ABSTRACT
Figure 6.1 Classification of spina bifida aperta. (a) Meningocele, (b) myelomeningocele, (c) myelocystocele, (d) myeloschisis. The spinal cord is shown in yellow
Figure 6.2 Myelomeningocele at 18 weeks of gestation. Upper left, sagittal ultrasound image. Note the spinal cord from spinal canal to the sac surface. Upper right, axial ultrasound image. Lower left; threedimensional surface reconstruction of myelomeningocele. Lower right, external appearance of the aborted fetus at 19 weeks of gestation
Figure 6.3 Myelomeningocele at 36 weeks of gestation. Sagittal image, axial image and three-dimensional surface reconstruction from the left side
Figure 6.4 Prenatal ultrasound image of myelomeningocele and spina bifida at 20 weeks of gestation. Upper left; sagittal ultrasound image. The
spinal cord protrudes into the sac surface from the spinal canal. Upper right, three-dimensional bony demonstration of lumbar spina bifida. Threedimensional ultrasound shows the exact level of spina bifida. Lower left, three-dimensional surface reconstruction of a large myelomeningocele (white arrows). Lower right, external appearance of the aborted fetus at 21 weeks of gestation. Note the central canal of the spinal cord (black arrow) in a large myelomeningocele
Figure 6.5 Prenatal ultrasound image of spina bifida at 9 and 12 weeks of gestation. Upper left, sagittal ultrasound image at 9 weeks and 3 days of gestation. Note the lumbar cystic lesion (arrowhead). Lower left, three-dimensional bony demonstration of lumbar spina bifida (arrows) at the same gestational age. Right, three-dimensional surface reconstruction of myelocystocele (arrows) at 12 weeks of gestation in the same fetus. This fetus has bladder extrophy. Termination of the pregnancy was carried out at 13 weeks and final diagnosis was omphalocele, bladder extrophy, imperforate anus and spine defect (OEIS)
Figure 6.6 Three-dimensional ultrasound image of myelomeningocele with kyphosis at 16 weeks of gestation. Three orthogonal views and a surface reconstruction image. Upper left, sagittal ultrasound image. The spinal cord completely protrudes into the sac surface from the spinal canal and severe kyphosis is seen. Upper right; axial ultrasound view. Lower left, coronal ultrasound view of myelomeningocele. Lower right, surface reconstruction image of myelomeningocele
Figure 6.7 Bony structural images of kyphosis and spina bifida at 16 weeks of gestation (same case as shown in Figure 6.6). Upper left, middle, three-dimensional skeleton images of severe kyphosis and spina bifida. Upper right, inside view of kyphosis and myelomeningocele. Note the spinal cord and nerves inside the myelomeningocele. Lower left, external appearance of the aborted fetus at 17 weeks of gestation. Lower right, photograph of the myelomeningocele. Note the tortuous spinal cord inside the sac
Figure 6.8 Meningocele in late pregnancy. Upper left, sagittal ultrasound image at 37 weeks of gestation. The spinal cord is located inside the spinal canal. Lower left, fetal magnetic resonance sagittal image. Right, external appearance of the neonate delivered by Cesarean section. The meningocele is completely covered by skin
Figure 6.9 Cervical meningomyelocele at 16 weeks of gestation. Left, sagittal
ultrasound image. A small cyst in the meningocele is demonstrated. The fetus has no nuchal translucency in the first trimester. Middle, threedimensional surface reconstruction image. Right, external appearance of the aborted fetus at 23 weeks of gestation. Meningocele at the level of C6 with abnormal vertebrae between C3-4 and T1 was confirmed. Images and photograph courtesy of Dr G.Malinger
Figure 6.10 Myeloschisis with kyphosis. Upper left, sagittal ultrasound image of myeloschisis and kyphosis at 30 weeks of gestation; there is no cystic formation. The spinal cord (white arrows) is visible with a defect of the skin. Upper middle, fetal magnetic resonance sagittal image. Upper right, three-dimensional demonstration of the surface of myeloschisis. Lower left, external appearance of neonatal myeloschisis. The central canal of the spinal cord (black arrow) is visible. Lower middle and right, postnatal three-dimensional reconstruction CT images of spina bifida and kyphosis
Figure 6.11 Myelomeningocele. The spinal cord and nerves are prolapsed into the sac. The sac, covered with a thin membrane, did not rupture
Figure 6.12 Myeloschisis. The black line on the center of the mass (arrow) indicates the central canal of the spinal cord
Figure 6.13 Thoracic meningocele. The wall of the cyst is thin but completely covered with skin
Figure 6.14 Spinal lipoma (spina bifida occulta)—lumbosacral subcutaneous
lipoma. These spinal lipomas penetrate into the intradural space
Figure 6.15 Spinal lipoma (spina bifida occulta) with a dermal sinus. In this case, the dermal sinus is complicated by spinal lipoma
Figure 6.16 Skin appendage; spinal bifida occulta (neonate). Left, middle; external appearance of a human tail after birth. This small cutaneous abnormality is a sign of spina bifida occulta. Right; magnetic resonance sagittal image of a tethered cord in the same neonate. Note abnormal location of the spinal cord in the spinal canal (yellow arrows)
Figure 6.17 External appearance of a dermal sinus. Through the thin skin, the funicular stalk penetrates into the intradural space
Figure 6.18 External appearance of sacrococcigeal teratoma. This disease should be differentiated from spinal lipoma
Figure 6.19 Three-dimensional reconstruction CT image of spina bifida. A defect of the lamina of the vertebrae is clearly demonstrated
Figure 6.20 Three-dimensional reconstruction CT image of spina bifida. A partial defect of the sacral bone is demonstrated in a case of spinal lipoma
Figure 6.21 Diastematomyelia (split cord). Left, three-dimensional CT and (right) magnetic resonance image. The spinal cord is divided into two parts (‘split cord’) by a chondro-osseous septum
Figure 6.22 Magnetic resonance image of spinal lipoma (before and after operation). Left, before operation. A subcutaneous lipoma penetrates into the intradural space and adheres to the terminus of the spinal cord (cornus). In this case, dilatation of the central canal of the spinal cord is a complication. Right, magnetic resonance image after resection of the spinal lipoma
Figure 6.23 Spinal lipoma; intraoperative photograph. Left; a spinal lipoma; penetrating into the intradural space, is exposed. Right, repair of the cornus after resection of lipoma. The spinal nerves of the cauda equina can be seen
abnormalities near the spinal lesion are found: skin bulge (subcutaneous lipoma), dimple; hair tuft, pigmentation, skin appendageand hemangioma (Figures 6.136.17). In cases with thickened film terminale, dermalsinus or diastematomyelia (split cord malformation, Figure 6.21); abnormal tethering and fixation of the spinal cord occur.
