Surgical histopathology of limited dorsal myeloschisis with flat skin lesion

Childs Nerv Syst. 2019 Jan;35(1):119-128. doi: 10.1007/s00381-018-3870-2. Epub 2018 Jun 22.


Purpose: Limited dorsal myeloschisis (LDM) is characterized by two invariable features: a focal closed neural tube defect and a fibroneural stalk linking the skin lesion to the underlying spinal cord. Although detailed histopathological findings of the LDM stalk were originally described by Pang et al., the precise relationship between the histopathological findings and clinical manifestations including intraoperative findings has not been fully determined.

Methods: We retrospectively analyzed the histopathological findings of the almost entire stalk and their relevance to the clinical manifestations in six Japanese LDM patients with flat skin lesions.

Results: Glial fibrillary acidic protein (GFAP)-immunopositive neuroglial tissues were observed in three of the six patients. Unlike neuroglial tissues, peripheral nerve fibers were observed in every stalk. In four patients, dermal melanocytosis, "Mongolian spot," was seen surrounding the cigarette-burn lesion. In three of these four patients, numerous melanocytes were distributed linearly along the long axis of the LDM stalk, which might represent migration of melanocytes from trunk neural crest cells during formation of the LDM stalk.

Conclusion: Immunopositivity for GFAP in the LDM stalk was observed in as few as 50% of our patients, despite the relatively extensive histopathological examination. We confirm that the clinical diagnosis of LDM should be made based on comprehensive histopathological examination as well as clinical manifestations. The profuse network of peripheral nerve fibers in every stalk and the high incidence of melanocyte accumulation associated with dermal melanocytosis might assist the histopathological diagnosis of LDM.

Keywords: Glial fibrillary acidic protein; Melanocyte; Peripheral nerves; Untethering.

MeSH terms

  • Child, Preschool
  • Female
  • Glial Fibrillary Acidic Protein / metabolism
  • Humans
  • Infant
  • Male
  • Melanocytes / pathology
  • Nerve Fibers / pathology
  • Neural Crest / pathology
  • Neurosurgical Procedures / methods*
  • Peripheral Nerves / pathology
  • Retrospective Studies
  • Skin Diseases / pathology
  • Skin Diseases / surgery*
  • Spinal Cord / abnormalities*
  • Spinal Cord / pathology*
  • Spinal Cord / surgery*


  • GFAP protein, human
  • Glial Fibrillary Acidic Protein