complex scm

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

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STUDY DESIGNSTUDY DESIGN

Retrospective chart reviewRetrospective chart review

24 month period (Jan 2005- Dec 24 month period (Jan 2005- Dec

2006)2006)

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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.

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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

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RESULTSRESULTS

PatientsPatients

Spinal DysraphismSpinal Dysraphism 107 pts107 pts

SCMSCM 53 pts53 pts

(49.5%)(49.5%)

Spinal Dysraphism

SCM

Patients

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RESULTSRESULTS

SCMSCM

SCMSCM 5353 Complex SCMComplex SCM 2323

(43.4%)(43.4%)

SCM,

Complex SCM,

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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

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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

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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))

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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