An Unusual Case of Split Cord Malformation
J. Moriyaa,
S. Kakedaa,
Y. Korogia,
Y. Soejimab,
E. Urasakib and
A. Yokotab
a Department of Radiology, University of Occupational and Environmental Health School of Medicine, Kitakyushu, Japan
b Department of Neurosurgery, University of Occupational and Environmental Health School of Medicine, Kitakyushu, Japan
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Fig 1. A, 3D spinal CT reconstruction of the spinal column shows spina bifida from L2 to S2 and a congenital spinal anomaly associated with hypoplasia of L1, T11, and T12.
B, CT myelography axial scan shows a congenital spinal anomaly associated with hypoplasia of L1.
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Fig 2. A, T2-weighted coronal MR imaging scan shows presence of split cord beginning at the T12 vertebral body level in a single dural tube, and the distal thecal sac was widened.
B, T2-weighted sagittal MR imaging scan shows the tethered cord at the level of L5 (arrow).
C, T2-weighted coronal MR imaging scan (magnified view of panel A).
D and E, T2-weighted axial MR imaging scans (section level) show the proximal part of left hemicord with an aberrant course anterolaterally to the spinal canal was tapered to a point of complete absence (arrow).
F, T2- weighted axial MR imaging scan (section level) shows the presence of lateral sets of nerve roots arising from each hemicord (arrows).
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Fig 3. A, Curved multiplanar reconstruction image obtained with a CT myelography shows the left hemicord with the small remnant of subarachnoid space running through the intravertebral cleft at the level of spinal anomalies (arrow).
B, CT myelography axial scan (section level) shows the left small remnant of subarachnoid space running through the intravertebral cleft (arrow).
C, CT myelography axial scan (section level) shows that the proximal part of the left hemicord with an aberrant course anterolaterally and tapering (arrow).
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Fig 4. Illustration of the suspected extradural neural tract through a canal in the deformed vertebrae and the continuity of the left hemicord to the upper cord (open arrow).
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Fig 5. Photograph of the intraoperative surgical field shows an asymmetric duplication of the spinal cord, which is encompassed by the single dural sac.
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Fig 6. The illustrations show the mechanism of the SCMs with coexisting SSD.
A, An abnormal communication between ectoderm and endoderm causes "regional" splitting of the notochord, and each separated notochord induces surrounding the paraxial mesoderm.
B, An embryologic derangement of the paraxial mesoderm causes on only left notochord (open arrow).
C, The illustration shows the dysgenesis of vertebra and left hemicord.
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