NEURORADIOLOGY / REVIEW PAPER
 
KEYWORDS
TOPICS
ABSTRACT
The aim of this paper is to present the currently used classification of split cord malformation. Split cord malformation (SCM) is a developmental defect arising during neurulation, resulting in abnormal neural tube development, with the formation of a division within the spinal cord and dural sac. The terms diastematomyelia and diplomyelia are used in the literature to describe this defect. In 1992, Pang proposed the term SCM to describe all dysraphic spinal cord defects and classified them into type I and type II, depending on the nature of the sagittal septum within the spinal canal and the presence or absence of a divided dural sac. SCM type I includes cases with a bony septum and a divided dural sac, while SCM type II includes cases without a divided dural sac but with a fibrous septum present. Depending on the type of defect, and the location and extent of the split, the condition is accompanied by neurological symptoms of varying localisation and severity. As symptoms may worsen with the child’s growth, surgical intervention to remove the septum is usually necessary. In this article, the authors present the defect based on literature data, describe the current terminology regarding the defect and associated anomalies, and present a set of features that should be assessed to classify lesions.
REFERENCES (42)
1.
Czochańska J, Lech M. Prevention of neural tube defects. An important health and social problem. Przegl Lek 1998; 55: 174-178 [Article in Polish].
 
2.
Mahapatra AK. Split cord malformation: a study of 300 cases at AIIMS 1990-2006. J Pediatr Neurosci 2011; 6 (Suppl 1): S41-S45. DOI: 10.4103/1817-1745.85708.
 
3.
Osborn AG. Diagnostic Neuroradiology. Mosby Year Book; 1994, pp. 811-813.
 
4.
Walecki J. Neuroradiology. Warsaw: UN-O; 2000.
 
5.
Eid E, Hochberg J, Saunders D. Skin abnormalities of the back in diastematomyelia. Plast Reconstr Surg 1979; 63: 534-539.
 
6.
Podsiadło-Kleinrok B. Assessment of the value of computed tomography and magnetic resonance imaging in the diagnosis and classification of spinal cord split defect: doctoral thesis. Kraków; 2002.
 
7.
Andar UB, Harkness WF, Hayward RD. Split cord malformation of the lumbar region: a model for the neurosurgical management of all types of occult spinal dysraphism. Pediatr Neurosurg 1997; 26: 17-24.
 
8.
Samson A, Łakomiec B. Diastematomyelia. Rez Magn Med 1995; 3: 28-33.
 
9.
Karim Ahmed A, Howell EP, Harward S, Sankey EW, Ehresman J, Schilling A, et al. Split cord malformation in adults: literature review and classification. Clin Neurol Neurosurg 2020; 193: 105733. DOI: 10.1016/j.clineuro.2020.105733.
 
10.
Zaleska-Dorobisz U, Bladowska J, Biel A, Pałka LW, Hołownia D. MRI diagnosis of diastematomyelia in a 78-year-old woman: case report and review of the literature. Pol J Radiol 2010; 75: 82-87.
 
11.
List J, Stendel R, Rudolph KH, Brock M. A case of diastematomyelia (split cord malformation type I) with clinical manifestation in adulthood. Zentralbl Neurochir 1994; 55: 212-217.
 
12.
Pang D, Dias MS, Ahab-Barnada M. Split cord malformation, Part I: A unified theory of embryogenesis for double spinal cord malformations. Neurosurgery 1992; 31: 451-480.
 
13.
Bartel H. Epidemiology. Warsaw: Wydawnictwo Lekarskie PZWL; 1999.
 
14.
Erşahin Y. Split cord malformation types I and II: a personal series of 131 patients. Childs Nerv Syst 2013; 29: 1515-1526.
 
15.
Pang D. Split cord malformation: Part II: Clinical syndrome. Neurosurgery 1992; 31: 481-500.
 
16.
Mahapatra AK, Gupta DK. Split cord malformations: a clinical study of 254 patients and a proposal for a new clinical-imaging classification. J Neurosurg 2005; 103 (6 Suppl): 531-536. DOI: 10.3171/ped.2005.103.6.0531.
 
17.
Herman T, Siegel M. Cervical and basocranial diastematomyelia. Am J Roentgenol 1990; 154: 806-808.
 
18.
Sikorska J, Walecki J. Dysraphic defects of the terminal segment of the spinal canal and spinal cord in magnetic resonance imaging. Rez Magn Med 1997; 5: 38-52.
 
19.
Urbanik A, Herman-Sucharska I, Podsiadło-Kleinrok B, Chojnacka I, Kleinrok K. Developmental defects of the canal and spinal cord in neuro­imaging. Przegl Lek 1998; 55: 168-173.
 
20.
Walecki J, Kulczycki, Bogusławska R. Modern imaging diagnostics of central nervous system diseases. Warsaw: ZUS; 1995.
 
21.
Tołkacz A. Contrast agents used in magnetic resonance imaging. Current knowledge. Rez Magn Med 1997; 5: 23-29.
 
22.
Valk J. Gd-DTPA in MR of spinal lesions. AJR Am J Roentgenol 1998; 9: 345-350.
 
23.
Kulkarni M, Ruparel M, Redkar R. Fetal diastematomyelia: MR imaging: a case report. Indian J Radiol Imaging 2009; 19: 78-80.
 
24.
Herman-Sucharska I, Bożek P, Bryll A. Spinal split defects: from diagnosis to therapy. Przegl Lek 2013; 70: 344-350.
 
25.
Raghavendra BN, Epstein FJ, Pinto RS, Subramanyam BR, Greenberg J, Mitnick JS. The tethered spinal cord: diagnosis by high-resolution real-time ultrasound. Radiology 1983; 149: 123-128.
 
26.
DiPietro MA. Spinal canal in children. Med Praktyczna 2001; 2: 67-97.
 
27.
Scheible W, James HE, Leopold GR, Hilton SV. Occult spinal dysraphism in infants: screening with high-resolution real-time ultrasound. Radiology 1983; 146: 743-746.
 
28.
Abramowicz JS, Jaffe R. Ultrasound detection of fetal abnormalities. Pediatr Ann 1996; 25: 228-238.
 
29.
Wei Q, Cai A, Wang X, Wang X, Xie L. The value of prenatal ultrasound diagnosis of diastematomyelia. J Ultrasound Med 2017; 36: 1129-1136.
 
30.
Karaşahin KE, Gezginç K, Alanbay I, Ulubay M, Başer I. Ultrasonographic diagnosis of diastematomyelia during the 14th week of gestation. Taiwan J Obstet Gynecol 2009; 48: 163-166.
 
31.
Biri AA, Turp AB, Kurdoğlu M, Himmetoğlu O, Tokgöz Ercan N, Balci S. Prenatal diagnosis of diastematomyelia in a 15-week-old fetus. Fetal Diagn Ther 2005; 20: 258-261.
 
32.
Lichtenstein BW. Spinal dysraphism: spina bifida and myelodysplasia. Arch Neurol Psychiatry 1940; 44: 792-810.
 
33.
Rokos J. Pathogenesis of diastematomyelia and spina bifida. J Pathol 1975; 117: 155-161.
 
34.
Herren RY, Edwards JE. Diplomyelia: duplication of the spinal cord. Arch Pathol 1940; 30: 1203-1214.
 
35.
Bremer JL. Dorsal intestinal fistula; accessory neurenteric canal; diastematomyelia. AMA Arch Pathol 1952; 54: 132-138.
 
36.
Barkovich AJ. Pediatric neuroimaging. New York: Raven Press; 1995.
 
37.
Emura T, Asashima M, Hashizume K. An experimental animal model of split cord malformation. Pediatr Neurosurg 2000; 33: 283-292.
 
38.
Gupta DK, Mahapatra AK. Proposal for a new clinicoradiological classification of type I split-cord malformations: a prospective study of 25 cases. Pediatr Neurosurg 2006; 42: 341-346.
 
39.
Vaishya S, Kumar Jain P. Split cord malformation: three unusual cases of composite split cord malformation. Childs Nerv Syst 2001; 17: 528-530.
 
40.
Meena RK, Doddamani RS, Gurjar HK, Kumar A, Chandra PS. Type 1.5 split cord malformations: an uncommon entity. World Neurosurg 2020; 133: 142-149.
 
41.
Wang KC, Yang J. We are cautious to use the term, ‘split cord malformation type 1.5’. J Korean Neurosurg Soc 2022; 65: 761-762.
 
42.
Sun M, Tao B, Luo T, Gao G, Shang A. Type 1.5 split cord malformation: a new theory of pathogenesis. J Korean Neurosurg Soc 2022; 65: 138-144.
 
Journals System - logo
Scroll to top