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Nawashiro T, Kurimoto M, Nagakura M, Kato M, Aoki K, Saito R. Comparison of the inter-laminar approach and laminotomy open approach for filum terminale lipoma: A retrospective analysis. Childs Nerv Syst 2024:10.1007/s00381-024-06507-4. [PMID: 38958731 DOI: 10.1007/s00381-024-06507-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 06/16/2024] [Indexed: 07/04/2024]
Abstract
PURPOSE Filum terminale lipoma (FTL) causes spinal-cord tethering and is associated with tethered-cord syndrome, which is treated by dissection of the entrapment. The conventional treatment for FTL involves dissection of the spinal cord through a laminotomy open approach (LOA). However, in recent years, the interlaminar approach (ILA) has gained popularity as a minimally invasive surgery. This study compares the effectiveness of the minimally invasive ILA with the conventional LOA in treating FTL. METHODS We retrospectively evaluated data on the ILA and LOA for FTL at our center. In total, 103 participants were enrolled, including 55 in the ILA group and 48 in the LOA group. RESULTS The ILA required significantly less surgical time and resulted in less blood loss. The improvement rate of symptoms in symptomatic patients was 84%, and for urinary symptoms and abnormal urodynamic study findings, it was 77%. The postoperative maintenance rate for asymptomatic patients was 100%. Postoperative complications of ILA included delayed wound healing in two patients (3.6%). CONCLUSION Compared with LOA, ILA offers advantages in terms of shorter operative time and less blood loss, with no significant difference in long-term symptom-improvement rates between the groups.
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Affiliation(s)
- Tomoki Nawashiro
- Department of Neurosurgery, Aichi Children's Health and Medical Center, Obu, Aichi, Japan
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Michihiro Kurimoto
- Department of Neurosurgery, Aichi Children's Health and Medical Center, Obu, Aichi, Japan.
| | - Masamune Nagakura
- Department of Neurosurgery, Aichi Children's Health and Medical Center, Obu, Aichi, Japan
| | - Mihoko Kato
- Department of Neurosurgery, Aichi Children's Health and Medical Center, Obu, Aichi, Japan
| | - Kousuke Aoki
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
- Sylvester Comprehensive Cancer Center, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Ryuta Saito
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
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Kitamura T, Murata Y, Shigemura T, Yamamoto Y. Surgical Outcomes in Patients Exhibiting Muscular Weakness Postadolescence Due to Tight Filum Terminale. Cureus 2024; 16:e64080. [PMID: 39114251 PMCID: PMC11305431 DOI: 10.7759/cureus.64080] [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] [Accepted: 07/08/2024] [Indexed: 08/10/2024] Open
Abstract
INTRODUCTION Tight filum terminale is a neurological condition marked by various symptoms, including muscle weakness. There is a notable lack of literature addressing muscle weakness, particularly in cases emerging during adolescence and beyond. The diagnosis is challenging due to a lack of radiological abnormalities, and the literature on its treatment, especially untethering, in adults is limited. This study aims to evaluate the effectiveness of untethering in improving muscle weakness and other symptoms in postadolescent patients diagnosed with tight filum terminale. METHODS A retrospective analysis was conducted on seven postadolescent patients diagnosed with tight filum terminale and presenting muscle weakness who underwent untethering at our institution between January 2018 and August 2022. Patients were monitored for muscle strength improvement, lumbar and lower extremity pain, and bowel and bladder dysfunction (BBD) after untethering. RESULTS Muscle weakness improved in all cases after untethering, with a mean duration of 9.1 weeks for the improvement. Patients unable to walk independently regained mobility in an average of 22.3 weeks. Lumbar and lower limb pain improved in all cases within an average of 8.1 weeks, while BBD improved in six of the seven cases within an average of 1.9 weeks. CONCLUSIONS Our findings suggest that untethering is an effective surgical intervention for postadolescent patients diagnosed with tight filum terminale and presenting muscle weakness.
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Affiliation(s)
- Takaki Kitamura
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, JPN
- Department of Orthopedic Surgery, Asahi General Hospital, Asahi, JPN
| | - Yasuaki Murata
- Department of Orthopedics, Teikyo University Chiba Medical Center, Ichihara, JPN
| | - Tomonori Shigemura
- Department of Orthopedics, Teikyo University Chiba Medical Center, Ichihara, JPN
| | - Yohei Yamamoto
- Department of Orthopedics, Teikyo University Chiba Medical Center, Ichihara, JPN
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3
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Jiao L, Wang S, Yang X, Ma JX, Zheng L, Wang H, Xiang LB, Yu HL, Chen Y. Current Global Research Trends of Tethered Cord Syndrome Surgery: A Scientometric and Visual Analysis. World Neurosurg 2024; 183:206-213. [PMID: 38143026 DOI: 10.1016/j.wneu.2023.12.107] [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] [Received: 12/13/2023] [Accepted: 12/18/2023] [Indexed: 12/26/2023]
Abstract
BACKGROUND Since tethered cord syndrome (TCS) may lead to neurologic and motor dysfunction, surgeries often are applied to relieve the symptoms. The aim of the research was to explore the current global research trends of TCS surgery. METHODS In this article, articles on TCS surgery in the Web of Science Core Collection from 1980 to 2023 were searched. Research trends, countries, institutions, journals, authors, highly cited articles, and key words were analyzed using bibliometric methods. The literature co-citation network was mapped using VOSviewer, and research hotspots and trends were analyzed using CiteSpace. RESULTS A total of 432 publications were included. The number of publications and related research interest in the field of TCS surgery has increased globally year by year. The United States is the largest contributor (154 publications). The journal Childs Nervous System has the greatest number of publications (48 publications) and the most frequently cited journal is Neurosurgery (973 citations). In network visualization, the institution with the greatest contribution is University of California System (16 publications). Lee JY and Wang KC are the authors with the greatest number of publications (8 publications), and the most frequently cited author is Klekamp J (268 citations). Neurogenic bladder and spina bifida may be the next hot spot in this field. CONCLUSIONS This study will help researchers to identify the mainstream research directions and the latest hotspots in the field of TCS surgery and provide a reference for further research.
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Affiliation(s)
- Liang Jiao
- Department of Orthopedics, General Hospital of Northern Theater Command, Shenyang, China
| | - Shuang Wang
- Department of Orthopedics, General Hospital of Northern Theater Command, Shenyang, China
| | - Xiao Yang
- Department of Anesthesiology, The Air Force Hospital of Northern Theater PLA, Shenyang, China
| | - Jun-Xiong Ma
- Department of Orthopedics, General Hospital of Northern Theater Command, Shenyang, China
| | - Liang Zheng
- Department of Orthopedics, General Hospital of Northern Theater Command, Shenyang, China
| | - Hong Wang
- Department of Orthopedics, General Hospital of Northern Theater Command, Shenyang, China
| | - Liang-Bi Xiang
- Department of Orthopedics, General Hospital of Northern Theater Command, Shenyang, China
| | - Hai-Long Yu
- Department of Orthopedics, General Hospital of Northern Theater Command, Shenyang, China
| | - Yu Chen
- Department of Orthopedics, General Hospital of Northern Theater Command, Shenyang, China.
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Hara T, Ohara Y, Kondo A. Diagnosis and Management of Tethered Cord Syndrome. Adv Tech Stand Neurosurg 2024; 49:35-50. [PMID: 38700679 DOI: 10.1007/978-3-031-42398-7_3] [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: 06/01/2024]
Abstract
Tethered cord syndrome is a condition in which the spinal cord is tethered by pathological structures such as a tight filum terminale, intradural lipomas with or without a connecting extradural component, intradural fibrous adhesions, diastematomyelia, and neural placode adhesions following closure of a myelomeningocele.It usually occurs in childhood and adolescence as the spine grows in length, but it can also develop in adulthood. Symptoms of tethered cord syndrome are slowly progressive and varied. Incorrect diagnosis and inappropriate treatment may be provided if the physician lacks knowledge and understanding of this disease.This chapter aims to describe the pathophysiology, syndromes, diagnostic imaging, surgical treatment, and prognosis of tethered cord syndrome to enhance the understanding of this condition.
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Affiliation(s)
- Takeshi Hara
- Department of Neurosurgery, Spine and Spinal Cord Center, Juntendo University School of Medicine, Tokyo, Japan.
| | - Yukoh Ohara
- Department of Neurosurgery, Spine and Spinal Cord Center, Juntendo University School of Medicine, Tokyo, Japan
| | - Akihide Kondo
- Department of Neurosurgery, Spine and Spinal Cord Center, Juntendo University School of Medicine, Tokyo, Japan
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Forlini V, Pellegrino C, Capitanucci ML, Beati F, Iacobelli BD, Conforti A, Sollini ML, Turchi B, Agamennone M, Marras CE, Esposito G, Palma P, Della Bella G, D'urzo R, Castelli E, Bagolan P, Mosiello G. Hypospadias management in children with anorectal malformation: a multidisciplinary single center experience. Pediatr Surg Int 2023; 39:226. [PMID: 37410181 DOI: 10.1007/s00383-023-05505-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/19/2023] [Indexed: 07/07/2023]
Abstract
Anorectal malformation (ARM) is often associated to other congenital malformations, requiring a tailored management. Hypospadias' treatment in ARM is poorly described. Aim of study is to describe our experience in ARM-hypospadias patients especially in relation to occult spinal dysraphism (OSD). ARM patients treated from 1999 to 2022 were retrospectively reviewed, selecting male with hypospadias. Clinical data, hypospadias's severity, ARM sub-type (Group A: perineal fistula; Group B: urethral fistula, bladder fistula, no fistula), OSD, other associated malformations, NLUTD were evaluated. Exclusion criteria: uncomplete data. Among 395 ARMs, 222 were males, 22 (10%) had hypospadias. Two patients were excluded. Group A: 8 patients, Group-B: 12. Hypospadias: proximal 9 patients, distal 11. Neuro-urological evaluation was performed before hypospadias repair. Eleven patients (55%) had OSD. Four OSD patients presented NLUTD and underwent detethering and CIC (two via cystostomy button, two via appendicostomy); two of them had hypospadias repaired. All proximal hypospadias underwent two stages of surgery. Distal hypospadias was corrected in 4/11 cases. Hypospadias is quite common in ARM patients and its surgical management must be scheduled considering the possible OSD and NLUTD, with the possible need for intermittent catheterization. Complexity of ARM and hypospadias appears to be related to each other.
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Affiliation(s)
- Valentina Forlini
- Division of Neuro-Urology, Bambino Gesu' Children's Hospital, IRCCS, Piazza di Sant'Onofrio, 4, 00165, Rome, RM, Italy
- Pediatric Surgery, University of Genoa, DINOGMI, Largo Paolo Daneo, 3, 16132, Genoa, GE, Italy
| | - Chiara Pellegrino
- Division of Neuro-Urology, Bambino Gesu' Children's Hospital, IRCCS, Piazza di Sant'Onofrio, 4, 00165, Rome, RM, Italy.
| | - Maria Luisa Capitanucci
- Division of Neuro-Urology, Bambino Gesu' Children's Hospital, IRCCS, Piazza di Sant'Onofrio, 4, 00165, Rome, RM, Italy
| | - Federico Beati
- Neonatal Surgery Unit, Bambino Gesu' Children's Hospital, IRCCS, Piazza di Sant'Onofrio, 4, 00165, Rome, RM, Italy
| | - Barbara Daniela Iacobelli
- Neonatal Surgery Unit, Bambino Gesu' Children's Hospital, IRCCS, Piazza di Sant'Onofrio, 4, 00165, Rome, RM, Italy
| | - Andrea Conforti
- Neonatal Surgery Unit, Bambino Gesu' Children's Hospital, IRCCS, Piazza di Sant'Onofrio, 4, 00165, Rome, RM, Italy
| | - Maria Laura Sollini
- Division of Physical Rehabilitation, University of Tor Vergata, Via Cracovia, 50, 00133, Rome, RM, Italy
| | - Beatrice Turchi
- Division of Neuro-Urology, Bambino Gesu' Children's Hospital, IRCCS, Piazza di Sant'Onofrio, 4, 00165, Rome, RM, Italy
- Urology Unit, Ospedale Sant'Andrea, 'Sapienza' University of Rome, Via di Grottarossa, 1035/1039, 00189, Rome, RM, Italy
| | - Marco Agamennone
- Division of Neuro-Urology, Bambino Gesu' Children's Hospital, IRCCS, Piazza di Sant'Onofrio, 4, 00165, Rome, RM, Italy
- Pediatric Surgery, University of Genoa, DINOGMI, Largo Paolo Daneo, 3, 16132, Genoa, GE, Italy
| | - Carlo Efisio Marras
- Neurosurgery Unit, Bambino Gesu' Children's Hospital, IRCCS, Piazza di Sant'Onofrio, 4, 00165, Rome, RM, Italy
| | - Giacomo Esposito
- Neurosurgery Unit, Bambino Gesu' Children's Hospital, IRCCS, Piazza di Sant'Onofrio, 4, 00165, Rome, RM, Italy
| | - Paolo Palma
- Neurosurgery Unit, Bambino Gesu' Children's Hospital, IRCCS, Piazza di Sant'Onofrio, 4, 00165, Rome, RM, Italy
| | - Gessica Della Bella
- Neurorehabilitation and Adapted Physical Activity Day Hospital, Bambino Gesù Children's Hospital, IRCCS, 00165, Rome, Italy
| | - Rossella D'urzo
- Neurorehabilitation and Adapted Physical Activity Day Hospital, Bambino Gesù Children's Hospital, IRCCS, 00165, Rome, Italy
| | - Enrico Castelli
- Neurorehabilitation Unit, Bambino Gesù Children's Hospital, IRCCS, 00165, Rome, Italy
| | - Pietro Bagolan
- Neonatal Surgery Unit, Area of Fetal, Neonatal and Cardiological Sciences, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Giovanni Mosiello
- Division of Neuro-Urology, Bambino Gesu' Children's Hospital, IRCCS, Piazza di Sant'Onofrio, 4, 00165, Rome, RM, Italy
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Rafiee F, Mehan WA, Rincon S, Rohatgi S, Rapalino O, Buch K. Diagnostic Utility of 3D Gradient-Echo MR Imaging Sequences through the Filum Compared with Spin-Echo T1 in Children with Concern for Tethered Cord. AJNR Am J Neuroradiol 2023; 44:323-327. [PMID: 36797030 PMCID: PMC10187807 DOI: 10.3174/ajnr.a7791] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 01/09/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND AND PURPOSE Fatty intrathecal lesions are a cause of tethered cord, and detection of these on spinal MR imaging is paramount. Conventional T1 FSE sequences are the mainstay of detecting fatty elements; however, 3D gradient-echo MR images, volumetric interpolated breath-hold examination/liver acquisition with volume acceleration (VIBE/LAVA), are popular, given the increased motion resistance. We sought to evaluate the diagnostic accuracy of VIBE/LAVA compared with T1 FSE for detection of fatty intrathecal lesions. MATERIALS AND METHODS In this retrospective, institutional review board-approved study, 479 consecutive pediatric spine MRIs obtained to evaluate cord tethering between January 2016 and April 2022 were reviewed. Inclusion criteria were patients who were 20 years of age or younger who underwent spine MRIs containing both axial T1 FSE and VIBE/LAVA sequences of the lumbar spine. The presence or absence of fatty intrathecal lesions was recorded for each sequence. If fatty intrathecal lesions were present, anterior-posterior and transverse dimensions were recorded. VIBE/LAVA and T1 FSE sequences were evaluated on 2 separate occasions (VIBE/LAVAs first followed by T1 FSE several weeks later) to minimize bias. Basic descriptive statistics compared fatty intrathecal lesion sizes on T1 FSEs and VIBE/LAVAs. Receiver operating characteristic curves were used to determine minimal fatty intrathecal lesion size detectable by VIBE/LAVA. RESULTS Sixty-six patients were included, with 22 having fatty intrathecal lesions (mean age, 7.2 years). T1 FSE sequences revealed fatty intrathecal lesions in 21/22 cases (95%); however, fatty intrathecal lesions on VIBE/LAVA were detected in 12/22 patients (55%). Mean anterior-posterior and transverse dimensions of fatty intrathecal lesions measured larger on T1 FSE compared with VIBE/LAVA sequences (5.4 × 5.0 mm versus 1.5 × 1.6 mm, respectively; P values = .039 anterior-posterior; .027 transverse). CONCLUSIONS While T1 3D gradient-echo MR images may have decreased the acquisition time and are more motion-resistant than conventional T1 FSE sequences, they are less sensitive and may miss small fatty intrathecal lesions.
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Affiliation(s)
- F Rafiee
- From the Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - W A Mehan
- From the Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - S Rincon
- From the Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - S Rohatgi
- From the Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - O Rapalino
- From the Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - K Buch
- From the Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Elsabaa A, Mahmoud MA, Nosseir M, Mahmoud MWS, Aziz MM. Does early tethered cord release in occult spinal dysraphism improve urological outcomes? A systematic review. EGYPTIAN JOURNAL OF NEUROSURGERY 2022. [DOI: 10.1186/s41984-022-00177-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Abstract
Introduction
Occult spinal dysraphism involves a wide range of congenital anomalies, e.g., lipoma, Lipomeningomyelocele, congenital dermal sinus, etc. Occult spinal dysraphism also may present with a wide spectrum of clinical manifestations and radiological findings, i.e., it ranges from asymptomatic patients that are accidentally discovered to low lying conus with neurological, skeletal and urological manifestations. Even though neurosurgeons are well-aware of neurological presentations that indicate surgical intervention in children with occult spinal dysraphism, urological symptoms may present some controversy in management. This review aims to discuss urological outcomes of detethering as regarding time of intervention, improvement of the urological symptoms after detethering, and the role of urodynamics preoperatively and during follow-up.
Methodology
An online search of the literature was done including studies in English language from 1990 to January 2022. Included studies were analytical with well conducted descriptive nature of acceptable quality (at least level 3 evidence). Patient characteristics included both male and female children and adolescents, up to 19 years old who presented with clinical and/or radiological evidence of tethering of the spinal cord. Most studies that were included had availability of urodynamics. A total of 15 studies were included involving 633 patients. Meningomyelocele (MMC) and other spina bifida operta cases are excluded.
Results
Results of all studies were collected and mean age of studies was gathered and plotted on a chart in relation to urological outcome and urodynamic improvement. Most results favored early detethering; however, many factors were found to affect the inverse proportion curve of age with clinical improvement or urodynamics. For example, studies that included secondary tethered cord showed poorer results than results that included primary tethered cord only, preoperative severity of urological symptoms (more severe symptoms were associated with irreversible poor outcomes), and preoperative urodynamic parameters.
Conclusion
The management of tethered cord syndrome and occult spinal dysraphism remains controversial. There is lack of class 1 evidence regarding tethered cord release surgery in occult spinal dysraphism. Heterogenicity of pathology, symptomatology and radiology make the randomization of such sample size difficult. The outcomes of surgical detethering are therefore multifactorial. A large sample of prospective randomized controlled studies addressing each factor, e.g., age, severity of symptoms, preoperative urodynamic parameters, is recommended in order to evaluate the impact of each factor on outcome.
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