PMC9560655_01
a - 'Tail-like' skin appendage on the nape of the neck. Fig. 1b and c - Sagittal and axial MRI scan demonstrating the C1/2 limited dorsal myeloschisis with evidence of tethered cord. White arrow indicates the skin appendage from which the stalk (black arrow) is going through the soft tissue. Fig. 1d-f - Fibrous stalk connecting the cutaneous appendage to the underlying spinal cord (white arrow). The visible stalk (black arrow) was disconnected flush to the cord to release the tethered cord below the obex (dotted black arrow).
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A 3-year-old girl was referred with a midline 'tail-like' cutaneous appendage at the nape of her neck that was present since birth (Fig. 1a). She had an MRI scan at the age of 24 months which demonstrated that the overlying cutaneous appendage was in continuity with the tethered spinal cord (Fig. 1b and c). The dura was opened, and the fibrous tract was visualised to extend intradurally (Fig. 1d). The spinal cord was tethered 3 mm inferior to the obex (Fig. 1e). The stalk was fully excised from the cord by sharp dissection and resected along with the cutaneous appendage (Fig. 1f).
a. Soft, pedunculated, transilluminable, mobile cystic swelling on the posterior aspect of the neck at the cranio-cervical junction.. Fig. 2b and c - Sagittal and axial MRI scan demonstrating the C0/1 LDM with associated tethering of the cord. Fig. 2d: and e - The overlying cutaneous lesion was connected to the deeper structures by a fibrolipomatous stalk. The deep portion of the stalk (white arrow) extended into the intradural space. Normal spinal cord (black arrow) was visualised between the dural opening cranial to the stalk.
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A newborn baby boy with normal antenatal scans was noted to have a 4 x 2cm, soft, pedunculated, transilluminable, mobile cystic swelling on the posterior aspect of the neck at the cranio-cervical junction (Fig. 2a). On day three of life, he underwent an MRI scan which revealed a C0/1 LDM with associated tethered cord and an overlying sac measuring 11 x 27 x 21mm which contained meninges, CSF and fat (Fig. 2b and c). The stalk extended deep through a midline defect in the ligamentum flavum and dura (Fig. 2d and e).