Retained medullary cord confirmed by intraoperative neurophysiological mapping

Sala, Francesco; Barone, Giovanni; Tramontano, Vincenzo; Gallo, Pasquale; Ghimenton, Claudio

doi:10.1007/s00381-014-2372-0

Cited by 33 publications

(20 citation statements)

References 13 publications

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“…Morphologically, there was a striking resemblance between the ependyma-lined canal with surrounding neuroglial tissues in our 6 patients with filar- and caudal-type lipomatous malformations and the RMC of the previous reports [8, 9], including ours [10, 11]. Furthermore, the cases were also similar to these previous cases in that there were always neuroglial tissues surrounded by variable amounts of collagenous and adipose tissues [8-11].…”

Section: Discussionsupporting

confidence: 72%

“…During surgery for RMC, the exact border between the functional true conus and nonfunctional RMC is recommended by tracing the evoked CMAPs with direct cord stimulation starting from the functional portion of the cord, then on to the nonfunctional RMC [9, 10]. In our 6 cases, stimulation of the apparent lipomatous portion with a current intensity of up to 3 mA was strong enough to evoke CMAPs with stimulation of the ventral roots.…”

Section: Discussionmentioning

confidence: 99%

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Ependyma-Lined Canal with Surrounding Neuroglial Tissues in Lumbosacral Lipomatous Malformations: Relationship with Retained Medullary Cord

et al. 2018

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Background: An ependyma-lined canal with surrounding neuroglial tissues can be present in lumbosacral lipomatous malformations; however, the precise embryological significance is still unclear. Method: Six out of 50 patients with lipomatous malformations had ependymal structures. We retrospectively analyzed the clinical, neuroradiological, and histological findings of these patients to demonstrate the relationship with the embryological background of the retained medullary cord (RMC), which normally regresses, but was retained here because of late arrest of secondary neurulation. Results: Five (13.9%) of 36 patients with filar and caudal types and 1 of 3 lipomyelomeningoceles had ependymal structures, while none with dorsal and transitional types had these tissues. Histologically, the ependymal structures surrounded by neuroglial tissue and containing various amounts of adipose tissue bear a striking resemblance to the ependymal structures in RMC. Conclusion: The 13.9% incidence of association between the ependymal structures and filar and caudal types is thought to be because of second ary neurulation failure with the same embryological background as that of RMC. Dorsal and transitional types, resulting from primary neurulation failure, therefore, did not have ependymal structures.

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Section: Discussionsupporting

confidence: 72%

Section: Discussionmentioning

confidence: 99%

Ependyma-Lined Canal with Surrounding Neuroglial Tissues in Lumbosacral Lipomatous Malformations: Relationship with Retained Medullary Cord

et al. 2018

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“…The key step in RMC surgery is to find the normal conus level based on electrophysiology. IONM enables identifying the normal function of the cord and root and severing the non-functioning RMC and vestigial root [15][16][17] .…”

Section: Surgical Treatmentmentioning

confidence: 99%

“…5). Sala et al 17) suggested rostrocaudal stimulation. This is a method to find the exact point when a signal becomes null.…”

Section: Surgical Treatmentmentioning

confidence: 99%

“…The prognosis of RMCs seems to be good. No patients have demonstrated new neurological deficits or progression after surgery in the literature 8,11,[15][16][17]19) . Since there is not much information available on RMC, it will be meaningful to compare the clinical outcomes of wide exposure with excision of the whole non-functional cord and those of limited exposure with only untethering.…”

Section: Clinical Outcomementioning

confidence: 99%

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Secondary Neurulation Defects-1 : Retained Medullary Cord

Kim

Lee

Wang

2020

J Korean Neurosurg Soc

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Retained medullary cord (RMC) is a relatively recent term. Pang et al. newly defined the RMC as a late arrest of secondary neurulation leaving a non-functional vestigial portion at the tip of the conus medullaris. RMC, which belongs to the category of closed spinal dysraphism, is a cord-like structure that is elongated from the conus toward the cul-de-sac. Because intraoperative electrophysiological confirmation of a non-functional conus is essential for the diagnosis of RMC, only a tentative or an assumptive diagnosis is possible before surgery or in cases of limited surgical exposure. We suggest the term 'possible RMC' for these cases. An RMC may cause tethered cord syndrome and thus requires surgery. This article reviews the literature to elucidate the pathoembryogenesis, clinical significance and treatment of RMCs.

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Disorders of Secondary Neurulation: Suggestion of a New Classification According to Pathoembryogenesis

Yang

Lee

Kim

et al. 2022

Advances and Technical Standards in Neurosurgery

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Retained medullary cord confirmed by intraoperative neurophysiological mapping

Abstract: Neurosurgical procedure for RMC should only be rendered with intraoperative neurophysiological mapping, as the anatomical judgment would not suffice to allow a safe cutting of these "normal-looking" neural structures.

Cited by 33 publications

References 13 publications

Ependyma-Lined Canal with Surrounding Neuroglial Tissues in Lumbosacral Lipomatous Malformations: Relationship with Retained Medullary Cord

Ependyma-Lined Canal with Surrounding Neuroglial Tissues in Lumbosacral Lipomatous Malformations: Relationship with Retained Medullary Cord

Secondary Neurulation Defects-1 : Retained Medullary Cord

Disorders of Secondary Neurulation: Suggestion of a New Classification According to Pathoembryogenesis

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