Lesões menores de pele como marcadores de disrafismos espinhais ocultos em recém-nascidos

Abstract

Neonates with occult spinal dysraphisms (OSD) may not present any clinical manifestations, but may be associated to cutaneous stigmas that indicate dysraphism. Association of minor cutaneous stigmas (discreet skin lesions, most of which are not assessed) with OSD was investigated in this study, as well as the use of ultra-sonography (US) as a screening method for those patients. Two thousand and ten neonates were evaluated trough active search. The pediatrician and the neurosurgeon performed, both, the search for the presence of cutaneous stigmas on the midline of the dorso. For all of them were recorded the gestational age, type of delivery, gender, ethnicity, age of mother, whether it was a high-risk gestation. Patients with skin lesions comprised the case group. For each case, another neonate of the same gender, gestational age and ethnicity was select as a control. Both groups were evaluated with respect to personal, social and medical information. Spinal US was performed in all case and control patients if altered or inconclusive, it was completed with magnetic resonance (MRI). Ofthe 2,010 patients, 144 presented cutaneous stigmas. Out of these, eighthad alterations to US (5.5%) and six of them to MRI. There were notalterations to US in the control group. The most frequent lesions were tufts of hair and dimples; through US, the most frequent finding were dermal sinuses. The so-called minor skin lesions were not markers of OSD in the evaluated population. However, in four patients of the study, US was decisive for the surgical decision. From the statistic point of view, there is no indication for complementary exams in patients with minor cutaneous stigmas. However, due to the feasibility, simplicity and low cost of the spinal US, the exam is justified in the benefits of early diagnosis, regardless of the need of immediate surgical treatment.