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Murakami N, Morioka T, Kurogi A, Suzuki SO, Shimogawa T, Mukae N, Yoshimoto K. Glial fibrillary acidic protein immunopositive neuroglial tissues with or without ependyma-lined canal in spinal lipoma of filar type: Relationship with retained medullary cord. Surg Neurol Int 2024; 15:326. [PMID: 39372996 PMCID: PMC11450895 DOI: 10.25259/sni_458_2024] [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: 06/11/2024] [Accepted: 08/08/2024] [Indexed: 10/08/2024] Open
Abstract
Background Retained medullary cord (RMC) and filar lipomas are believed to originate from secondary neurulation failure; filar lipomas are reported to histopathologically contain a central canal-like ependyma-lined lumen with surrounding neuroglial tissue with ependyma-lined central canal (NGT w/E-LC) as a remnant of the medullary cord, which is a characteristic histopathology of RMC. With the addition of glial fibrillary acidic protein (GFAP) immunostaining, we reported the presence of GFAP-positive NGT without E-LCs (NGT w/o E-LCs) in RMC and filar lipomas, and we believe that both have the same embryopathological significance. Methods We examined the frequency of GFAP-positive NGT, with or without E-LC, in 91 patients with filar lipoma. Results Eight patients (8.8%) had NGT w/E-LC, 25 patients (27.5%) had NGT w/o E-LC, and 18 patients (19.8%) had tiny NGT w/o E-LC that could only be identified by GFAP immunostaining. Combining these subgroups, 56% of the patients (n = 51) with filar lipoma had GFAP immunopositive NGT. Conclusion The fact that more than half of filar lipomas have NGT provides further evidence that filar lipoma and RMC can be considered consequences of a continuum of regression failure that occurs during late secondary neurulation.
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Affiliation(s)
- Nobuya Murakami
- Department of Neurosurgery, Fukuoka Children’s Hospital, Fukuoka, Japan
| | - Takato Morioka
- Department of Neurosurgery, Hachisuga Hospital, Fukuoka, Japan
| | - Ai Kurogi
- Department of Neurosurgery, Fukuoka Children’s Hospital, Fukuoka, Japan
| | | | | | - Nobutaka Mukae
- Department of Neurosurgery, Kyushu University, Fukuoka, Japan
| | - Koji Yoshimoto
- Department of Neurosurgery, Kyushu University, Fukuoka, Japan
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Kurogi A, Murakami N, Suzuki SO, Shimogawa T, Mukae N, Yoshimoto K, Morioka T. Retained medullary cord and caudal lipoma with histopathological presence of terminal myelocystocele in the epidural stalk. Surg Neurol Int 2023; 14:279. [PMID: 37680925 PMCID: PMC10481812 DOI: 10.25259/sni_479_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 07/14/2023] [Indexed: 09/09/2023] Open
Abstract
Background The retained medullary cord (RMC), caudal lipoma, and terminal myelocystocele (TMCC) are thought to originate from the failed regression spectrum during the secondary neurulation, and the central histopathological feature is the predominant presence of a central canal-like ependyma-lined lumen (CC-LELL) with surrounding neuroglial tissues (NGT), as a remnant of the medullary cord. However, reports on cases in which RMC, caudal lipoma, and TMCC coexist are very rare. Case Description We present two patients with cystic RMC with caudal lipoma and caudal lipoma with an RMC component, respectively, based on their clinical, neuroradiological, intraoperative, and histopathological findings. Although no typical morphological features of TMCC were noted on neuroimaging, histopathological examination revealed that a CC-LELL with NGT was present in the extraspinal stalk, extending from the skin lesion to the intraspinal tethering tract. Conclusion This histopathological finding indicates the presence of TMCC that could not be completely regressed and further supports the idea that these pathologies can be considered consequences of a continuum of regression failure during secondary neurulation.
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Affiliation(s)
- Ai Kurogi
- Department of Neurosurgery, Fukuoka Children’s Hospital, Fukuoka, Japan
| | - Nobuya Murakami
- Department of Neurosurgery, Fukuoka Children’s Hospital, Fukuoka, Japan
| | | | | | - Nobutaka Mukae
- Department of Neurosurgery, Iizuka Hospital, Iizuka, Japan
| | - Koji Yoshimoto
- Department of Neurosurgery, Kyushu University, Fukuoka, Japan
| | - Takato Morioka
- Department of Neurosurgery, Hachisuga Hospital, Munakata, Japan
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Kawamoto Y, Harada A, Ikura Y, Fujinaga T, Utsunomiya H. Limited dorsal myeloschisis without extradural stalk continuity to coexisting congenital dermal sinus. Childs Nerv Syst 2023; 39:511-515. [PMID: 35939129 DOI: 10.1007/s00381-022-05631-3] [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: 02/24/2022] [Accepted: 07/19/2022] [Indexed: 11/03/2022]
Abstract
Limited dorsal myeloschisis (LDM) is characterized by a fibroneural tethering stalk linking the skin lesion to the underlying spinal cord. LDM without an extradural stalk is rare. A full-term boy was noted at birth to have a dimple in the upper back (dorsal skin of the lower thoracic region). Computed tomographic scan showed spina bifida at the T9-12 vertebral level and osteochondral tissue at the T10 level. Magnetic resonance imaging (MRI) demonstrated a tiny dorsal lipoma at the T8 vertebral level, but the intradural tethering tract was not apparent. At 18 days of age, the congenital dermal sinus (CDS) tract started from the dimple and terminated at the osteochondral tissue, without continuity of the dura mater, and the osteochondral tissues were resected. At age 2 years 8 months, he developed spastic paresis of the right foot. On MRI, the tethering tract from the dorsal lipoma became apparent. During the second surgery at age 2 years 11 months, the intradural stalk started from the dorsal lipoma and joined the inner surface of the dura mater was untethering from the cord. Postoperatively, right spastic paresis was improved. Histological examination of the intradural stalk revealed the distribution of S100-immunopositive peripheral nerve fibers, which is one of the histopathological hallmarks of LDM. We speculated that the extradural stalk with coexisting CDS originally linked from the skin lesion subsequently regressed and was replaced by fibroadipose tissue with osteochondral tissue migration. Intradural exploration should always be seriously considered in these disorders of persisting neurocutaneous connection.
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Affiliation(s)
- Yuki Kawamoto
- Department of Pediatric Neurosurgery, Takatsuki General Hospital, Takatsuki, Japan
| | - Atsuko Harada
- Department of Pediatric Neurosurgery, Takatsuki General Hospital, Takatsuki, Japan.
| | - Yoshihiro Ikura
- Department of Pathology, Takatsuki General Hospital, Takatsuki, Japan
| | - Takahiro Fujinaga
- Department of Pediatric Neurosurgery, Takatsuki General Hospital, Takatsuki, Japan
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Murakami N, Kurogi A, Suzuki SO, Shimogawa T, Mukae N, Yoshimoto K, Morioka T. Histopathological presence of dermal elements in resected margins of neural structures obtained from initial repair surgery for myelomeningocele. Surg Neurol Int 2023; 14:7. [PMID: 36751452 PMCID: PMC9899468 DOI: 10.25259/sni_989_2022] [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: 10/27/2022] [Accepted: 12/23/2022] [Indexed: 01/09/2023] Open
Abstract
Background Development of dermoid or epidermoid cysts in myelomeningocele (MMC) sites is generally thought to occur in a delayed fashion due to implantation of dermal elements during initial repair surgery. Another theory is that dermal and dermoid elements may already be present within dysplastic neural structures at birth. Methods We experienced histopathological presence of dermal elements in resected tissues at initial repair surgery in four out of 18 cases with MMC who required resection of parts or margins of the neural structures to perform cord untethering. Since one of these cases has already been reported, we describe the clinicopathological findings for the remaining three cases. Results In Case1, cryptic dermoid elements were discovered in the terminal filum-like structure (FT-LS) caudal to the open neural placode (NP). The FT-LS had histopathological characteristics similar to the retained medullary cord. In Case 2, dermoid elements were discovered in the caudal margin of the dysplastic conus medullaris. In Case 3, a thin squamous epithelial layer overlapped the rostral margin of the NP where the NP was located near the skin. Case 1 developed an epidermoid cyst at 1 year and 2 months of age, which was totally resected. Conclusion Prenatally existing cryptic dermoid elements in the caudal portion of neural structures and remnants of dermal elements overlapping the rostral margin of the NP are associated with delayed occurrence of dermoid/ epidermoid cysts. Postoperative histopathological investigation of the resected specimens is recommended. Once dermal elements are revealed, repeated imaging examination and additional surgery should be considered.
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Affiliation(s)
- Nobuya Murakami
- Department of Neurosurgery, Fukuoka Children’s Hospital, Fukuoka, Japan,Corresponding author: Nobuya Murakami, Department of Neurosurgery, Fukuoka Children’s Hospital, Fukuoka, Japan.
| | - Ai Kurogi
- Department of Neurosurgery, Fukuoka Children’s Hospital, Fukuoka, Japan
| | | | - Takafumi Shimogawa
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Iizuka, Japan
| | - Nobutaka Mukae
- Department of Neurosurgery, Iizuka Hospital, Iizuka, Japan
| | - Koji Yoshimoto
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Iizuka, Japan
| | - Takato Morioka
- Department of Neurosurgery, Hachisuga Hospital, Fukuoka, Japan
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Oketani H, Harimaya K, Ono T, Terado K, Inoha S, Suzuki SO, Morioka T. A Presenile Patient with Filar Lipoma Who Developed Tethered Spinal Cord Syndrome Triggered by Lumbar Canal Stenosis. NMC Case Rep J 2023; 10:109-113. [PMID: 37197285 PMCID: PMC10185357 DOI: 10.2176/jns-nmc.2022-0347] [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: 11/01/2022] [Accepted: 02/09/2023] [Indexed: 05/19/2023] Open
Abstract
Lumbar canal stenosis (LCS) has been reported as a precipitating factor by which a tethered spinal cord, which is asymptomatic during childhood, develops into tethered cord syndrome (TCS) in adulthood. However, only a few reports on surgical strategies for such cases are available. A 64-year-old woman presented with unbearable pain in the left buttock and dorsal aspect of the thigh approximately 1 year ago. Magnetic resonance imaging showed cord tethering with a filar-type spinal lipoma and LCS due to the thickening of the ligamentum flavum at the L4-5 vertebral level. Five months after the decompressive laminectomy for the treatment of LCS, an untethering surgery was performed at the dural cul-de-sac at the S4 level. The severed end of the filum was elevated rostrally by 7 mm, and the pain subsided postoperatively. This case study shows that surgeries for both lesions should be indicated for adult-onset TCS triggered by LCS.
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Affiliation(s)
- Hiroshi Oketani
- Department of Neurosurgery, Hachisuga Hospital, Munakata, Fukuoka, Japan
| | - Katsumi Harimaya
- Department of Orthopedic Surgery, Kyushu University Beppu Hospital, Beppu, Oita, Japan
| | - Teruaki Ono
- Department of Orthopedic Surgery, Kyushu University Beppu Hospital, Beppu, Oita, Japan
| | - Kazushige Terado
- Department of Orthopedic Surgery, Hachisuga Hospital, Munakata, Fukuoka, Japan
| | - Satoshi Inoha
- Department of Neurosurgery, Hachisuga Hospital, Munakata, Fukuoka, Japan
| | - Satoshi O Suzuki
- Department of Psychiatry, Shourai Hospital, Karatsu, Saga, Japan
| | - Takato Morioka
- Department of Neurosurgery, Hachisuga Hospital, Munakata, Fukuoka, Japan
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Embryopathological relationship between retained medullary cord and caudal spinal lipoma. INTERDISCIPLINARY NEUROSURGERY 2022. [DOI: 10.1016/j.inat.2022.101534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Kurogi A, Murakami N, Mukae N, Shimogawa T, Goto K, Shono T, Suzuki SO, Yoshimoto K, Morioka T. Congenital dermal sinus and filar lipoma located in close proximity at the dural cul-de-sac mimicking limited dorsal myeloschisis. INTERDISCIPLINARY NEUROSURGERY 2022. [DOI: 10.1016/j.inat.2021.101455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Matsubara Y, Murakami N, Kurogi A, Lee S, Mukae N, Shimogawa T, Shono T, Suzuki SO, Yoshimoto K, Morioka T. Intramedullary abscess at thoracolumbar region transmitted from infected dermal sinus and dermoid through retained medullary cord. Surg Neurol Int 2022; 13:54. [PMID: 35242420 PMCID: PMC8888283 DOI: 10.25259/sni_1197_2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 01/28/2022] [Indexed: 11/23/2022] Open
Abstract
Background: A retained medullary cord (RMC) is a relatively newly defined entity of closed spinal dysraphism that is thought to originate from regression failure of the medullary cord during secondary neurulation. A congenital dermal sinus (CDS) may provide a pathway for intraspinal infections such as repeated meningitis. Intramedullary abscesses are the rarest but most serious complication of a CDS. Case Description: We treated a female infant with an intramedullary abscess in the thoracolumbar region, which was caused by infection of the CDS. Surgery revealed that the cord-like structure (C-LS) started from the cord with the intramedullary abscess, extended to the dural cul-de-sac, and further continued to the CDS tract and skin dimple. The boundary between the functional cord and the non-functional CL-S was electrophysiologically identified, and the entire length of the C-LS (the RMC) with an infected dermoid cyst was resected. As a result, the abscess cavity was opened and thorough irrigation and drainage of the pus could be performed. Histopathological examination of the C-LS revealed an infected dermoid cyst and abscess cavity with keratin debris in the fibrocollagenous tissue. The abscess cavity had a central canal-like ependymal lined lumen (CCLELL), with surrounding glial fibrillary acidic protein (GFAP)-immunopositive neuroglial tissues. Conclusion: We demonstrated that the transmission of an infection through the RMC was involved in the development of the intramedullary abscess. A good postoperative outcome was obtained because a terminal ventriculostomy for pus drainage could be achieved by excising the nonfunctional RMC.
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Affiliation(s)
- Yoshie Matsubara
- Department of Pediatric Neurology, Fukuoka Children’s Hospital, Fukuoka,
| | - Nobuya Murakami
- Department of Neurosurgery, Fukuoka Children’s Hospital, Fukuoka,
| | - Ai Kurogi
- Department of Neurosurgery, Fukuoka Children’s Hospital, Fukuoka,
| | - Sooyoung Lee
- Department of Pediatrics, National Hospital Organization, Fukuoka-Higashi Medical Center, Koga, Fukuoka,
| | - Nobutaka Mukae
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka,
| | - Takafumi Shimogawa
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka,
| | - Tadahisa Shono
- Department of Neurosurgery, Harasanshin Hospital, Fukuoka,
| | | | - Koji Yoshimoto
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka,
| | - Takato Morioka
- Department of Neurosurgery, Harasanshin Hospital, Fukuoka,
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Kurogi A, Murakami N, Mukae N, Shimogawa T, Shono T, Suzuki SO, Morioka T. Retained Medullary Cord Associated with Terminal Myelocystocele and Intramedullary Arachnoid Cyst. Pediatr Neurosurg 2022; 57:184-190. [PMID: 35259748 DOI: 10.1159/000523976] [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: 04/24/2021] [Accepted: 03/04/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The retained medullary cord (RMC) is a newly defined entity of closed spinal dysraphism that is thought to originate from regression failure of the medullary cord during the last phase of secondary neurulation. The terminal myelocystocele (TMC) is an unusual type of closed spinal dysraphism, characterized by localized cystic dilatation of the terminal part of the central canal that then herniates through a posterior spinal bifida. The co-occurrence of RMC and TMC is extremely rare. CASE PRESENTATION We treated a baby girl with a huge sacrococcygeal meningocele-like sac with two components. Untethering surgery and repair surgery for the sac revealed that RMC, associated with intramedullary arachnoid cyst (IMAC), was terminated at the bottom of the rostral cyst, forming the septum of the two cystic components, and the caudal cyst was TMC derived from the central canal-like ependymal lining lumen (CC-LELL) of the RMC at the septum. IMAC within the RMC communicated with TMC, and both contained xanthochromic fluid with the same properties. CONCLUSION We speculated that the mass effect of the coexistent IMAC impeded the flow of cerebrospinal fluid in the CC-LELL within the RMC and eventually formed a huge TMC. In surgical strategies for such complex pathologies, it is important to identify the electrophysiological border between the functional cord and nonfunctional RMC and the severe RMC to untether the cord, as with a typical or simple RMC.
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Affiliation(s)
- Ai Kurogi
- Department of Neurosurgery, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Nobuya Murakami
- Department of Neurosurgery, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Nobutaka Mukae
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | | | - Tadahisa Shono
- Department of Neurosurgery, Harasanshin Hospital, Fukuoka, Japan
| | | | - Takato Morioka
- Department of Neurosurgery, Harasanshin Hospital, Fukuoka, Japan
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Shimogawa T, Mukae N, Kanata A, Tsukamoto H, Murakami N, Kurogi A, Shono T, Suzuki SO, Morioka T. Spinal cord deformity with aggravation of tethering in saccular limited dorsal myeloschisis during the first 2 months of life. Surg Neurol Int 2021; 12:476. [PMID: 34621591 PMCID: PMC8492443 DOI: 10.25259/sni_517_2021] [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: 05/25/2021] [Accepted: 07/01/2021] [Indexed: 11/04/2022] Open
Abstract
Background Although the optimal timing of prophylactic untethering surgery for limited dorsal myeloschisis (LDM) with intact or subtle neurological findings diagnosed at birth remains undetermined, intentional delayed surgery is commonly used for flat and tail-like LDM. Conversely, for saccular LDM, early surgery is indicated during the postnatal period because it prevents rupture of the sac. We treated a saccular LDM patient, in whom intentional delayed surgery was selected because the sac was thickly covered with normal skin. We describe the clinical course of the case and discuss the optimal timing of the surgery. Case Description The patient had a dorsal midline sac in the upper lumbar region. Initial magnetic resonance imaging (MRI) after birth revealed a tethering tract that began at the dome of the sac and joined the lumbar cord. Dorsal bending of the cord at the stalk-cord union and invagination of the cord into the sac were noted. At 2 months, he was neurologically normal; however, the second MRI examination revealed that the cord tethering was aggravated. The cord was markedly displaced dorsally and to the left, with deviation of the cord to the sac out of the spinal canal. Following untethering surgery, the spinal cord deformity markedly improved. Conclusion Early surgery may be recommended for saccular LDM when tethering is present, including dorsal bending of the cord at the stalk-cord union and invagination of the cord into the sac observed on detailed MRI examination, even if the sac has no risk of rupture.
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Affiliation(s)
- Takafumi Shimogawa
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Nobutaka Mukae
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Akiko Kanata
- Department of Neurosurgery, Kitakyushu Municipal Medical Center, Kitakyushu, Japan
| | - Haruhisa Tsukamoto
- Department of Neurosurgery, Kitakyushu Municipal Medical Center, Kitakyushu, Japan
| | - Nobuya Murakami
- Department of Neurosurgery, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Ai Kurogi
- Department of Neurosurgery, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Tadahisa Shono
- Department of Neurosurgery, Harasanshin Hospital, Fukuoka, Japan
| | | | - Takato Morioka
- Department of Neurosurgery, Harasanshin Hospital, Fukuoka, Japan
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Morioka T, Murakami N, Suzuki SO, Mukae N, Shimogawa T, Kurogi A, Shono T, Mizoguchi M. Surgical histopathology of a filar anomaly as an additional tethering element associated with closed spinal dysraphism of primary neurulation failure. Surg Neurol Int 2021; 12:373. [PMID: 34513140 PMCID: PMC8422463 DOI: 10.25259/sni_340_2021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 06/09/2021] [Indexed: 11/12/2022] Open
Abstract
Background: Closed spinal dysraphism of primary neurulation failure could be associated with filar anomalies, such as filar lipoma or thickened and tight filum terminale (TFT), resulting from impaired secondary neurulation. Retained medullary cord (RMC) is a remnant of the cavitary medullary cord originating from the secondary neurulation failure. Some filar lipomas are known to contain a central canal-like ependyma-lined lumen with surrounding neuroglial tissues (E-LC w/NGT), that is, a characteristic histopathology of RMC. To clarify the embryological background of these filar anomalies, we evaluated the histopathological findings. Methods: Among 41 patients with lesions of primary neurulation failure who underwent initial untethering surgery, the filum including cord-like structure (C-LS) was additionally resected in 10 patients (five dorsal and transitional lipomas; five limited dorsal myeloschisis). We retrospectively analyzed the clinical, neuroradiological, intraoperative, and histopathological findings. Results: Among 10 patients, two patients were diagnosed with RMC based on morphological features and intraoperative neurophysiological monitoring. The diagnosis of filar lipoma was made in six patients, since various amounts of fibroadipose tissue were histopathologically noted in the filum. Two patients were diagnosed with TFT, since the filum was composed solely of fibrocollagenous tissue. E-LC w/NGT was noted not only in both C-LSs of RMCs but also in two out of six fila both with filar lipomas and fila with TFTs. Conclusion: These findings provide further evidence for the idea that entities, such as filar lipoma, TFT, and RMC, can be considered consequences of a continuum of regression failure occurring during late secondary neurulation.
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Affiliation(s)
- Takato Morioka
- Department of Neurosurgery, Fukuoka Children's Hospital, Fukuoka, Japan.,Department of Neurosurgery, Harasanshin Hospital, Karatsu, Saga
| | - Nobuya Murakami
- Department of Neurosurgery, Fukuoka Children's Hospital, Fukuoka, Japan
| | | | - Nobutaka Mukae
- Department of Neurosurgery, Graduate School of Medical Sciences, Fukuoka, Japan
| | | | - Ai Kurogi
- Department of Neurosurgery, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Tadahisa Shono
- Department of Neurosurgery, Harasanshin Hospital, Karatsu, Saga
| | - Masahiro Mizoguchi
- Department of Neurosurgery, Graduate School of Medical Sciences, Fukuoka, Japan
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12
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KUROGI A, MORIOKA T, MURAKAMI N, SHIMOGAWA T, MUKAE N, MATSUO Y, IMAMOTO N, TATEISHI Y, SUZUKI SO. Saccular Limited Dorsal Myeloschisis with Spinal Cord Deviation out of the Spinal Canal to the Sac. NMC Case Rep J 2021; 8:739-746. [PMID: 35079542 PMCID: PMC8769447 DOI: 10.2176/nmccrj.cr.2021-0168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 08/19/2021] [Indexed: 12/04/2022] Open
Abstract
Saccular limited dorsal myeloschisis (LDM) is characterized by a fibroneural stalk linking the saccular skin lesion to the underlying spinal cord. Since untethering surgery during the early postnatal period is often indicated to prevent sac rupture, saccular LDM should be distinguished from myelomeningocele (MMC) during the perinatal period. We treated two patients with the spinal cord deviation from the spinal canal to the sac, which mimicked a prolapse of the neural placode into the MMC sac. In patient 1, pre- and postnatal magnetic resonance imaging (MRI) revealed that the spinal cord was strongly tethered to the thick stalk. During surgery, the dorsally bent cord and stalk were united, and the border between these two was determined with intraoperative neurophysiological mapping (IONM). In patient 2, the spinal cord was tethered to two slender stalks close to each other, which was visible with the combined use of sagittal and axial postnatal three-dimensional heavily T2-weighted imaging (3D-hT2WI). The preoperative MRI hallmark of saccular LDM is the visualization of a stalk that links the bending cord and sac. Complete untethering surgery to return the cord into the spinal canal and correct its dorsal bending is recommended.
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Affiliation(s)
- Ai KUROGI
- Department of Neurosurgery, Fukuoka Children’s Hospital, Fukuoka, Fukuoka, Japan
| | - Takato MORIOKA
- Department of Neurosurgery, Harasanshin Hospital, Fukuoka, Fukuoka, Japan
| | - Nobuya MURAKAMI
- Department of Neurosurgery, Fukuoka Children’s Hospital, Fukuoka, Fukuoka, Japan
| | - Takafumi SHIMOGAWA
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Fukuoka, Japan
| | - Nobutaka MUKAE
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Fukuoka, Japan
| | - Yoshihiro MATSUO
- Department of Neurosurgery, Japan Community Health Care Organization (JCHO), Kyushu Hospital, Kitakyushu, Fukuoka, Japan
| | - Naoyuki IMAMOTO
- Department of Neurosurgery, Japan Community Health Care Organization (JCHO), Kyushu Hospital, Kitakyushu, Fukuoka, Japan
| | - Yuki TATEISHI
- Department of Pathology, Japan Community Health Care Organization (JCHO), Kyushu Hospital, Kitakyushu, Fukuoka, Japan
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