Zusammenfassung
Ziel: Kutane Stigmata im lumbosakralen Bereich können Hinweise auf okkulte spinale Dysrhaphien
sein. Mit der spinalen Sonografie können anatomische Auffälligkeiten des Rückenmarks
in der Neonatalperiode erkannt werden. Patienten: Wir berichten über 6 Säuglinge mit kutanen lumbosakralen Auffälligkeiten, die mit einem
hochauflösenden Linearschallkopf (> 7,5 MHz) zwischen dem 1. Lebenstag und der 9.
Woche (m: 26 Tage) untersucht wurden. Bei den Kindern bestanden folgende kutane Auffälligkeiten:
asymmetrische rima ani (4); lumbale Weichteilschwellung (2); Dermalsinus (2); Haarnaevus
(1); Pigmentnävus (1); häutiges Hautanhängsel (1); Hämangiom (1) sowie einseitige
Peroneuslähmung mit trophischer Störung der unteren Exremität. Ergebnisse: Folgende Diagnosen wurden gestellt: tethered cord (6); Diastematomyelie (2); tight
filum terminale (2); spinales Lipom (3); Lipomyelomeningocele (2); Myelocystocele
und Hydromyelie (1). Bei allen Kindern konnte die sonografische Diagnose kernspintomografisch
und bei der operativen Korrektur im Alter von 2 bis 12 Monaten (m: 7,7 Monate) bestätigt
werden. Schlussfolgerung: Bei allen Kindern mit kutanen lumbosakralen Auffälligkeiten sollte das Rückenmark
in der Neonatalperiode untersucht werden, um okkulte spinale Dysrhaphien und ein tethered
cord frühzeitig zu diagnostizieren und die operative Korrektur vor Einsetzen neurologischer
Störung gegen Ende des 1. Lebensjahres durchführen zu können.
Abstract
Aim: Cutaneous markers in the lumbo-sacral region are indicators of occult spinal dysrhaphism
and tethered cord. By means of spinal sonography, anatomical abnormalities of the
spinal cord can be shown in the neonatal period. Patients: We report on 6 infants with lumbo-sacral cutaneous abnormalities who were investigated
with a high resolution linear transducer (> 7.5 MHz) and a computer sonographic unit
(Sequoia, Acuson). The investigations were performed between the first day of life
and the ninth week (m: 26 days). The following cutaneous markers could be found: Asymmetrical
gluteal crease (4); dermal sinus (2), hairy tuft (1); pigmented naevus (1); cutaneous
appendage (1); haemangioma (1); unilateral peroneal paralysis with hypotrophic correspondic
leg (1). Results: Sonographic evaluation showed the following abnormalities: Tethered cord (6); diastematomyelia
(2); tight filum terminale (2); spinal lipoma (3); lipomyelomeningocele (2), myelocystocele
and hydromyelia (1). In all infants, sonographic diagnosis could be confirmed by MR
imaging and intraoperatively. Surgical correction was performed at the age of 2 to
12 months (m: 7.7 months). Conclusion: All infants with cutaneous markers in the lumbo-sacral region should be investigated
by spinal sonography as long as the vertebral arches are not completely ossified.
Sonography of the spinal cord may detect occult spinal dysrhaphism and tethered cord
and prevent neurological damage by early surgical correction at the end of the first
year of life.
Key words
spine - occult spinal dysrhaphism - tethered cord - diastematomyelia - lipomyelomeningocele
- myelocystocele - cutaneous birth markers
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Hans-Martin Lode
Klinik für Kinderheilkunde und Jugendmedizin, Sozialstiftung Bamberg Klinikum am Bruderwald
Buger Str. 80
96049 Bamberg
Phone: ++49/9 51/5 03 56 91
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Email: Hans-Martin.Lode@sozialstiftung-bamberg.de