a comprehensive presentation on the subject of spinal dysraphism and spina bifida and its neurosurgical management as well as the management of its various other types
Dandy–Walker malformation (DWM) encompasses cystic dilatation of the fourth ventricle, complete or partial agenesis of cerebella vermis and enlarged posterior fossa while Dandy–Walker variant (DWV) comprises cystic posterior mass with variable hypoplasia of the cerebella vermis and no enlargement of the posterior fossa.
Dandy–Walker malformation (DWM) encompasses cystic dilatation of the fourth ventricle, complete or partial agenesis of cerebella vermis and enlarged posterior fossa while Dandy–Walker variant (DWV) comprises cystic posterior mass with variable hypoplasia of the cerebella vermis and no enlargement of the posterior fossa.
Birth Defects was written for healthcare workers who look after individuals with birth defects, their families, and women who are at increased risk of giving birth to an infant with a birth defect. This book is being used in the Genetics Education Programme which trains healthcare workers in genetic counselling in South Africa. It covers: modes of inheritance, medical genetic counselling, birth defects due to chromosomal abnormalities, single gene defects, teratogens, multifactorial inheritance
Congenital diseases causing Spinal Cord CompressionRAMA UNIVERSITY
Compression of spinal cord is a serious anomaly which gives rise serious comorbidities with respect to the site of its occurrence. There can be varies reasons for compression of spinal cord which can be either acquired during the life processes or can be congenital. Diseases which lead to congenitally compressing the spinal cord have been explained in brief.
Some conditions are the most important factor for compression of spinal cord at various levels and earlier diagnosis of which can not only prevent but also make the patients liable for early rehabilitative regimes. Conditions like Spina Bifida, Tethered Cord, fault at notochord formation, etc. can be summarised to understand the basic concept and knowledge regarding the conditions.
Hydrocephalous is a serious disease of the central nervous system which has both congenital and aquired subtypes. the congenital variety affects the children and is a considerable burden especially is the developing countries. I tleads to long term morbidity and high rates of mortality
Spinal stenosis is a degenrative spine disorder in which the AP and transverse diameter are decreased causing neural compression and symptoms of chronic & acute nerve compression
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
Contact us if you are interested:
Email / Skype : kefaya1771@gmail.com
Threema: PXHY5PDH
New BATCH Ku !!! MUCH IN DEMAND FAST SALE EVERY BATCH HAPPY GOOD EFFECT BIG BATCH !
Contact me on Threema or skype to start big business!!
Hot-sale products:
NEW HOT EUTYLONE WHITE CRYSTAL!!
5cl-adba precursor (semi finished )
5cl-adba raw materials
ADBB precursor (semi finished )
ADBB raw materials
APVP powder
5fadb/4f-adb
Jwh018 / Jwh210
Eutylone crystal
Protonitazene (hydrochloride) CAS: 119276-01-6
Flubrotizolam CAS: 57801-95-3
Metonitazene CAS: 14680-51-4
Payment terms: Western Union,MoneyGram,Bitcoin or USDT.
Deliver Time: Usually 7-15days
Shipping method: FedEx, TNT, DHL,UPS etc.Our deliveries are 100% safe, fast, reliable and discreet.
Samples will be sent for your evaluation!If you are interested in, please contact me, let's talk details.
We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stockrebeccabio
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stock
Telegram: bmksupplier
signal: +85264872720
threema: TUD4A6YC
You can contact me on Telegram or Threema
Communicate promptly and reply
Free of customs clearance, Double Clearance 100% pass delivery to USA, Canada, Spain, Germany, Netherland, Poland, Italy, Sweden, UK, Czech Republic, Australia, Mexico, Russia, Ukraine, Kazakhstan.Door to door service
Hot Selling Organic intermediates
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
7. Aims
• Essential Embryology
• Introduction to Spinal Dysraphism
• Types of Spinal Dysraphism
• Management Strategies
• Tethered Cord Syndrome
• Management of TCS
8. Objectives
• At the end of this presentation the audience
will be able to;
– Know the essential spine embryology & its
aberrations
– Appreciate the types of developmental spinal
anomalies & spinal dysraphism
– Understand Neurosurgical management
strategies for spinal dysraphism
– Get an overview of the sequelae of spinal
dysraphism and tethered cord syndrome
13. Embryology contd.
• Neural crest becomes
peripheral nervous
system (PNS)
• Neural tube becomes
central nervous system
(CNS)
• Somites become spinal
vertebrae.
Somites
14.
15. Spinal Dysraphism
• Incomplete closure of the neural tube around
third and fourth week of embryonic development
• Combined malformations of the vertebral column
and spinal cord
• Lesions types;
– Spina bifida cystica: closed lesions but outside skin
– Spina bifida aperta: lesions communicating with the
outside
– Spina bifida occulta: concealed, no skin defect
• Recently classified as Open and Closed spinal
Dysraphism (OSD and CSD)
16. Aetiology
• Familial tendency (2.5% vs. 0.2% risk in
general population)1
• Nutritional factors; social class difference in
incidence1,2
• Folic acid use preconception and during
pregnancy1,2,3
• Teratogens e.g., valproate, phenytoin,
alcohol etc3,5,6
• Homeobox and pax3 embryonic genes3
17. Pathogenesis
• Occurs between days 20 to 28 of gestation7
• Failure to close of the neural folds at the caudal
end of neural tube
• Followed by failure of closure of the caudal
somites, resulting in a gap of the spine
• The various varieties of spinal dysraphism are a
result of the time and extent of failure of the
neural tube closure7
18. Pathogenesis (contd.)
• Open Spinal Dysraphism:
– Most common; 95% cases
– A ratio of 9:1 of OSD to CSD
– Vertebral defect with meningeal or spinal cord as the
wall of the extruding cyst
– Almost all OSD are with Chiari II malformation and
Hydrocephalus
– Worst form is Rachischisis; associated with anencephaly
– Diagnosed antenatal or at birth
– Neurologic dysfunction is due to;
• Primary defect in development of the nervous tissue
• Exposure to amniotic fluid
• Injury during birth
19. Pathogenesis (contd.)
• Closed Spinal Dysraphism:
– 5% of cases; occult;
– With or without a subcutaneous mass
– Intact skin covering
– No meningeal or spinal cord cystic lesion
– Most subcutaneous masses are lipomatous
– Usually identified during investigation of urologic,
orthopaedic or dermal and limb problems8
20.
21. Classification
• Spina bifida cystica and aperta Open
Spinal Dysraphism (OSD)
• Spina bifida occulta Closed Spinal
Dysraphism (CSD)
• CSD is further subdivided by the presence or
absence of a subcutaneous mass
• Most recent and comprehensive
classification in use was proposed by Tortori-
Donati et al in 2000 9,10
23. Classification11 (contd.)
2. Closed Spinal Dysraphism (5%)
With a
subcutaneous mass
Without a
subcutaneous mass
Cervical Cervical myelocystocele Simple Tight filum terminale
Cervical
myelomeningocele
Intradural lipoma
Cervical meningocele Posterior spina bifida
Lumbosacral Lipomyelomeningocele Complex Diastematomyelia /
Diplomyelia
Lipomyeloschisis Neurenteric cysts
Dermal sinus
Caudal regression
syndrome
Dorsal enteric fistula
24. Myelomeningocele (MMC)
• Most common spinal birth defect
• Bony defect through which the spinal cord and its
coverings protrude
• Prevalence in Pakistan unknown (estimated at 5-
15/1000 live births)
• Almost all associated with Chiari II malformation
and hydrocephalus (85 – 95%)
• Lumbosacral involvement is the commonest1,2,3,10,11
25. Myelomeningocele (contd.)
• Antenatal diagnosis possible at 14 to 20
weeks
• Ultrasound, serum AFP, amniocentesis for
acetylcholinestrase (accuracy about 90%)
• T2 weighted MRI useful in delineating the
neurological defects antenatally
• Delivery is usually by C-Section
• Surgical Correction of the sac (48-72 hours)
• Management of Hydrocephalus require
special attention
26.
27. Surgical Management
• To treat or not to treat?
– Improving the quality of life
– Effectiveness of early and aggressive intervention
• John Larbor’s Experiment (1970s)
– Withhold extreme measures for those with severe
anomalies
• Medical ethics and individual rights
– The right to health and the right to life is for everyone
– Education of the parents regarding care of the infant
– Role of the treating physician
28. Surgical Management
• Careful clinical assessment
– Spina bifida neurological scale
• Pre-op counseling of the parents regarding
neurological recovery
• Surgery is for prevention of infection & correcting
CSF leak
• Abnormal bladder function persists in most cases
• Lower limbs difficult to assess
– Preservation of L3 ability to stand
– Preservation L4-L5 ability to ambulate
29. Surgical Management
• antibiotics if the surgery has to be delayed
• Nursing in prone position or laterally, keeping the
defect wet with soaked gauze
• Complete excision of zona epitheliosa and
closure of the dural sac and skin is the goal of the
surgery
• Failure to achieve the above, results in inclusion
cysts and tethered cord
• Closure of the normal skin is done along the long
axis of the defect
32. Post-op care
• Wound complications, shunt malfunction,
hydromyelia, tethered cord or worsening CM II are
the common complication
• Care of the patient with MMC is lifelong requiring
paediatric, urologic, physiotherapic, orthopedic,
neurologic and psychologic support
• Stridor, apnoea and bradycardia are signals of
poor prognosis and a result of advancing CM II
• Hydrocephalus is either treated simultaneously,
before closure of MMC or after clinical appearance
33. Post-op outcome
• Ten to 15% of children die in the first 6 years of
their lives despite aggressive treatment
• 75 to 80% with normal IQ
• Survival:
– 92% survive to 1 year
– 78% to 17 years of age
– 46% to age > 40 years
• It is to be remembered that surgical treatment
aims at reducing disability & death and not the
neurological deficits that has already occurred
• Hydrocephalus and shunt complications tend to
affect intelligence
34.
35. Closed Spinal Dysraphism & Tethered
Cord Syndrome
• Some conditions leading to anatomical tethering
of the cord are;
– Lipomyelomeningcele
– Diastematomyelia and Diplomyelia
– Anterior sacral meningocele
– Myelocystocele
– Dural dermal sinus
36. • Tethering of the cord may result in significant
disabilities and prolonged morbidities
• The leading problems are pain, motor
weakness, urologic issues, dermatologic
manifestations, orthopedic problems and
psychologic sequelae
• These problems occasionally present in
infancy while a majority is diagnosed in late
childhood to early adulthood
37. • All conditions need surgical intervention to
release the cord
• The primary aim of neurosurgical intervention
is to stop further progression and help in
good physical and neuro-rehabilitation
• A multidisciplinary approach and high degree
of clinical vigilance is necessary for diagnosis
• Signs and symptoms are non-specific to any
particular tethering cause
41. Lipomyelomeningocele
• derives from the secondary remnant cells of
the notochords’ caudal end
• mature adipose tissue fused to the dorsal
dura and protruding through the spinal defect
• Eventually causes tethering
• Two main types;
– adherent to the dorsal surface of the cord itself
– Adherent to the lower part of conus and filum
• Treatment is laminectomy and untethering of
the cord
47. Diastematomyelia / Diplomyelia
• Also called Split Cord Malformations
• Caused by duplication of the cord either by an
intervening bony spur or dural septum
• Causes cord tethering and neurological problems
• Incontinence, gait abnormalities, lower limbs pain
and sensory loss in feet
• Associated with midline dermal stigmata, i.e.,
faun’s tail (but not specific)
• May be associated with scoliosis
50. Diastematomyelia / Diplomyelia
• Two types;
– Split cord with an intervening bony spur
– without bony spur
• Female preponderance
• MRI is the confirming investigation
• Treatment is laminectomy, followed by excision of
the bony spur and repair of dura
• There is small risk of neurologic deterioration post-
operatively which should be communicated to the
patients / parents
51. Anterior Sacral Meningocele
• Evagination of meningeal sac anteriorly into the
pelvic cavity through a defect in the sacrum
• Rare cause of cord tethering
• Usually found accidentally on DRE or investigations
for pelvic pathology/ rarely during a laparotomy
• Any breach of the meningeal wall may increase the
risk of meningitis
52. Anterior Sacral Meningocele
• Pelvic ultrasound, CT myelography or MRI are
useful investigations
• Treatment is surgical reduction of the meningeal
sac and closure of the defect some times with a
fascial patch
• A posterior sacral laminectomy is the preferred
approach
• Division of filum terminale is essential step for
untethering
54. Congenital Dermal Sinus
• A tubular connection between the skin surface
where the channel may end subcutaneously,
interspinous area, inside the spinal canal,
intradurally or intramedullary cystic extension
• This type of sinus may easily be mistaken with a
pilonidal sinus
• Differentiation is done by the dimple created by the
tethered overlying skin which is not the case in
pilonidal sinus
55. Congenital Dermal Sinus
• Treatment is by complete dissection of the sinus
tract and its excision in toto followed by water tight
closure of the dura and releasing the tethering
elements
• Extensive laminectomy is required in some cases
• Filum terminale is usually divided in the wake of
untethering of the cord
58. Surgical Management of TCS
• Tethered cord syndrome needs surgical correction
• The neurologic deterioration is improved in majority
of cases postoperatively
• A small risk of neurological deterioration still persist
even in experienced hands
• Almost all types of tethering lesions require removal
of the tethering elements and release of the spinal
cord
• All operated cases of MMC do have cord tethering,
but needs careful assessment before being labelled
as TCS
59.
60. Recent Advancements
• Foetal MMC repair is an advancing development
but no definitive data exists
• Results are favourable in decreasing neurologic
deficits and reducing the occurrence of CM II and
hydrocephalus
• No final consensus or guidelines; still experimental
• Issues of medical ethics; issue of two individuals
61. Pearls
• periconceptional folate results in a 72%
relative risk reduction in the recurrence of
spina bifida in subsequent children
• periconceptional folic acid intake results in a
42% relative risk reduction in the incidence
of first occurrence of spina bifida
• In patients with lumbosacral dimples, US
exam is more cost effective than MRI in
screening for occult spinal dysraphism
• the anomaly could not be eradicated due to
its multifactorial nature
62. References
1. Group MRCVRS. Prevention of neural tube defects: results of the Medical Research Council Vitamin Study. Lancet.
1991;338(8760):131-137.
2. Czeizel AE, Dudas I. Prevention of the first occurrence of neural-tube defects by periconceptional vitamin supplementation. N Engl J
Med. 1992;327(26):1832-1835.
3. Cochrane D, Wilson R, Steinbok P, et al. Prenatal spinal evaluation and functional outcome of patients born with myelomeningocele:
information for improved prenatal counselling and outcome prediction. Fetal Diagn Ther. 1996;11(3):159-168.
4. Luthy D, Wardinsky T, Shurtleff D. Cesarean section before the onset of labor and subsequent motor function in infants with
myelomeningocele diagnosed antenatally. N Engl J Med. 1991;324(10):662-666.
5. Rintoul N, Sutton L, Hubbard A, et al. A new look at myelomeningoceles: functional level, vertebral level, shunting, and the
implications for fetal intervention. Pediatrics. 2002;109(3):409-413.
6. Johnson M, Sutton L, Rintoul N, et al. Fetal myelomeningocele repair: short term clinical outcomes. Am J Obstet
Gynecol.2003;189(2):482-487.
7. Mazzola C, Albright A, Sutton L, et al. Dermoid inclusion cysts and early spinal cord tethering after fetal surgery for
myelomeningocele. N Engl J Med. 2002;347(4):256-259.
8. Adzick NS, Thom EA, Spong CY, et al. A randomized trial of prenatal versus postnatal repair of myelomeningocele. N Engl J Med.
2011;364:993-1004.
9. Pang D, Dias M, Ahab-Barmada M. Split cord malformation: Part I: a unified theory of embryogenesis for double cord malformations.
Neurosurgery. 1992;31(3):451-480.
10. Gibson P, Britton J, Hall D, Hill C. Lumbosacral skin markers and identification of occult spinal dysraphism in neonates. Acta Paediatr.
1995;84(2):208-209.
11. Tortori-Donati P, Rossi A, Cama A. Spinal dysraphism: a review of neuroradiological features with embryological correlations and
proposal for a new classification. Neuroradiology. 2000 Jul;42(7):471-91.
12. James HE, Walsh JW. Spinal dysraphism. Curr Probl Pediatr. 1981;11(8):6-25.
13. Warder DE. Tethered cord syndrome and occult spinal dysraphism. Neurosurg Focus. 2001;10(1):e1.
14. Bulsara K, Zomorodi A, Enterline D, George T. The value of magnetic resonance imaging in the evaluation of fatty filum terminale.
Neurosurgery. 2004;54:375-379.
15. Kanev P, Bierbrauer K. Reflections on the natural history of lipomyelomeningocele. J Neurosurg. 1995;22(3):137-140.
16. Özek M, Cinalli G, Maixner W. J. The spina bifida, management and outcome. 1° ed. Springer-Verlag Italia 2008.
17. Oi S, Matsumoto S (1992) A proposed grading and scoring system for spina bifida : Spina bifida neuro-logical scale. Childs Nerv Syst
8:337-342