Pediatric Neurosurgery by David M. Frim, N. Gupta

By David M. Frim, N. Gupta

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They may lead to recurrent infection or to focal symptoms secondary to compression of the cord or cauda equina. Their delineation by MRI is improved by addition of contrast-enhanced T1-weighted sequences with fat saturation. Spinal lipomas are the most common occult spinal dysraphism, and are likely also due to improper disjunction during neurulation. They can be further categorized as intradural lipoma, lipomyelocele or lipomyelomeningocele, and fibrolipomas of the filum terminale. Intradural lipomas may not have an associated defect in the bone of the spinal canal, and usually appear as well-defined fatty dorsal intradural masses (hypodense on CT and T1 hyperintense on MRI) that are in direct contact with neural tissue.

However, a T1-weighted transaxial MR sequence with fat saturation through the skull base and neck is usually the modality of choice because of its relative convenience and high sensitivity in detecting blood within the crescentic false lumen lining the injured artery. Venous infarcts are a consequence of thrombosis of dural venous sinuses, deep or cortical veins. They occur in the setting of dehydration or other causes of hypercoagulability, and as a complication of meningitis. Venous infarcts appear as illdefined areas of edema, and approximately 25% have concomitant hemorrhage.

Extramedullary masses commonly demonstrate well-defined margins and can indent or compress the adjacent spinal cord (Table 16). Extramedullary masses can also be further characterized as within (intradural) or outside the dura (extradural). MR is the imaging modality of choice for all spinal masses; pre- and postcontrast T1-weighted images in all 3orthogonal planes and sagittal T2-weighted images are essential to properly characterize the lesion(s). It should be noted that there are many extradural tumors that arise 2 30 2 Pediatric Neurosurgery primarily in the vertebral bodies.

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