Viele Varianten an der Wirbelsäule sind Raritäten, einige bleiben oft klinisch stumm. Andere hingegen haben klinische Bedeutung. Keil- und Blockwirbel können zu Drehverbiegungen der Wirbelsäule ...(kongenitale Skoliosen), aber auch Kyphosen und Lordosen führen. Diese Veränderungen müssen stets orthopädisch betreut werden, da bei einer Progression eine rechtzeitige operative Versorgung angezeigt ist. Hier ist der Manualmediziner unserer Einschätzung nach nur die „helfende Hand“. Gleiches gilt für die verschiedenen Ausformungen der Schlussstörungen des Neuralrohrs, die sich in Form der verschiedenen Arten der Spina bifida manifestieren können. Hier gewinnt zunehmend das Feld der Fetalchirurgie eine große Bedeutung, u. a. bei der Versorgung der Spina bifida aperta. Diese Patienten müssen zeit ihres Lebens interdisziplinär betreut werden, wo sich auch die manuelle Medizin wiederfinden kann. Erworbene „Anomalien“ im Sinne von degenerativen Veränderungen, die zu Form- und Funktionsveränderungen führen, sind hingegen ein dankbares Feld für die manuelle Medizin. Hier sollte zunehmend auch an die Prävention im Sinne des Funktionserhalts gedacht werden. Ebenso sollte der funktionell denkende Mediziner die zugrunde liegenden Ursachen der Veränderungen erkennen und behandeln können. Dazu ist das Verständnis der Grundlagenfächer Anatomie, Neurophysiologie, Embryologie usw., die in den letzten Jahren zunehmend wieder Einzug in die manuelle Medizin gefunden haben, eminent.
High-resolution volume reconstruction from multiple motion-corrupted stacks of 2D slices plays an increasing role for fetal brain Magnetic Resonance Imaging (MRI) studies. Currently existing ...reconstruction methods are time-consuming and often require user interactions to localize and extract the brain from several stacks of 2D slices. We propose a fully automatic framework for fetal brain reconstruction that consists of four stages: 1) fetal brain localization based on a coarse segmentation by a Convolutional Neural Network (CNN), 2) fine segmentation by another CNN trained with a multi-scale loss function, 3) novel, single-parameter outlier-robust super-resolution reconstruction, and 4) fast and automatic high-resolution visualization in standard anatomical space suitable for pathological brains. We validated our framework with images from fetuses with normal brains and with variable degrees of ventriculomegaly associated with open spina bifida, a congenital malformation affecting also the brain. Experiments show that each step of our proposed pipeline outperforms state-of-the-art methods in both segmentation and reconstruction comparisons including expert-reader quality assessments. The reconstruction results of our proposed method compare favorably with those obtained by manual, labor-intensive brain segmentation, which unlocks the potential use of automatic fetal brain reconstruction studies in clinical practice.
Purpose
To investigate the association of spinal anomalies with lumbar spondylolysis and spina bifida occulta (SBO).
Methods
A total of 1190 patients with thoracic, abdominal, and pelvic computed ...tomography scans available were categorized according to the number of presacral (thoracic and lumbar) mobile vertebrae and the presence or absence of lumbosacral transitional vertebrae (LSTV). The prevalence of spondylolysis and SBO and the association of spinal anomalies with these disorders were evaluated.
Results
Normal morphology (17 mobile vertebra with no LSTV) was found in 607 men (86.5%) and 419 women (85.9%) and about 14% of patients had anomalies. Spondylolysis was found in 74 patients (6.2%), comprising 54 men (7.7%) and 20 women (4.1%). SBO involving the lumbar spine was found in 9 men (1.3%) and 2 women (0.4%). Spondylolysis was significantly more common in men with 18 vertebrae without LSTV (21.1%) than in those with 17 vertebrae without LSTV (7.2%) (
p
= 0.002). The prevalence of spinal anomalies was 55.6% in men and 50.0% in women with SBO that included a lumbar level was significantly higher than in both men (13.5%,
p
< 0.001) and women (4.8%,
p
= 0.003) without SBO.
Conclusion
These findings indicate that there is a relationship between spinal anomalies and both spondylolysis and SBO, which may lead to elucidation of the mechanism of onset of spondylolysis and improve its treatment and prognosis. Awareness that patients with SBO involving the lumbar spine have an increased likelihood of a spinal anomaly may help to prevent level errors during spinal surgery.
Given the maternal morbidity of open fetal surgery, the development of prenatal fetoscopic repair for spina bifida aperta (SBA) is encouraged.
We hereby report the early results from our center, ...using a laparotomy-assisted CO2-fetoscopic approach.
This study was conducted in patients with an SBA < T1 and >S1, <26 weeks of gestation, with Chiari II. Fetoscopic repair was performed using 2 operating trocars in the uterus exteriorized through a transverse laparotomy. Endoscopy was performed under humidified and heated CO2 insufflation. Following dissection of the lesion, a 1-layer approach was performed with a muscle/skin flap sutured over a patch of Duragen. Main outcomes were watertight repair at birth and the need for postnatal neurosurgical surgery including shunting within 6 months.
Of 87 women assessed for prenatal therapy, 7 were included. Surgery was performed at 24 (23-26) weeks' gestation. There was no fetal demise. Conversion to hysterotomy was not performed, although surgery could not be performed in 1 case because of fetal position. Severe preeclampsia developed postoperatively in 1 case. In the other 6 cases, follow-up was uneventful except for premature rupture membranes which occurred in 3/6 cases at 30, 34, and 36+5 weeks' gestation. Gestational age at delivery was 32 + 5 (31-36 + 5) weeks' gestation. Repair was watertight at birth except in 2 cases which required complementary postnatal surgical repair. Reverse hindbrain herniation during pregnancy was observed in 4/6 cases. In 3/6 cases, shunting was necessary within 6 months after birth. At 12 months, a functional gain of ≥2 metameric levels was observed in 3 cases of the 6 survivors.
Laparotomy-assisted fetoscopic repair is a reasonable option for women who choose and are eligible for antenatal surgery, both in terms of maternal and perinatal morbidity.
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