Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

Complex scm

914 views

Published on

Published in: Health & Medicine
  • Be the first to comment

  • Be the first to like this

Complex scm

  1. 1. Complex Split Cord Malformations- The Untold Story Deepak Agrawal Department of Neurosurgery, Neurosciences & Gamma Knife centre, All India Institute of Medical Sciences, New Delhi
  2. 2. DEFINITION <ul><li>Complex SCM are SCM associated with other intraspinal anomalies like lipomeningocele, myelomeningocele, neuroenteric cyst and/or tumors (such as dermoids). </li></ul>
  3. 3. CURRENT STATUS <ul><li>The literature is sparse regarding the epidemiology of complex SCM. </li></ul><ul><li>Pubmed search reveals only 15 papers </li></ul><ul><li>Most are case reports </li></ul>
  4. 4. INDIAN EXPERIENCE <ul><li>Easy availability of 1.5T MRI </li></ul><ul><li>MR costs USD 50/pt </li></ul><ul><li>MR feasible in infants & neonates with minimal sedation </li></ul>
  5. 5. AIMS & OBJECTIVES <ul><li>To assess the incidence and clinico-radiological findings of complex SCM in a tertiary level pediatric neurosurgery unit </li></ul>
  6. 6. STUDY DESIGN <ul><li>Retrospective chart review </li></ul><ul><li>24 month period (Jan 2005- Dec 2006) </li></ul>
  7. 7. MATERIALS & METHODS <ul><li>Operative and clinical-radiological records of all patients (age<21yrs) with spinal dysraphism who underwent surgery in our department were reviewed. </li></ul>
  8. 8. MRI PROTOCOL <ul><li>MRI whole spine with screening MRI Brain on a 1.5T Machine </li></ul><ul><li>Picks up assoc Spinal & Brain abnormalities </li></ul><ul><li>Helps in prognosticating </li></ul>
  9. 9. RESULTS <ul><li>Patients </li></ul><ul><li>Spinal Dysraphism 107 pts </li></ul><ul><li>SCM 53 pts </li></ul><ul><li>(49.5%) </li></ul>
  10. 10. RESULTS <ul><li>SCM </li></ul><ul><li>SCM 53 </li></ul><ul><li>Complex SCM 23 </li></ul><ul><li>(43.4%) </li></ul>
  11. 11. RESULTS <ul><li>Demographics (Complex SCM) </li></ul><ul><li>Mean age 4.7yrs (1 mth-20yrs) </li></ul><ul><li>M: F 2.2:1 </li></ul>
  12. 12. RESULTS <ul><li>SCM </li></ul><ul><li>SCM I 12 pts (52.2%) </li></ul><ul><li>SCM II 11 pts (47.8%) </li></ul>
  13. 13. 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)
  14. 17. SCM I & SCM II
  15. 18. IMPORTANT FINDINGS <ul><li>Very high incidence of SCM in patients with spinal dysraphism (49.5% in this study). </li></ul><ul><li>Very high incidence of Complex SCM in patients with SCM (43% in this study). </li></ul><ul><li>Incidence of hydrocephalus different ( 50% of MMC & 30% of LMMC ) </li></ul>
  16. 19. CONCLUSIONS <ul><li>Very high incidence of complex SCM in patients with spinal dysraphism. </li></ul><ul><li>Preoperative MRI can be extremely useful in operative planning and management of such patients and should be done in all cases </li></ul><ul><li>Our is the largest study in literature till date </li></ul>
  17. 20. THANK YOU

×