MRI

Hydrocephalus is a common neurological disorder in children and the result of a variety of causes. However, with the advancement of imaging modalities, particularly MRI, previously reported rarer causes of hydrocephalus in children are now being more readily appreciated. We report an 11-year-old boy with diffuse villous hyperplasia of the choroid plexus. He had a ventriculo-peritoneal (VP) shunt in-situ and a prior diagnosis from infancy of congenital aqueduct stenosis as the cause of his hydrocephalus. His current presentation was with further shunt dysfunction. CT and MRI demonstrated enlarged choroid plexuses but did not confirm aqueduct stenosis. CSF overproduction was demonstrated from the externalized ventricular drain. The enlarged choroid plexuses were surgically resected and histology confirmed choroid plexus hyperplasia. Identification of choroid plexus hyperplasia is important since the neurosurgical management of hydrocephalus is not VP shunt insertion, but resection of the hyperplastic choroid plexus.

Aim and Purpose: It is very difficult to manage the treatment of early onset scoliosis (EOS). It is necessary to start the diagnosis and
treatment of patients with EOS as early as possible and to plan the treatment well. We investigated the pathologies seen in spinal,
orthopedic, cardiovascular and the other organ systems caused by different etiologies in EOS with the help of magnetic resonance
imaging (MRI) and other diagnostic methods based on etiologic reasons.
Material and Method: We evaluated 62 EOS patients (with 26 congenital, 21 neuromuscular, 10 syndrome and 5 idiopathic reasons)
whose spines were investigated with MRI that were operated and/or managed due to having scoliosis between the years of 2005-
2011. The evaluation mean age with MRI was about 4.3 years (3 months-11 years 10 months) and 38 of them were females and 24 of
whom were males. In all patients, we investigated the intraspinal, extraspinal and additional organ anomalies with MRI. We measured
the coronal and sagittal plain deformity of the spine with the Cobb method. We also investigated the orthopedic pathologies clinically,
radiologically and the additional organ anomalies with abdominal ultrasound and echocardiogram.
Results: We found intraspinal anomalies in 48 patients (77.4%), intraspinal anomalies in 46 patients (74.1%), and additional organ
anomalies in 9 patients (14.5%). We saw 98 intraspinal and 101 extraspinal pathologies with MRI. When evaluated according to the
spinal regions, 50 (80.6%) patients had thoracic, 38 (61%) had lumbar, 28 (45%) cervical, 4 (6.4%) sacral areas. There was syringomyelia at most as intraspinal anomalies in 54.8% (34 patients). We found intraspinal anomalies in neuromuscular scoliosis mostly 55.1% (54 pathologies). The most extraspinal was hemivertebra 38.7% (in 24 patients) and the most frequent was congenital scoliosis 62.37% (63 pathologies). The mean Cobb angle in all cases was measured as 46.6° (10-113°). We found kyphosis increase in 18 (29%) cases and lordosis increase in 4 (6.4%) cases. Additionally in 37 (59.6%) patients 56 orthopedic pathologies were found. The problems seen together most were motor weakness in lower extremities in 12 patients (21%), hip dysplasia in 9 (16%) patients and thorax deformities in 9 (16%) patients. Orthopedic pathologies were seen in neuromuscular scoliosis in 19 (32%) patients. We found cardiovascular anomalies in 7 (11.2%) patients (at most ASD), urogenital anomalies in 11 (17.74%) patients (at most bowel and bladder incontinence), other organic defects in 12 (%19.35) patients (at most inguinal hernia). 33 (53.2%) patients were operated. 18 (29%) of them had been operated before because of intraspinal anomaly, 15 (24.1%) were operated due to orthopedic or other organ anomalies, only in 7 (11.2%) cases VEPTR (4), growing rod (1), epiphysiodesis (1) and hemivertebra (1) excision were applied.
Discussion: Even though scoliosis has differences based on its causes, all spinal and other organ anomalies will probably accompany
EOS. While the intraspinal anomaly of the spine is seen in NS, syringomyelia is the most common reason of intraspinal anomalies.
The extraspinal anomaly of the spine is CS and the most common cause is hemivertebra. Thoracic vertebra is mostly affected. The
orthopedic pathologies are mostly seen in NS. As a cardiovascular anomaly mostly ASD is seen together with SS. In addition to careful
clinical and radiologic investigations, with an early MRI we can understand better the other anomalies that are seen together.