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Complex scm


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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