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Chen S, Tu P, Mu L. Prenatal ultrasound diagnosis and prognosis of fetus with isolated filar cyst: a retrospective analysis. Front Med (Lausanne) 2024; 11:1304803. [PMID: 38318249 PMCID: PMC10839057 DOI: 10.3389/fmed.2024.1304803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 01/08/2024] [Indexed: 02/07/2024] Open
Abstract
Objective This study aimed to investigate the prenatal ultrasonographic diagnosis and prognosis of fetuses with isolated filar cysts (FCs). Methods The ultrasonographic features, reasons for missed diagnosis, and prognosis of eight isolated FCs diagnosed using ultrasound were analyzed retrospectively through follow-up. Results Eight isolated FCs showed round or fusiform cystic anechoic areas at the end of the conus medullaris. Among them, six cases were prenatally diagnosed and the other two cases were diagnosed after birth. Of the six cases diagnosed prenatally, four (66.7%) disappeared during pregnancy, and the shortest time to disappearance was 1 month after the first diagnosis. All patients were followed up without any clinical symptoms or functional abnormalities. Conclusion Isolated FCs may exhibit physiological variations that disappear spontaneously during pregnancy and usually have no clinical symptoms. They are usually benign and have a good prognosis. Ultrasonography is helpful for the diagnosis and follow-up of FCs.
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Affiliation(s)
| | | | - Lan Mu
- Department of Ultrasound, Chongqing Health Center for Women and Children, Women and Children’s Hospital of Chongqing Medical University, Chongqing, China
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2
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Atallah O, Badary A, El-Ghandour NMF, Almealawy YF, Wireko AA, Syrmos N, Umana GE, Al-Barbarawi M, Ergen A, Shrestha P, Chaurasia B. Cystic dilatation of the ventriculus terminalis: A narrative review. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2023; 14:319-329. [PMID: 38268679 PMCID: PMC10805159 DOI: 10.4103/jcvjs.jcvjs_98_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 10/01/2023] [Indexed: 01/26/2024] Open
Abstract
Introduction The terminal ventricle, also known as the fifth ventricle, is a tiny relic cavity in the conus medullaris of the human spinal cord. Our purpose in bringing attention to this condition is to get the word out about the signs and symptoms, diagnostic hurdles, and therapeutic options available for it. Methods All relevant studies involving patients diagnosed with ventriculus terminalis (VT) were retrieved from PubMed, Google Scholar, and Scopus. Studies published in complete English language reports were included. The terms VT, terminal ventricle, and 5th ventricle. Age, gender, presenting symptoms, magnetic resonance imaging findings, treatment, and outcome of patients with ventriculus terminalis were all included and recorded. Results The average age of the patients was 39 years, and there were 13 men among them (14.4%). Motor deficits and sciatica were the most commonly reported symptoms in 38 and 34 patients (42.2%, 37.7%), respectively. In 48 patients (53.3%), cyst fenestration was performed, and in 25 patients (27.7%), myelotomy was performed. Fifty-eight patients (64.4%) saw a reduction in cyst size after surgery. The majority of patients reported an improvement in their symptoms in 64 cases (51.1%), with only three cases (3.3%) reporting a worsening. Conclusions In cases where the VT is the source of symptoms such as motor, sensory, or bladder dysfunction, surgical intervention is recommended. This review compiles information from the available literature to shed light on the anatomy, clinical presentation, imaging, and treatment options for this variant. It also aims to pinpoint any potential drawbacks or restrictions connected to the surgical techniques.
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Affiliation(s)
- Oday Atallah
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
| | - Amr Badary
- Department of Neurosurgery, Klinikum Dessau, Dessau-Roßlau, Germany
| | | | - Yasser F. Almealawy
- Department of Neurosurgery, Faculty of Medicine, University of Kufa, Kufa, Iraq
| | - Andrew Awuah Wireko
- Department of Neurosurgery, Faculty of Medicine, Sumy State University, Sumy, Ukraine
| | - Nikolaos Syrmos
- Department of Neurosurgery, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Giuseppe Emmanuele Umana
- Department of Neurosurgery, Trauma Centre, Gamma Knief Centre, Cannizzaro Hospital, Catania, Italy
| | | | - Anil Ergen
- Department of Neurosurgery, Derince Research Hospital, Derince, Kocaeli, Turkey
| | - Prabin Shrestha
- Department of Neurosurgery, Kathmandu Neuro and General Hospital, Kathmandu, Nepal
| | - Bipin Chaurasia
- Department of Neurosurgery, Neurosurgery Clinic, Birgunj, Nepal
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3
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Arjipour M, Ownagh F, Eftekharian M. Fatty syringomyelia mimicking lipoma with spinal cord pilocytic astrocytoma. Neuroradiol J 2023; 36:357-360. [PMID: 36384332 PMCID: PMC10268085 DOI: 10.1177/19714009221140535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2024] Open
Abstract
The reporting case is a 27 year-old woman. She was admitted with complaints of clumsy gait and dysesthesia over her upper limbs and spasticity in the legs. The investigations revealed a long segment cervical intramedullary tumor, associated with whole cord syringomyelia. The superior part of syringomyelia image intensity matched intramedullary lipoma completely. C1-C5 intramedullary tumor was resected grossly under microscopic view, and a fat-containing liquid exited the syringomyelia cavity at its superior pole. After a transient paresis just following the surgery, neurological condition was improved. The follow-up imaging showed that the fatty syringomyelia reduced in dimensions. Conclusion. According to this case and another similar case due to instability, it appears that as a rare phenomenon, syringomyelia liquid content sometimes could have fatty droplets which could mimic intramedullary lipoma with an unknown mechanism. It seems these fat droplets in syringomyelia would not change its natural history.
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Affiliation(s)
- Mahdi Arjipour
- Department of Neurosurgery, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Farid Ownagh
- Department of Neurosurgery, Hamadan University of Medical Sciences, Hamadan, Iran
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4
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de Beaufort CMC, Groenveld JC, Mackay TM, Slot KM, de Beer SA, de Jong JR, van Schuppen J, McDonald CJ, Bakker DP, van den Berg E, Kuijper CF, Gorter RR. Spinal cord anomalies in children with anorectal malformations: a retrospective cohort study. Pediatr Surg Int 2023; 39:153. [PMID: 36934393 PMCID: PMC10025224 DOI: 10.1007/s00383-023-05440-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/10/2023] [Indexed: 03/20/2023]
Abstract
PURPOSE First, to assess the number of spinal cord anomalies (SCA), specifically tethered spinal cord (TSC) in patients with anorectal malformations (ARM), identified with spinal cord imaging (i.e. spinal cord US and/or MRI). Second, to report outcomes after TSC treatment. METHODS A retrospective mono-center study was performed. All ARM patients born between January 2000 and December 2021 were included. Screening for SCA consisted of spinal cord US and/or MRI. Radiology reports were scored on presence of SCA. Data were presented with descriptive statistics. RESULTS In total, 254 patients were eligible for inclusion, of whom 234 (92.1%) underwent spinal cord imaging. In total, 52 (22.2%) patients had a SCA, diagnosed with US (n = 20, 38.5%), MRI (n = 10, 19.2%), or both US and MRI (n = 22, 42.3%), of whom 12 (23.5%) with simple, 27 (52.7%) intermediate, and 12 (23.5%) complex ARM types. TSC was identified in 19 patients (8.1%), of whom 4 (21.1%) underwent uncomplicated neurosurgical intervention. CONCLUSIONS SCA were present in 22% of ARM patients both in simple, as well as more complex ARM types. TSC was present in 19 patients with SCA, of whom 4 underwent uncomplicated neurosurgical intervention. Therefore, screening for SCA seems to be important for all ARM patients, regardless of ARM type. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Cunera M C de Beaufort
- Department of Pediatric Surgery, Emma Children's Hospital Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.
- Amsterdam UMC, Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.
- Amsterdam UMC, University of Amsterdam, Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands.
- Department of Pediatric Surgery, Emma Children's Hospital Amsterdam UMC, Location University of Amsterdam, Amsterdam Gastroenterology and Metabolism Research Institute and Amsterdam Reproduction and Development Research Institute, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Julia C Groenveld
- Department of Pediatric Surgery, Emma Children's Hospital Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Tara M Mackay
- Amsterdam UMC, Department of Surgery, Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - K Mariam Slot
- Amsterdam UMC, Department of Neurosurgery, Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - Sjoerd A de Beer
- Department of Pediatric Surgery, Emma Children's Hospital Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Justin R de Jong
- Department of Pediatric Surgery, Emma Children's Hospital Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam UMC, Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam UMC, University of Amsterdam, Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - Joost van Schuppen
- Amsterdam UMC, Department of Radiology and Nuclear Medicine, Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - Carola J McDonald
- Amsterdam UMC, Department of Pediatric Neurology, Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - Dewi P Bakker
- Amsterdam UMC, Department of Pediatric Neurology, Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - Elske van den Berg
- Amsterdam UMC, Department of Pediatric Neurology, Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - Caroline F Kuijper
- Department of Pediatric Urology, Emma Children's Hospital Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - Ramon R Gorter
- Department of Pediatric Surgery, Emma Children's Hospital Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam UMC, Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam UMC, University of Amsterdam, Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
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Dasic D, Signorelli F, Ligarotti GKI, D'Onofrio GF, Rapisarda A, Syrmos N, Chibbaro S, Visocchi M, Ganau M. Cystic Dilatation of the Ventriculus Terminalis: Examining the Relevance of the Revised Operative Classification Through a Systematic Review of the Literature, 2011-2021. ACTA NEUROCHIRURGICA. SUPPLEMENT 2023; 135:399-404. [PMID: 38153500 DOI: 10.1007/978-3-031-36084-8_61] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
The literature features limited evidence on the natural history of the cystic dilatation of the ventriculus terminalis (CDVT) and its response to treatment. The goal of this study is to ascertain which impact the revised operative classification of CDVT had on the management of patients diagnosed over the past 10 years.Ten new clinical articles presenting a total of 30 cases of CDVT were identified and included for qualitative analysis. Two take-home messages can be identified: (1) Adequate consideration should be given to designing national pathways for referral to tertiary centers with relevant expertise in the management of lesions of the conus medullaris, and (2) we suggest that type Ia should be, at least initially, treated conservatively, whereas we reckon that the signs and symptoms described in types Ib, II, and III seem to benefit, although in some patients only partially, from surgical decompression in the form of cystic fenestration, cyst-subarachnoid shunting, or both.While the level of evidence gathered in this systematic review remains low because the literature on CDVT consists only of retrospective studies based on single-center series (level of evidence 4 according to the Oxford Centre for Evidence-Based Medicine (OCEBM)), the strength of recommendation for adopting the revised operative classification of CDVT is moderate.
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Affiliation(s)
- Davor Dasic
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Francesco Signorelli
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Ginevra Federica D'Onofrio
- Institute of Neurosurgery, IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Alessandro Rapisarda
- Institute of Neurosurgery, IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Nikolaos Syrmos
- School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Salvatore Chibbaro
- Division of Neurosurgery, University of Strasbourg, Strasbourg, France
- Department of Neurosurgery, Oxford University Hospitals, NHS Foundation Trust, Oxford, UK
| | | | - Mario Ganau
- Division of Neurosurgery, University of Strasbourg, Strasbourg, France
- Department of Neurosurgery, Oxford University Hospitals, NHS Foundation Trust, Oxford, UK
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6
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D'Onofrio GF, Rapisarda A, Signorelli F, Ganau M, Chibbaro S, Montano N, Polli FM, Visocchi M. Toward the End of the Funnel: The Ventriculus Terminalis-The State of Art of an Ancient Entity with a Recent History. ACTA NEUROCHIRURGICA. SUPPLEMENT 2023; 135:395-397. [PMID: 38153499 DOI: 10.1007/978-3-031-36084-8_60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
PURPOSE The ventriculus terminalis (VT), also called the fifth ventricle, is a small cavity containing cerebrospinal fluid (CSF) that is in the conus medullaris in continuity with the central canal of the spinal cord. In adults, persistent VT is a very rare entity, and the diagnosis is incidental in most cases. Rarely, VT may become symptomatic for still-uncertain reasons but most often for its cystic dilatation. The management of these selected cases is still controversial and sometimes associated with unsatisfactory outcomes. METHODS We performed a critical review of the existing literature on the management of symptomatic VT in adults. The etiology, pathophysiology, and treatment of VT are presented and discussed, focusing on the best timing for surgery. RESULTS Conservative management, marsupialization, or the placement of a T drain have been reported. The existing classifications describe the most correct approach for each clinical presentation, but scarce importance has been given to the delay from symptoms' onset to surgical treatment. CONCLUSION Although different cases have been described in the literature, this rare pathology remains unknown to most neurosurgeons.
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Affiliation(s)
| | - Alessandro Rapisarda
- Fondazione Policlinico Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy.
| | - Francesco Signorelli
- Fondazione Policlinico Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Mario Ganau
- Department of Neurosurgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - Nicola Montano
- Fondazione Policlinico Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Filippo Maria Polli
- Fondazione Policlinico Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Massimiliano Visocchi
- Fondazione Policlinico Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy
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7
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Kim KH, Lee JY, Wang KC. Secondary Neurulation Defects: Retained Medullary Cord. Adv Tech Stand Neurosurg 2023; 47:215-223. [PMID: 37640876 DOI: 10.1007/978-3-031-34981-2_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
Retained medullary cord (RMC) is a defect resulting from impaired secondary neurulation. Intraoperatively, RMC is recognizable as an elongated cord-like structure caudal to the conus, that contains histologically confirmed neuroglial components and a lumen with an ependymal lining. It characteristically does not possess neurological function. This chapter aims to summarize (1) the mechanisms that lead to the occurrence of RMC; (2) the various forms of RMC, such as cystic RMC and 'possible RMC', and (3) the treatment strategies, especially untethering through limited exposure.
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Affiliation(s)
- Kyung Hyun Kim
- Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul, Republic of Korea
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ji Yeoun Lee
- Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul, Republic of Korea
- Department of Anatomy and Cell Biology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kyu-Chang Wang
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Republic of Korea.
- Neuro-oncology Clinic, National Cancer Center, Goyang, Republic of Korea.
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8
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Núñez Báez SG, De Jesus O, Labat EJ, Feliciano CE. Ventriculus terminalis or conus medullaris arachnoid cyst: a diagnostic dilemma. BMJ Case Rep 2022; 15:e250812. [PMID: 35623655 PMCID: PMC9150153 DOI: 10.1136/bcr-2022-250812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2022] [Indexed: 11/03/2022] Open
Affiliation(s)
- Sergio G Núñez Báez
- Neurosurgery, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Orlando De Jesus
- Neurosurgery, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Eduardo J Labat
- Department of Radiological Sciences and Diagnostic Radiology, Neuroradiology, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Caleb E Feliciano
- Neurosurgery, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
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