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Commentary to the paper double neural tube defect: a case report and discussions on neural tube development by V. Ravindran

Authors
Journal
Child s Nervous System
0256-7040
Publisher
Springer-Verlag
Publication Date
Volume
26
Issue
5
Identifiers
DOI: 10.1007/s00381-010-1095-0
Keywords
  • Commentary

Abstract

COMMENTARY Commentary to the paper double neural tube defect: a case report and discussions on neural tube development by V. Ravindran Dachling Pang Received: 25 January 2010 /Accepted: 26 January 2010 /Published online: 12 March 2010 # The Author(s). 2010 This article is published with open access at Springerlink.com This is a case report of a child with double neural tube defect (NTD) comprising a parietal encephalocoele and an open thoracic myelomeningocoele. The authors use this case to endorse the multi-site neural tube closure theory as aetiology for all multiple NTDs. Proponents of this theory claim that neural tube defects occur at “collision sites” of neural tube closure with opposing closure directions, and because up to five or six of these waves are thought to be operational, there are, accordingly, multiple collision sites. The multi-site closure theory was used originally to explain the different favoured locations of encephalcoeles, and as such, the theory is seductive. At collision sites, the overlying myocutaneous tissues may be potentially weaker and, therefore, susceptible to being stretched but not disrupted by a focal herniation of the alar plates of the already closed cranial neural tube and surrounding meninges. The disorganised gyral development and cortical dysplasia of the herniated brain may be secondary to early tissue distortion. The overlying skin and meninges are intact. Spinal open neural tube defects (ONTD) are due to focal absence of neural plate closure, as shown in numerous, very credible animal experiments. The skin, muscles, neural arches and dura are wide open, and the exposed neural material is an unfused neural plate. This true “closure lesion” is thus fundamentally different from a “collision lesion” exemplified by the encephalocoele. Most spinal ONTDs are terminal lesions involving the end of the primary neural tube, but there are rare examples of segmental lesions in which the “suspended” open neural placode is flanked by normal spinal

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