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03.07.2017 | Original Article

Tethered cord in patients affected by anorectal malformations: a survey from the ARM-Net Consortium

verfasst von: María Fanjul, I. Samuk, P. Bagolan, E. Leva, C. Sloots, C. Giné, D. Aminoff, P. Midrio, On behalf of the ARM-Net Consortium

Erschienen in: Pediatric Surgery International | Ausgabe 8/2017

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Abstract

Purpose

The goal of this study was to determine the degree of consensus in the management of spinal cord tethering (TC) in patients with anorectal malformation (ARM) in a large cohort of European pediatric centers.

Methods

A survey was sent to pediatric surgeons (one per center) members of the ARM-Net Consortium.

Results

Twenty-four (86%) from ten different countries completed the survey. Overall prevalence of TC was: 21% unknown, 46% below 15, and 29% between 15 and 30%. Ninety-six agreed on screening all patients for TC regardless the type of ARM and 79% start screening at birth. Responses varied in TC definition and diagnostic tools. Fifty percent of respondents prefer ultrasound (US), 21% indicate either US or magnetic resonance (MRI) based on a pre-defined risk of presenting TC, and 21% perform both. Discrepancy exists in complementary test: 82% carry out urodynamic studies (UDS) and only 37% perform somatosensory-evoked potentials (SSEP). Prophylactic untethering is performed in only two centers (8%).

Conclusions

Survey results support TC screening in all patients with ARM and conservative management of TC. There is discrepancy in the definition of TC, screening tools, and complementary test. Protocols should be developed to avoid such variability in management.

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Lew SM, Kothbauer KF (2007) Tethered cord syndrome: an update review. Pediatr Neurosurg 43:236–248CrossRefPubMed

van den Hondel D, Sloots C, de Jong TH, Lequin M, Wijnen R (2015) Screening and treatment of tethered spinal cord in anorectal malformation patients. Eur J Pediatr Surg 26(1):22–28CrossRefPubMed

Uchida K, Inoue M, Matsubara T, Otake K, Koike Y, Okugawa Y, Kawamoto A, Miki C, Kusunoki M (2007) Evaluation and treatment for spinal cord tethering in patients with anorectal malformation. Eur J Pediatr Surg 17(6):408–411CrossRefPubMed

Levitt MA, Peña A (2005) Outcomes from the correction of anorectal malformations. Curr Opin Pediatr 17(3):394–401CrossRefPubMed

Di Cesare A, Leva E, Macchini F, Canazza L, Carrabba G, Fumagalli M, Mosca F, Torricelli M (2010) Anorectal malformations and neurospinal dysraphism: is this association a major risk for continence? Pediatr Surg Int 26(11):1077–1081CrossRefPubMed

Borg HC, Holmdahl G, Gustavsson K, Doroszkiewicz M, Sillén U (2013) Longitudinal study of bowel function in children with anorectal malformation. J Pediatr Surg 48(3):597–606CrossRefPubMed

Kyrklund K, Pakarinen MO, Taskinen S, Kivisaari R, Rintala RJ (2016) Spinal cord anomalies in patients with anorectal malformations without severe sacral abnormalities or meningomyelocele: outcomes after expectant, conservative management. J Neurosurg Spine 25(6):782–789CrossRefPubMed

Totonelli G, Morini F, Catania VD, Schingo PM, Mosiello G, Palma P, Iacobelli BD, Bagolan P (2016) Anorectal malformations associated spinal cord anomalies. Pediatr Surg Int 32(8):729–735CrossRefPubMed

Tuuha SE, Aziz D, Drake J, Wales P, Kim PC (2004) Is surgery necessary for asymptomatic tethered cord in anorectal malformation patients? J Pediatr Surg 39(5):773–777CrossRefPubMed

10.

Levitt MA, Patel M, Rodriguez G, Gaylin DS, Pena A (1997) The tethered spinal cord in patients with anorectal malformations. J Pediatr Surg 32(3):462–468CrossRefPubMed

11.

Teo AT, Gan BK, Tung JS, Low Y, Seow WT (2012) Low-lying spinal cord and tethered cord syndrome in children with anorectal malformations. Singap Med J 53(9):570–576

12.

Miyasaka M, Nosaka S, Kitano Y, Ueoka K, Tsutsumi Y, Kuroda T, Honna T (2009) Utility of spinal MRI in children with anorectal malformation. Pediatr Radiol 39(8):810–816CrossRefPubMed

13.

Podberesky DJ, Towbin AJ, Eltomey MA, Levitt MA (2013) Magnetic resonance imaging of anorectal malformations. Magn Reson Imaging Clin N Am 21(4):791–812CrossRefPubMed

14.

Taskinen S, Valanne L, Rintala R (2002) Effect of spinal cord abnormalities on the function of the lower urinary tract in patients with anorectal abnormalities. J Urol 168(3):1147–1149CrossRefPubMed

15.

Frainey B, Yerkes E, Menon V, Gong E, Meyer T, Bowman R, McLone D, Cheng E (2014) Predictors of urinary continence following tethered cord release in children with occult spinal dysraphism. J Pediatr Surg 10:627–633

16.

Bischoff A, Levitt MA, Peña A (2013) Update on the management of anorectal malformations. Pediatr Surg Int 29(9):899–904CrossRefPubMed

17.

Borg H, Holmdahl G, Olsson I, Wiklund LM, Sillén U (2009) Impact of spinal cord malformation on bladder function in children with anorectal malformations. J Pediatr Surg 44(9):1778–1785CrossRefPubMed

18.

Scottoni F, Iacobelli BD, Zaccara AM, Totonelli G, Schingo AM, Bagolan P (2014) Spinal ultrasound in patients with anorectal malformations: is this the end of an era? Pediatr Surg Int 30(8):829–831CrossRefPubMed

19.

Kim SM, Chang HK, Lee MJ, Shim KW, Oh JT, Kim DS, Kim MJ, Han SJ (2010) Spinal dysraphism with anorectal malformation: lumbosacral magnetic resonance imaging evaluation of 120 patients. J Pediatr Surg 45(4):769–776CrossRefPubMed

20.

Golonka NR, Haga LJ, Keating RP, Eichelberger MR, Gilbert JC, Hartman GE, Powell DM, Vezina G, Newman KD (2002) Routine MRI evaluation of low imperforate anus reveals unexpected high incidence of tethered spinal cord. J Pediatr Surg 37(7):966–969CrossRefPubMed

21.

Chern JJ, Aksut B, Kirkman JL, Shoja MM, Tubbs RS, Royal SA, Wellons JC 3rd, Rozzelle CJ (2012) The accuracy of abnormal lumbar sonography findings in detecting occult spinal dysraphism: a comparison with magnetic resonance imaging. J Neurosurg Pediatr 10(2):150–153CrossRefPubMed

22.

Tsuji H, Okada A, Nakai H, Azuma T, Yagi M, Kubota A (2002) Follow-up studies of anorectal malformations after posterior sagittal anorectoplasty. J Pediatr Surg 37(11):1529–1533CrossRefPubMed

23.

Eltomey MA, Donnelly LF, Emery KH, Levitt MA, Peña A (2008) Postoperative pelvic MRI of anorectal malformations. AJR Am J Roentgenol 191(5):1469–1476CrossRefPubMed

24.

Mosiello G, Capitanucci ML, Gatti C, Adorisio O, Lucchetti MC, Silveri M, Schingo PS, De Gennaro M (2003) How to investigate neurovesical dysfunction in children with anorectal malformations. J Urol 170(4 Pt 2):1610–1613CrossRefPubMed

25.

Tsuda T, Iwai N, Kimura O, Kubota Y, Ono S, Sasaki Y (2007) Bowel function after surgery for anorectal malformations in patients with tethered spinal cord. Pediatr Surg Int 23(12):1171–1174CrossRefPubMed

26.

Suppiej A, Dal Zotto L, Cappellari A, Traverso A, Castagnetti M, Drigo P, Midrio P (2009) Tethered cord in patients with anorectal malformation: preliminary results. Pediatr Surg Int 25(10):851–855CrossRefPubMed

27.

Morimoto K, Takemoto O, Wakayama A (2003) Tethered cord associated with anorectal malformation. Pediatr Neurosurg 38(2):79–82CrossRefPubMed

28.

Severino M, Manara R, Faggin R, Dalle Nogare C, Gamba P, Midrio P (2008) Anorectal malformation and spinal dysraphism: the value of diffusion-weighted imaging in detecting associated intradural (epi)dermoid cyst. J Pediatr Surg 43(10):1935–1938CrossRefPubMed

Titel: Tethered cord in patients affected by anorectal malformations: a survey from the ARM-Net Consortium
verfasst von: María Fanjul
I. Samuk
P. Bagolan
E. Leva
C. Sloots
C. Giné
D. Aminoff
P. Midrio
On behalf of the ARM-Net Consortium
Publikationsdatum: 03.07.2017
Verlag: Springer Berlin Heidelberg
Erschienen in: Pediatric Surgery International / Ausgabe 8/2017
Print ISSN: 0179-0358
Elektronische ISSN: 1437-9813
DOI: https://doi.org/10.1007/s00383-017-4105-4

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Tethered cord in patients affected by anorectal malformations: a survey from the ARM-Net Consortium