Microsurgical approach for resection of the filum terminale internum in tethered cord syndrome—a case demonstration of technical nuances and vignettes

Abdulrazeq, Hael; Shao, Belinda; Sastry, Rahul; Klinge, Petra M.

doi:10.1007/s00701-023-05568-9

Cited by 4 publications

(2 citation statements)

References 10 publications

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“…Two hundred and eighty-eight consecutive patients presenting with TCS who underwent microsurgical resection of the FT at a single academic tertiary medical center between January 2013 and December 2021 were included in this study. These cases included both adult and pediatric cases in which the routine procedure consisted of a lumbar midline combined interlaminar/translaminar approach performed at the most proximal level of the FT with the removal of at least a 4 cm portion of the FT, which was then sent for pathologic analysis using a standard surgical technique recently described [ 21 ]. The patient cohort and the clinical symptoms and signs to support and substantiate the diagnosis of tethered cord syndrome are summarized in Table 1 .…”

Section: Methodsmentioning

confidence: 99%

The Surgical Histopathology of the Filum Terminale: Findings from a Large Series of Patients with Tethered Cord Syndrome

Abdulrazeq,

Leary,

Tang

et al. 2023

JCM

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This study investigated the prevalence of embryonic and connective tissue elements in the filum terminale (FT) of patients with tethered cord syndrome (TCS), examining both typical and pathological histology. The FT specimens from 288 patients who underwent spinal cord detethering from 2013 to 2021 were analyzed. The histopathological examination involved routine hematoxylin and eosin staining and specific immunohistochemistry when needed. The patient details were extracted from electronic medical records. The study found that 97.6% of the FT specimens had peripheral nerves, and 70.8% had regular ependymal cell linings. Other findings included ependymal cysts and canals, ganglion cells, neuropil, and prominent vascular features. Notably, 41% showed fatty infiltration, and 7.6% had dystrophic calcification. Inflammatory infiltrates, an underreported finding, were observed in 3.8% of the specimens. The research highlights peripheral nerves and ganglion cells as natural components of the FT, with ependymal cell overgrowth and other tissues potentially linked to TCS. Enlarged vessels may suggest venous congestion due to altered FT mechanics. The presence of lymphocytic infiltrations and calcifications provides new insights into structural changes and mechanical stress in the FT, contributing to our understanding of TCS pathology.

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Section: Methodsmentioning

confidence: 99%

The Surgical Histopathology of the Filum Terminale: Findings from a Large Series of Patients with Tethered Cord Syndrome

Abdulrazeq,

Leary,

Tang

et al. 2023

JCM

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“…The classical surgical treatment of lar lipoma is one-level laminectomy or laminectomy and microsurgical sectioning of the lum terminale [8,9]. To keep surgical invasiveness and complications to a minimum, minimally invasive techniques such as the interlaminar approach or endoscopic-assisted techniques have been increasingly used in recent years [5,9,10,11,12]. We present our surgical technique for a minimally invasive full-endoscopic untethering that can be performed through a 1 cm skin incision, the smallest skin incision that has been reported to date.…”

Section: Introductionmentioning

confidence: 99%

Endoscopic spinal cord untethering using a 1 cm skin incision technique in pediatrics: A technical case report

Ishisaka,

Tahara,

Tsukiyama

et al. 2023

Preprint

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Background Spinal cord untethering by sectioning the filum terminale is commonly performed in tethered cord syndrome patients with minor abnormalities such as filar lipoma, thickened filum terminale, and low conus medullaris. Our endoscopic surgical technique, using the interlaminar approach, allows for sectioning the filum terminale through a very small skin incision. To our knowledge, this procedure has not been previously reported. This is the first case report involving a 1 cm skin incision. Case presentation A 9-month-old male patient was referred to our neurosurgical department due to a coccygeal dimple. MRI revealed a thickened fatty filum. After considering the treatment options for this patient, the parents agreed to spinal cord untethering. A midline 1 cm skin incision was made at the L4/5 vertebral level. Untethering by sectioning the filum terminale was performed by full endoscopic surgery using the interlaminar approach. The procedure was uneventful and there were no postoperative complications. Conclusions In terms of visibility and minimizing invasiveness, our surgical technique of using the interlaminar approach with endoscopy allows for untethering by sectioning the filum terminale through a very small skin incision.

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Comparison of the inter-laminar approach and laminotomy open approach for filum terminale lipoma: A retrospective analysis

Nawashiro,

Kurimoto,

Nagakura

et al. 2024

Childs Nerv Syst

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Microsurgical approach for resection of the filum terminale internum in tethered cord syndrome—a case demonstration of technical nuances and vignettes

Cited by 4 publications

References 10 publications

The Surgical Histopathology of the Filum Terminale: Findings from a Large Series of Patients with Tethered Cord Syndrome

The Surgical Histopathology of the Filum Terminale: Findings from a Large Series of Patients with Tethered Cord Syndrome

Endoscopic spinal cord untethering using a 1 cm skin incision technique in pediatrics: A technical case report

Comparison of the inter-laminar approach and laminotomy open approach for filum terminale lipoma: A retrospective analysis

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