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Principles of Pediatric Neurosurgery Series Editor: Anthony J. Raimondi Principles of Pediatric Neurosurgery Head Injuries in the Newborn and Infant The Pediatric Spine 1: Development and Dysraphic State The Pediatric Spine II: Developmental Anomalies The Pediatric Spine III: Cysts, Tumors, and Infections Edited by Anthony J. Raimondi, Maurice Choux, and Concezio Di Rocco The Pediatric Spine III Cysts, Tumors, and Infections Edited by Anthony J. Raimondi, Maurice Choux, and Concezio Di Rocco With 87 Figures Springer Verlag New York Berlin Heidelberg London Paris Tokyo ANTHONY J. RAIMONDI, 37020 Gargagnago (Verona), Italy MAURICE CHOUX, M.D., H6pital des Enfants de la Timone, Rue Saint Pierre, 13005 Marseille, France CONCEZIO 01 Rocco, M.D., Istituto di Neurochirurgia, Universita Cattolica del Sacro Cuore, Largo Gemelli 8, 00168 Rome, Italy Library of Congress Cataloging-in-Publication Data The pediatric spine. (Principles of pediatric neurosurgery) Includes bibliographies and index. Contents: I. Development and the dysraphic state- - 3. Cysts, tumors, and infections. I. Spine-Diseases. 2. Spine-Abnormalities. 3. Spine-Surgery. 4. Pediatric neurology. I. Raimondi, Anthony J., 1928- . II. Choux, M. (Maurice) III. Di Rocco, C. (Concezio) IV. Series. [DNLM: I. Spinal Diseases-in infancy and childhood. 2. Spine­ growth & development. WE 725 P3711] RD768.P36 1989 618.92'73 88-24822 © 1989 by Springer-Verlag New York Inc. Softcover reprint of the hardcover 1st edition 1989 All rights reserved. This work may not be translated or copied in whole or in part without the written permission of the publisher (Springer-Verlag, 175 Fifth Avenue, New York, NY 10010, USA), except for brief excerpts in connection with reviews or scholarly analysis. Use in connection with any form of information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed is forbidden. The use of general descriptive names, trade names, trademarks, etc. in this publication, even ifthe former are not especially identified, is not to be taken as a sign that such names, as understood by the Trade Marks and Merchandise Marks Act, may accordingly be used freely by anyone. While the advice and information in this book are believed to be true and accurate at the date of going to press, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein. Typeset by David E. Seham Associates, Inc., Metuchen, New Jersey. 9 8 7 6 5 4 3 2 I ISBN-13:978-1-4613-8809-8 e-ISBN-13:978-1-4613-8807-4 DOl: 10.1007/978-1-4613-8807-4 Series Preface It is estimated that the fU,nctionally significant body of knowledge for a given medical specialty changes radically every 8 years. New specialties and "sub-specialization" are occurring at approximately an equal rate. Historically, established journals have not been able either to absorb this increase in publishable material or to extend their readership to the new specialists. International and national meetings, symposia and seminars, workshops and newsletters successfully bring to the attention of physicians within developing specialties what is occurring, but generally only in dem­ onstration form without providing historical perspective, pathoanatomical correlates, or extensive discussion. Page and time limitations oblige the authors to present only the essence of their material. Pediatric neurosurgery is an example of a specialty that has developed during the past 15 years. Over this period, neurosurgeons have obtained special training in pediatric neurosurgery, and then dedicated themselves primarily to its practice. Centers, Chairs, and educational programs have been established as groups of neurosurgeons in different countries throughout the world organized themselves respectively into national and international societies for pediatric neurosurgery. These events were both preceded and followed by specialized courses, national and international journals, and ever-increasing clinical and investigative studies into all as­ pects of surgically treatable diseases of the child's nervous system. Principles of Pediatric Neurosurgery is an ongoing series of pUblications, each dedicated exclusively to a particular subject, a subject which is cur­ rently timely either because of an extensive amount of work occurring in it, or because it has been neglected. The two first subjects, "Head Injuries in the Newborn and Infant" and "The Pediatric Spine," are expressive of those extremes. Volumes will be published continuously, as the subjects are dealt with, rather than on an annual basis, since our goal is to make this information available to the specialist when it is new and informative. If a volume becomes obsolete because of newer methods of treatment and concepts, we shall publish a new edition. vi Series Preface The chapters are selected and arranged to provide the reader, in each instance, with embryological, developmental, epidemiological, clinical, therapeutic, and psychosocial aspects of each subject, thus permitting each specialist to learn what is current in his field and to familiarize himself with sister fields of the same subject. Each chapter is organized along classical lines, progressing from introduction through symptoms and treatment, to prognosis, for clinical material; and introduction through history and data, to results and discussion, for experimental material. Contents Series Preface .......................................................... v Contributors . ix Chapter 1 Spinal Meningeal Malformations CONCEZIO DI Rocco, ANTONELLO CEDDlA, and CESARE COLOSIMO JR. ................................ Chapter 2 Syringomyelia and Hydromyelia RAINER W. OBERBAUER ................................. 17 Chapter 3 Intraspinal Tumors CONCEZIO DI Rocco, ALDO IANNELLI, and CESARE COLOSIMO JR. .. 45 Chapter 4 Nonoperative Treatment of Tumors of the Spinal Cord in Children SAMUEL NEFF and R. MICHAEL SCOTT ................ 121 Chapter 5 Surgical Considerations for Access to the Spinal Canal ANTHONY J. RAIMONDI .................................. 135 Chapter 6 Nonsurgical Diseases of the Spinal Cord Presenting as Surgical Diseases JOAN L. VENES .......................................... 147 Chapter 7 Infectious Diseases of the Spine in Childhood WARWICK J. PEACOCK .................................. 153 Chapter 8 Parasitosis of the Spine ADELOLA ADELOYE ..................................... 173 viii Contents Chapter 9 Diagnostics and Management of Urinary Problems in Neurogenic Vesico-Sphincteric Dysfunction GERARD MONFORT........................................ 187 Index 209 Contributors ADELOLA ADELOYE Department of Surgery, University College Hospital, University of Ibadan, Ibadan, Nigeria ANTONELLO CEDDIA Istituto di Neurochirurgia, Universita Cattolica del Sacro Cuore, Rome, Italy CESARE COLOSIMO JR. Istituto di Radiologia, Universita Cattolica del Sacro Cuore, Rome, Italy CONCEZIO DI Rocco Istituto di Neurochirurgia, Universita Cattolica del Sacro Cuore, Rome, Italy ALDO IANNELLI Istituto di Neurochirurgia, Universita Cattolica del Sacro Cuore, Rome, Italy GERARD MONFORT Centre Hospitalier de la Timone, Hopital des Enfants, Marseille, France SAMUEL NEFF Department of Neurosurgery, New England Medical Center and Tufts University School of Medicine, Boston, Massachusetts, USA RAINER W. OBERBAUER Neurosurgical Department, University of Graz, Graz, Austria WARWICK J. PEACOCK Division of Neurosurgery, The Center for the Health Sciences, University of California at Los Angeles, Los Angeles, California, USA x Contributors ANTHONY J. RAIMONDI Northwestern University Medical School, Chicago, Illinois, USA (Emeritus) and Dipartimento di Neurochirurgia, Universita degli Studi, Verona, Italy R. MICHAEL SCOTT Childrens Hospital, Boston, Massachusetts, USA JOAN L. VENES Section of Neurosurgery, Department of Surgery, University of Michigan, Ann Arbor, Mkhigan, USA CHAPTER 1 Spinal Meningeal Malformations Concezio Di Rocco, Antonello Ceddia, and Cesare Colosimo Jr. Introduction Spinal meningeal malformations include idiopathic intraspinal arachnoid cysts, paravertebral meningoceles, anterior sacral meningoceles, and per­ ineurial cysts (Tarlov's cyst) (34). These malformations should be distin­ guished from acquired cysts of the meninges, which may develop after trauma, laminectomy, or lumbar puncture. Cystic meningeal malformations usually become symptomatic in children aged from 10 to 12 years, in ad­ olescence, and in adulthood. Intraspinal Arachnoid Cysts Idiopathic intraspinal arachnoid cysts originate from the arachnoid of the spinal cord, which extends to the sheaths of the roots ofthe spinal nervus. They may appear as an isolated cystic mass lesion, which does not com­ municate with the subarachnoid space or, more commonly, as an ex­ panding diverticulum of the arachnoid, continuing into the subarachnoid space through a relatively narrow neck (25). Intraspinal arachnoid cysts may remain confined within the intradural space (intradural arachnoid cysts) or may protrude into the extradural space through a dural defect (extradural arachnoid cysts). These cysts rarely exhibit both intradural and extradural components (8). According to some, they may develop "interdurally," between the leaves of the dura (9), but this is difficult to understand anatomically since there is only one layer of dura enveloping

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