ABSTRACT:
INTRODUCTION: Limited dorsal myeloschisis (LDM) is a rare form
of spinal dysraphism characterized by two constant features: a focal
”closed” midline skin defect and a fibro neural tract connecting the
skin lesion to the underlying spinal cord. Excision of the tract
followed by reconstruction is the preferred management. Intraoperative
neurophysiologic monitoring (IONM) is widely used in neurosurgery to
recognize important neurological structures but can be challenging in
the pediatric population due to incomplete neural development.
CASE REPORT: A 7-day-old male baby presented with a history of
dorsal ”cigarette burn” skin lesion noted at birth. Clinical assessment
and imaging findings revealed a fibro neural tract extending from the
skin surface into the lumbar spinal canal at the level of L5-S1.
Excision of skin lesion/ tract and untethering of filum terminale with
dural tube reconstruction under Intraoperative neurophysiological
monitoring (INOM) was performed. The procedure went smoothly.
Postoperatively, the child showed no neurological compromise or
dermatological complications. In addition, the wound healed well, and
the neonate was completely normal.
CONCLUSION: This case demonstrates the successful management of
LDM through an IONM-guided complex reconstruction surgery in a neonate
and the effective use of IONM in such challenging cases.