• Clinical and Experimental Pediatrics
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• v.62 no.2
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• pp.68-74
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• 2019

Purpose: To investigate the prevalence of occult spinal dysraphism (OSD) and subsequent neurosurgery in pediatric patients with isolated or combined dorsal midline cutaneous stigmata with or without other congenital malformations. Methods: We carried out a retrospective review of patients who underwent sonography or magnetic resonance imaging (MRI) for OSD because of suspicion of dorsal midline cutaneous stigmata (presumed to be a marker for OSD) between January 2012 and June 2017. Information about patient characteristics, physical examination findings, spinal ultrasound and MRI results, neurosurgical notes, and accompanying congenital anomalies was collected. Results: Totally 250 patients (249 ultrasound and one MRI screening) were enrolled for analysis. Eleven patients underwent secondary MRI examinations. The prevalence of OSD confirmed by an MRI was 2.4% (6 patients including one MRI screening). Five patients (2%) had tethered cord and underwent prophylactic neurosurgery, 3 of whom had a sacrococcygeal dimple and a fibrofatty mass. Prevalence of tethered cord increased as markers associated with a sacrococcygeal dimple increased (0.5% of the isolated marker group, 8.1% of the 2-marker group, and 50% of the 3-marker group). Incidence of OSD with surgical detethering in 17 other congenital anomaly patients was 11.8%, which was higher than the 1.3% in 233 patients without other congenital anomalies. Conclusion: Our results suggest that the presence of dorsal midline cutaneous stigmata, particularly fibrofatty masses, along with a sacrococcygeal dimple is associated with OSD or cord tethering requiring surgery. OSD should be suspected in patients with concurrent occurrence of other congenital anomalies.

• Journal of Korean Neurosurgical Society
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• v.63 no.3
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• pp.272-278
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• 2020

Compared to any other decade, the last two decades have been the most dynamic period in terms of advances in the knowledge on spinal dysraphism. Among the several factors of rapid advancement, such as embryology during secondary neurulation and intraoperative neurophysiological monitoring, there is no doubt that Professor Dachling Pang stood high amidst the period. I review here the last two decades from my personal point of view on what has been achieved in the field of spinal dysraphism, focusing on occult tethered cord syndrome, lumbosacral lipomatous malformation, terminal myelocystocele, retained medullary cord, limited dorsal myeloschisis and junctional neural tube defect. There are still many issues to revise, add and extend. Profound knowledge of basic science is critical, as well as refined clinical analysis. I expect that young scholars who follow the footsteps of precedent giants will shed bright light on this topic in the future.

• Journal of Korean Neurosurgical Society
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• v.64 no.3
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• pp.414-417
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• 2021

During the last two decades, there have been remarkable advances in knowledge regarding secondary neurulation. An increased number of cases of occult spinal dysraphism and progress in basic embryology research have provoked the continuous discovery of new disease entities and the reclassification of occult spinal dysraphic lesions. Examples of such changes are described. The characteristics of secondary neurulation compared with those of primary neurulation are listed and discussed. Our fundamental questions include what the evolutionary significance of secondary neurulation is and what the advantages of having secondary neurulation are. However, our current data and speculations are insufficient to support scientific inference. The direction of future progress of research in this field is predicted. The role of clinicians in this progress is emphasized.

• Journal of Korean Neurosurgical Society
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• v.57 no.3
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• pp.225-228
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• 2015

Congenital dermal sinus (CDS) is a type of occult spinal dysraphism characterized by a midline skin dimple. A 12-month-old girl presented with fever and ascending quadriparesis. She had a midline skin dimple in the upper sacral area that had been discovered in her neonatal period. Imaging studies revealed a holocord intramedullary abscess and CDS. Overlooking CDS or misdiagnosing it as benign sacrococcygeal dimple may lead to catastrophic infection and cause serious neurological deficits. Therefore, further imaging work-up or consultation with a pediatric neurosurgeon is recommended following discovery of any atypical-looking dimples in the midline.

• Journal of Korean Neurosurgical Society
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• v.29 no.4
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• pp.569-573
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• 2000

Spinal meningeal cyst of the sacrum is uncommon congenital lesion. We experienced two cases of sacral meningeal cyst, so called Tarlov's cyst, who presented with radiating pain. Magnetic resonance imaging is a highly effective way of locating and approximating the size of these entities, which generally appear as intraspinal masses of low intensity on T1-weighted and high intensity on T2-weighted images, similar to cerebrospinal fluid(CSF). We evaluated 2 patients who had Tarlov's cyst diagnosed with conventional MRI. The clinical features, radiological findings, gross appearances of the lesion at surgery, surgical technique, histopathological features of the cyst wall, and surgical outcome are described. We conclude that excellent result can be expected in the case of symptomatic Tarlov's cyst by surgical decompression.