery - Volume 47
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Article
Limited exposure to preserve stability and achieve complete excision of limited dorsal myeloschisis — the “Skip-Hop Laminectomy” technique: a technical note
The fibroneural stalk of an LDM has variable thickness, complexity, and length, which can span 5 to 6 vertebral segments from its skin attachment to its “merge point” with the dorsal spinal cord. Therefore, co...
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Chapter
Secondary Neurulation Defect: Terminal Myelocystocele, a Biological Leviathan
Terminal myelocystocele (TMC) has been a puzzling entity of spinal dysraphism. It is found in the sacrococcygeal region usually forming a subcutaneous hump of various sizes. The wide variation of its morpholog...
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Chapter
Junctional Neural Tube Defect (JNTD): A Rare and Relatively New Spinal Dysraphic Malformation
Junctional neurulation completes the sequential embryological processes of primary and secondary neurulation as the intermediary step linking the end of primary neurulation and the beginning of secondary neuru...
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Chapter
Focal Spinal Nondisjunctional Disorders: Including a Discussion on the Embryogenesis of Cranial Focal Nondisjunctional Lesions
The publication of a comprehensive report on limited dorsal myeloschisis by the senior author (DP) in 2010 has brought full attention to the concept of limited myeloschisis that he first formulated in 1992 and...
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Chapter
The Current Status of the Surgical Management of Complex Spinal Cord Lipomas: Still Navigating the Labyrinth?
This review summarises the classification, anatomy and embryogenesis of complex spinal cord lipomas and describes in some detail the technique of total lipoma resection and radical reconstruction of the affect...
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Book
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Chapter
A New Surgical Paradigm for Postnatal Repair of Open Neural Tube Defects Using Intraoperative Neurophysiology Monitoring
An open neural tube defect (ONTD) features an exposed, unclosed neural plate in the form of an expanded and frequently hefty neural placode. Traditional philosophy of ONTD repair aims at preserving the placode...
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Article
Limited dorsal myeloschisis involving one hemicord of a split cord malformation — a “hemi-LDM”
This is a case report of an exceedingly rare case of a limited dorsal myeloschisis (LDM) with its stalk inserted on the midline dorsal surface of one of a pair of hemicords in a type II split cord malformation...
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Article
Radical resection of lumbosacral lipomas in children: the Great Ormond Street Hospital experience
In 2009, Pang described a radical resection technique for congenital lumbosacral lipomas, with lower long-term symptomatic re-tethering rates compared with partial resections and conservative management, and l...
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Article
New surgical paradigm for open neural tube defects
An open neural tube defect (ONTD) features an exposed, unclosed neural plate in the form of an expanded, flat, and frequently hefty neural placode. Traditional philosophy of ONTD repair aims at preserving func...
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Video
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Video Segment
Intraoperative Electrophysiology Monitoring
To preserve neural tissues durng the surgery, sophisticated intraoperative electrophysiology monitoring techniques are used. Insertion of needle electrodes into key muscles are shown in detail.
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Video Segment
Step 1: Wide Bony Exposure
The extent of lamiectomy should include at least 1 cm above the rostral end of the lipoma, and 1 cm past its caudal pole. Wide resection of the lateral elements up to the pedicles of each level is important fo...
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Video Segment
Step 5: Expansile Dural Grafting with Bovine Pericardium
Large dural graft of bovine pericardium is measured exactly to size and sutured to dural edges with a running 5-0 prolene suture. This is to create a large cord-sac ratio.
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Video Segment
Embryogenesis of Dorsal Lipoma
The Embryogenesis of dorsal lipomas is briefly explained.
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Video Segment
Laminectomy Localization
Localising the skin incision using metal markers on the lumbar skin.
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Video Segment
Radiological Images
The MRI images of a large complex lipoma are shown and explained, emphasising on the extent and unevenness of the fat-cord interface on both sagittal and axial images.
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Video Segment
Step 3: Resecting the Lipoma
Shows the actual lipoma resection The concept of the “White Plane” is introduced, describing the thin nettle of fibrous tissue between cord and fat. Resection is from rostral to caudal direction.
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Video Segment
Step 2: Detaching Fat-Neural Placode assembly from Inner Dura
The lipoma-neural placode assembly, the “Hammock”, is unhinged and detached from the inner dura using the technique called “crotch dissection”.
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Video Segment
Step 4: Pia to Pia Neurolation
The neural placode is rolled up dorsally and the opposing pial fringes are sutured together with 8-0 nylon sutures.
