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Cai Y, Wang R, Wang J, Zhan Q, Wei M, Xiao B, Wang Q, Jiang W. The discrepancy in triggered electromyography responses between fatty filum and normal filum terminale. BMC Surg 2024; 24:60. [PMID: 38365696 PMCID: PMC10874075 DOI: 10.1186/s12893-024-02351-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 02/07/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND Functional role of filum terminale (FT) was not well studied though it contains structure basis for nerve impulse conduction. We aimed to explore the possible functions of the FT from the perspective of triggered electromyography (EMG) during surgery. METHODS We retrospectively reviewed intraoperative neurophysiological monitoring data from pediatric patients who underwent intradural surgeries at the lumbar level in Shanghai Children's. Hospital from January 2018 to March 2023. Altogether 168 cases with complete intraoperative neurophysiological recordings of the FT were selected for further analysis. Triggered EMG recordings of the filum originated from two main types of surgeries: selective dorsal rhizotomy (SDR) and fatty filum transection. RESULTS 96 cases underwent SDR and 72 cases underwent fatty filum transection. Electrical stimulation of the FT with fatty infiltration did not elicit electromyographic activity in the monitored muscles with the maximum stimulus intensity of 4.0 mA, while the average threshold for FT with normal appearance was 0.68 mA, and 89 out of 91 FT could elicit electromyographic responses in monitored channels. The threshold ratio of filum to motor nerve roots at the same surgical segment was significantly higher in patients with fatty filum, and a cut-off point of 21.03 yielded an area under curve of 0.943, with 100% sensitivity and 85.71% specificity. CONCLUSION Filum with normal appearance can elicit electromyographic activity in the lower limbs/anal sphincter similar to the performance of the cauda equina nerve roots. The threshold of fatty filum is different from that of normal appearing FT. Triggered EMG plays an important role in untethering surgeries.
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Affiliation(s)
- Yizi Cai
- Department of Neonatology, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Rui Wang
- Department of Neurosurgery, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, 355 Luding Road, Shanghai, 200062, China
| | - Junlu Wang
- Department of Neurosurgery, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, 355 Luding Road, Shanghai, 200062, China
| | - Qijia Zhan
- Department of Neurosurgery, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, 355 Luding Road, Shanghai, 200062, China
| | - Min Wei
- Department of Neurosurgery, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, 355 Luding Road, Shanghai, 200062, China
| | - Bo Xiao
- Department of Neurosurgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Qiang Wang
- College of Computer and Network Engineering, Shanxi Datong University, Datong, China
| | - Wenbin Jiang
- Department of Neurosurgery, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, 355 Luding Road, Shanghai, 200062, China.
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Klinge PM, McElroy A, Leary OP, Donahue JE, Mumford A, Brinker T, Gokaslan ZL. Not Just an Anchor: The Human Filum Terminale Contains Stretch Sensitive and Nociceptive Nerve Endings and Responds to Electrical Stimulation With Paraspinal Muscle Activation. Neurosurgery 2022; 91:618-624. [PMID: 35852974 PMCID: PMC9447435 DOI: 10.1227/neu.0000000000002081] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 05/23/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Neural components of the fibrous filum terminale (FT) are well known but are considered as embryonic remnants without functionality. OBJECTIVE To investigate the ultrastructure of human FT specimens for sensory nerve endings and record paraspinal muscle activity on electrostimulation of the FT. METHODS We prospectively investigated a cohort of 53 patients who underwent excision of the FT for the treatment of tethered cord syndrome. Surgical FT specimens were investigated by light and transmission electron microscopy. Intraoperative electrophysiological routine monitoring was extended by recording paraspinal muscles above and below the laminotomy level. RESULTS Light microscopy revealed tiny peripheral nerves piercing the pia mater of the FT and entering its fibrous core. Transmission electron microscopy unveiled within the fibrous core of the FT myelinated nerve structures in 8 of the 53 patients and unmyelinated ones in 10 of the 53 patients. Both nerve endings encapsulated in fibrous tissue or unencapsulated nonmyelinated Schwann cell nerve bundles, that is, Remak cells, were found. Those nerve endings resembled mechanoreceptor and nociceptive receptor structures found in human skin, muscle tendons, and skeletal ligaments. Specifically, we found Ruffini mechanoreceptors and in addition nerve endings which resembled nociceptive glioneural structures of the skin. Bipolar electrostimulation of the FT was associated with paraspinal muscle activity above and below the spinal segment at which the FT was stimulated. CONCLUSION Morphological and electrophysiological results indicate the presence of functional sensory nerve endings in the FT. Like other spine ligaments, the FT may serve as a proprioceptive element but may also contribute to back pain in spine disorders.
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Affiliation(s)
- Petra M. Klinge
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Abigail McElroy
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Owen P. Leary
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - John E. Donahue
- Department of Pathology, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Andrew Mumford
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Thomas Brinker
- Department of Neurosurgery, Medical School Hannover, Hannover, Germany
| | - Ziya L. Gokaslan
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
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3
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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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4
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Jiang Q, Tao B, Gao G, Sun M, Wang H, Li J, Wang Z, Shang A. Filum Terminale: A Comprehensive Review with Anatomical, Pathological, and Surgical Considerations. World Neurosurg 2022; 164:167-176. [PMID: 35500871 DOI: 10.1016/j.wneu.2022.04.098] [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: 03/02/2022] [Revised: 04/22/2022] [Accepted: 04/23/2022] [Indexed: 11/28/2022]
Abstract
The conus medullaris is the distal tapering end of the spinal cord, and the filum terminale (FT) is regarded as a bundle of non-functional fibrous tissue; therefore, some scholars call it the spinal ligament, while others describe the human FT as "remnants of the spinal cord." It was later found that in the human spinal cord, the FT is composed of an intradural segment and an epidural segment, and the end of the FT is connected to the coccyx periosteum. Because some nerve tissue is also found in the FT, as research progresses, FT may have the potential for transplantation. A lack of exhaustive overviews on the FT in the present literature prompted us to conduct this review. Considering that a current comprehensive review seemed to be the need of the hour, herein, we attempted to summarize previous research and theories on the FT, elucidate its anatomy, and understand its pathological involvement in various diseases.
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Affiliation(s)
- Qingyu Jiang
- Chinese PLA Medical School, Beijing 100853, China
| | - Benzhang Tao
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing 100853, China; Tianjin Medical University
| | - Gan Gao
- Chinese PLA Medical School, Beijing 100853, China
| | - Mengchun Sun
- Chinese PLA Medical School, Beijing 100853, China; Medical School, Nankai University, Nankai District, Tianjin, China
| | - Hui Wang
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing 100853, China
| | - Junyang Li
- Chinese PLA Medical School, Beijing 100853, China; Medical School, Nankai University, Nankai District, Tianjin, China
| | | | - Aijia Shang
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing 100853, China.
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5
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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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6
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Tuleasca C, Ducos Y, Knafo S, Levivier M, Aghakhani N, Parker F. Surgery for cyst dilatation of a ventriculus terminalis in adults: Keep it simple! Neurochirurgie 2020; 67:211-213. [PMID: 32504646 DOI: 10.1016/j.neuchi.2020.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 04/11/2020] [Indexed: 12/01/2022]
Affiliation(s)
- C Tuleasca
- Service de neurochirurgie, hôpitaux universitaires Paris Sud, CHU de Bicêtre, AP-HP, Le-Kremlin-Bicêtre, France; Faculté de médecine, Sorbonné Université, Paris, France; Neurosurgery Service and Gamma Knife Center, Lausanne University Hospital (CHUV), Lausanne, Switzerland; Faculté de biologie et de médecine (FBM), université de Lausanne (Unil), Lausanne, Switzerland; Signal Processing Laboratory (LTS 5), Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland.
| | - Y Ducos
- Service de neurochirurgie, hôpitaux universitaires Paris Sud, CHU de Bicêtre, AP-HP, Le-Kremlin-Bicêtre, France
| | - S Knafo
- Service de neurochirurgie, hôpitaux universitaires Paris Sud, CHU de Bicêtre, AP-HP, Le-Kremlin-Bicêtre, France
| | - M Levivier
- Neurosurgery Service and Gamma Knife Center, Lausanne University Hospital (CHUV), Lausanne, Switzerland; Faculté de biologie et de médecine (FBM), université de Lausanne (Unil), Lausanne, Switzerland
| | - N Aghakhani
- Service de neurochirurgie, hôpitaux universitaires Paris Sud, CHU de Bicêtre, AP-HP, Le-Kremlin-Bicêtre, France
| | - F Parker
- Service de neurochirurgie, hôpitaux universitaires Paris Sud, CHU de Bicêtre, AP-HP, Le-Kremlin-Bicêtre, France
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7
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Lotfinia I, Mahdkhah A. The cystic dilation of ventriculus terminalis with neurological symptoms: Three case reports and a literature review. J Spinal Cord Med 2018; 41:741-747. [PMID: 29791269 PMCID: PMC6217512 DOI: 10.1080/10790268.2018.1474680] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
Abstract
CONTEXT The ventriculus terminalis (VT) is a very small ependymal-lined residual lumen in the conus medullaris. It is normally present in all subjects during fetal development. VT in adults appears as an unusual pathology with an uncertain pathogenesis. FINDINGS In this paper, we described three case reports of symptomatic fifth ventricle cystic dilations. All of them were female and their mean age was 59 years. We treated them surgically and all three patients were improved based on clinical and imaging assessments. CONCLUSION Our cases suggested that surgical decompression was a safe and effective treatment in symptomatic patients and the neurosurgeons should be aware of such rare situations. A complete list of differential diagnosis about other cystic dilations of the conus medullaris should be emphasized to select the correct clinical approach.
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Affiliation(s)
- Iraj Lotfinia
- Professor of Neurosurgery Department of Neurosurgery, Tabriz University of Medical Science, Tabriz, Iran
| | - Ata Mahdkhah
- Assistant Professor of Neurosurgery Department of Neurosurgery, Urmia University of Medical Science, Urmia, Iran
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8
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Kwon M, Je BK, Hong D, Choi BM. Ultrasonographic features of the normal filum terminale. Ultrasonography 2017; 37:129-133. [PMID: 28736427 PMCID: PMC5885475 DOI: 10.14366/usg.17032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 06/08/2017] [Accepted: 06/08/2017] [Indexed: 11/21/2022] Open
Abstract
Purpose The filum terminale (FT) is a fibrous band that connects the conus medullaris to the posterior body of the coccyx. Considering the advances of ultrasonography (US) technology and improvements in the resolution of US images, we aimed to re-establish the US features of the normal FT in infants younger than 6 months of age. Methods We retrospectively reviewed 30 spinal US scans, stored as video clips. The internal structure of the FT and the marginal echogenicity of the FT were assessed, and transverse and longitudinal US were compared. Results On US, a central echogenic line was defined in 18 (60%) normal FTs; however, there was no visible internal structure in 12 cases (40%). The marginal echogenicity of the FT was hyperechoic in eight cases (27%) in comparison with the cauda equina and was isoechoic in 22 cases (73%). In differentiating the normal FT from the surrounding nerve roots, transverse US was superior in 18 cases (60%), while longitudinal US was superior in two cases (7%). Conclusion On US, the central canal of the FT was defined in 60% of normal FTs. Hyperechoic marginal echogenicity and the use of transverse US were helpful in distinguishing the normal FT from the nerve roots of the cauda equina.
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Affiliation(s)
- Myoungae Kwon
- Department of Radiology, Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Bo-Kyung Je
- Department of Radiology, Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Doran Hong
- Department of Radiology, Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Byung Min Choi
- Department of Pediatrics, Ansan Hospital, Korea University College of Medicine, Ansan, Korea
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Saker E, Henry BM, Tomaszewski KA, Loukas M, Iwanaga J, Oskouian RJ, Tubbs RS. The filum terminale internum and externum: A comprehensive review. J Clin Neurosci 2017; 40:6-13. [DOI: 10.1016/j.jocn.2016.12.020] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 12/27/2016] [Indexed: 10/20/2022]
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10
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Saker E, Henry BM, Tomaszewski KA, Loukas M, Iwanaga J, Oskouian RJ, Tubbs RS. The Human Central Canal of the Spinal Cord: A Comprehensive Review of its Anatomy, Embryology, Molecular Development, Variants, and Pathology. Cureus 2016; 8:e927. [PMID: 28097078 PMCID: PMC5234862 DOI: 10.7759/cureus.927] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The human central canal of the spinal cord is often overlooked. However, with advancements in imaging quality, this structure can be visualized in more detail than ever before. Therefore, a timely review of this part of the cord seemed warranted. Using standard search engines, a literature review was performed for the development, anatomy, and pathology involving the central canal. Clinicians who treat patients with issues near the spine or interpret imaging of the spinal cord should be familiar with the morphology and variants of the central canal.
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Affiliation(s)
- Erfanul Saker
- Department of Anatomical Sciences, St. George's University School of Medicine, Grenada, West Indies
| | - Brandon M Henry
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | | | - Marios Loukas
- Department of Anatomical Sciences, St. George's University School of Medicine, Grenada, West Indies
| | | | - Rod J Oskouian
- Neurosurgery, Complex Spine, Swedish Neuroscience Institute
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11
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Chrenek R, Magnotti LM, Herrera GR, Jha RM, Cardozo DL. Characterization of the Filum terminale as a neural progenitor cell niche in both rats and humans. J Comp Neurol 2016; 525:661-675. [PMID: 27511739 PMCID: PMC5216448 DOI: 10.1002/cne.24094] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Revised: 07/26/2016] [Accepted: 07/26/2016] [Indexed: 01/24/2023]
Abstract
Neural stem cells (NSCs) reside in a unique microenvironment within the central nervous system (CNS) called the NSC niche. Although they are relatively rare, niches have been previously characterized in both the brain and spinal cord of adult animals. Recently, another potential NSC niche has been identified in the filum terminale (FT), which is a thin band of tissue at the caudal end of the spinal cord. While previous studies have demonstrated that NSCs can be isolated from the FT, the in vivo architecture of this tissue and its relation to other NSC niches in the CNS has not yet been established. In this article we report a histological analysis of the FT NSC niche in postnatal rats and humans. Immunohistochemical characterization reveals that the FT is mitotically active and its cells express similar markers to those in other CNS niches. In addition, the organization of the FT most closely resembles that of the adult spinal cord niche. J. Comp. Neurol. 525:661–675, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Ryan Chrenek
- Department of NeurobiologyHarvard Medical SchoolBostonMassachusettsUSA
- Department of GeneticsHarvard Medical SchoolBostonMassachusettsUSA
| | - Laura M. Magnotti
- Department of NeurobiologyHarvard Medical SchoolBostonMassachusettsUSA
| | | | - Ruchira M. Jha
- Department of NeurobiologyHarvard Medical SchoolBostonMassachusettsUSA
| | - David L. Cardozo
- Department of NeurobiologyHarvard Medical SchoolBostonMassachusettsUSA
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12
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Hendson G, Dunham C, Steinbok P. Histopathology of the filum terminale in children with and without tethered cord syndrome with attention to the elastic tissue within the filum. Childs Nerv Syst 2016; 32:1683-92. [PMID: 27236780 DOI: 10.1007/s00381-016-3123-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 05/16/2016] [Indexed: 11/25/2022]
Abstract
PURPOSE To compare histologically transected fila from pediatric patients with tethered cord syndrome (TCS), with and without a low conus, with controls, focusing on collagenous and elastic tissue. METHODS Thirty fila from patients with TCS, including 5 where minimal cautery was used prior to filum section, were compared with fila from 27 pediatric cadavers without TCS (controls). Sections of fila were stained with H&E, Masson trichrome and Verhoeff von Gieson elastic stains, and 7 with Gordon and Sweet's reticulin stain. RESULTS Fila from controls showed loose fibrous connective tissue (FCT) with thin and evenly dispersed elastic fibers (EFs). Reticulin fibers (RFs) were seen in blood vessel walls and nerve twigs. Fat was identified microscopically in 2 fila. All fila from patients with TCS had dense FCT. The EFs were in normal numbers in 17, and focally or diffusely decreased in 13. All 25 patients where the fila were cauterized during resection had thick and coiled EFs. Coiling was not seen when minimal cautery was applied. RFs were seen in blood vessel walls and nerve twigs. Fat was identified in 19 patients. Findings were similar, whether the conus termination was normal or low. CONCLUSION The fila of all patients with TCS, whether or not the conus was low, showed abnormal FCT. EFs were decreased in 48 % of patients; however, there were thick and coiled EFs in all patients. Coiling of EFs, initially thought to be an abnormality in patients, is considered most likely to be a result of cautery (i.e., artifactual/iatrogenic coiling).
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Affiliation(s)
- Glenda Hendson
- Division of Anatomic Pathology, Department of Pathology and Laboratory Medicine, British Columbia Children's Hospital, 4500 Oak Street, Vancouver, British Columbia, V6H 3N1, Canada.
| | - Christopher Dunham
- Division of Anatomic Pathology, Department of Pathology and Laboratory Medicine, British Columbia Children's Hospital, 4500 Oak Street, Vancouver, British Columbia, V6H 3N1, Canada
| | - Paul Steinbok
- Division of Neurosurgery, Department of Surgery, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
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13
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The Filum Terminale: A Cadaver Study of Anatomy, Histology, and Elastic Properties. World Neurosurg 2016; 90:565-573.e1. [DOI: 10.1016/j.wneu.2015.12.103] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 12/31/2015] [Indexed: 11/22/2022]
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14
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Yener U, Güdük M, Ekşi MŞ, Aytar MH, Sav A, Özgen S. Concomitant Double Tumors of Myxopapillary Ependymoma Presented at Cauda Equina-Filum Terminale in Adult Patient. KOREAN JOURNAL OF SPINE 2016; 13:33-6. [PMID: 27123029 PMCID: PMC4844659 DOI: 10.14245/kjs.2016.13.1.33] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 01/28/2016] [Accepted: 01/29/2016] [Indexed: 11/21/2022]
Abstract
A 32-year-old man presented with gradually increasing bilateral buttock pain. He had intermittent claudication. Multiple, homogenously enhanced intradural extramedullary lesions at L2-L3 and L5-S1 levels were observed on magnetic resonance imaging. The tumors were debulked and were removed in piecemeal pattern until they had completely been resected. Histopathological examination of the surgical specimens confirmed that both tumors were myxopapillary ependymomas (MPE). MPE presenting as concomitant double tumor at conus-cauda-filum level are very rare. This kind of presentation could not be directly considered as dissemination, since both tumors were in the site of classical origin of MPE. Ten cases of double spinal MPEs have been reported to date. Including the present case, analysis of the 11 patients revealed some facts. There is a male predominance, which is opposite to the ependymomas that are commonly observed in females. Median age at presentation is 15 years. Most pronounced symptom is low back pain that sometimes radiates to lower extremities. Surgical approach was aimed in all tumors, which could be succeeded in all tumors except one. Adjuvant radiation therapy was applied in 5 patients. No recurrences have been reported after surgery or surgery + radiotherapy regimens.
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Affiliation(s)
- Ulaş Yener
- Department of Neurosurgery, Acıbadem University Faculty of Medicine, Istanbul, Turkey
| | - Mustafa Güdük
- Department of Neurosurgery, Acıbadem University Faculty of Medicine, Istanbul, Turkey
| | - Murat Şakir Ekşi
- Department of Orthopedic Surgery-Spine Center, University of California at San Francisco, CA, USA
| | - Murat Hamit Aytar
- Department of Neurosurgery, Acıbadem University Vocational School of Health Services, Istanbul, Turkey
| | - Aydın Sav
- Department of Pathology, Acıbadem University Faculty of Medicine, Istanbul, Turkey
| | - Serdar Özgen
- Department of Neurosurgery, Acıbadem University Faculty of Medicine, Istanbul, Turkey
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15
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Namba K. Vascular Anatomy of the Cauda Equina and Its Implication on the Vascular Lesions in the Caudal Spinal Structure. Neurol Med Chir (Tokyo) 2016; 56:310-6. [PMID: 27021641 PMCID: PMC4908074 DOI: 10.2176/nmc.ra.2016-0006] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The cauda equina is composed of the lumbosacral and the coccygeal nerve roots and the filum terminale. In the embryonic period, discrepancy in development between the termination of the spinal cord and the spinal column results in elongation of the nerve roots as well as the filum terminale in this region. Although the vascular anatomy of the caudal spinal structure shares many common features with the other metameric levels, this elongation forms the basis of the characteristic vascular anatomy in this region. With the evolution of the high quality imaging techniques, vascular lesions in the cauda equina are being diagnosed more frequently than ever before. Albeit the demand for accurate knowledge of the vascular anatomy in this region, descriptions are often fragmented and not easily accessible. In this review, the author attempted to organize the existing knowledge of the vascular anatomy in the cauda equina and its implication on the vascular lesions in this region. Also reviewed is the clinically relevant embryological development of the cauda equina.
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Affiliation(s)
- Katsunari Namba
- Center for Endovascular Therapy, Division of Neuroendovascular Surgery, Jichi Medical University
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16
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Kural C, Guresci S, Simsek GG, Arslan E, Tehli O, Solmaz I, Izci Y. Histological structure of filum terminale in human fetuses. J Neurosurg Pediatr 2014; 13:362-7. [PMID: 24506339 DOI: 10.3171/2014.1.peds13520] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The structure of the filum terminale (FT) is important in the development of tethered cord syndrome (TCS) in children. Although many studies have been performed on the histological structure of the FT in adults, there has been no detailed investigation for those of fetuses. The aim of this study was to examine the histological structure of the FT in normal human fetuses and to compare the results with those of previous studies. METHODS The histological examination of the FT was performed in 15 normal human fetuses; 11 of them were female and 4 were male. The gestational age of the fetuses ranged between 14 weeks and 35 weeks, and they weighed between 180 g and 1750 g. The FT of each fetus was cut and examined for adipose tissue, fibrous tissue, peripheral nerve, ganglion, ependymal cells, gliosis, elastic fibers, and collagen types (Types I and III). RESULTS Adipose tissue was observed in 2 specimens (13%), whereas fibrous tissue was found in 8 specimens. Peripheral nerve was detected in 11 (73%), ganglion in 6, ependymal cells in 5, and glial tissue in 7 FT samples. Type III collagen was present in 12 specimens (80%) with different concentrations, whereas Type I collagen and elastic fibers were not detected. CONCLUSIONS The normal structure of the FT in fetuses is different from its structure in adults. The FT has no elasticity during intrauterine life because of the lack of elastic fibers. More detailed studies are needed to understand the histological basis of TCS in children.
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Affiliation(s)
- Cahit Kural
- Department of Neurosurgery, Gulhane Military Medical Academy; and
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17
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The nature of double concomitant myxopapillary ependymoma: report of a case. Childs Nerv Syst 2014; 30:527-30. [PMID: 23904042 DOI: 10.1007/s00381-013-2251-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2013] [Accepted: 07/22/2013] [Indexed: 10/26/2022]
Abstract
Myxopapillary ependymomas are almost exclusively seen at the conus medullaris/filum terminale/cauda equina region, usually as solitary space-occupying lesions. The authors report the case of a 14-year-old boy with double concomitant myxopapillary ependymoma, proximal and caudal on the filum terminale in which a totally gross removal was achieved in two stages. This presentation is rare and, so far, we have known just three similar cases that were previously reported in children. The true nature of these lesions is controversial, and while some argue that they are related to metastatic seeding, others consider them independent lesions developing synchronously. A review on dissemination of spinal myxopapillary ependymomas was done.
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Thompson EM, Strong MJ, Warren G, Woltjer RL, Selden NR. Clinical significance of imaging and histological characteristics of filum terminale in tethered cord syndrome. J Neurosurg Pediatr 2014; 13:255-9. [PMID: 24404969 DOI: 10.3171/2013.12.peds13370] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The pathophysiology of tethered cord syndrome (TCS) is uncertain; however, it has been suggested that fibrous and fatty elements within the filum terminale (FT) play a role. The objective of this study was to describe the radiological and histological features of the FT in TCS and determine if there are associations between those features and clinical outcomes, complications, and urodynamics. METHODS In this retrospective study, histological, MRI, and clinical data obtained in 293 patients with TCS who underwent FT transection were reviewed and analyzed in a multivariate analysis. RESULTS The median patient age was 4.9 years (range 0.3-64.3 years). On MRI, a fatty filum was present in 65% of patients and a thickened filum (> 2 mm) was seen in 45%. Histologically, the FT contained prominent fibrous tissue in 95%, nerve twigs in 79%, adipose tissue in 59%, and vascular tissue in 36%. Histological features associated with a thickened filum on MR images were adipose tissue (OR 3.5, p < 0.001), nerve twigs (OR 2.2, p = 0.028), and vascular tissue (OR 0.5, p = 0.025). Adipose tissue was associated with a conus level below the L2-3 disc space (OR 2.3, p = 0.031) and with a fatty filum on imaging (OR 9.8, p < 0.001). Nerve twigs were associated with abnormal urodynamics (OR 10.9, p = 0.049). The only variable predictive of clinical improvement was conus level; patients with conus levels caudal to L-2 were less likely to improve postoperatively (OR 0.3, p = 0.042). CONCLUSIONS Fibrous tissue was ubiquitous and may be important in the pathophysiology of TCS. Nerve twigs and adipose tissue were associated with abnormal urodynamics and low-lying coni, respectively. Although the majority of patients clinically improved, patients with normal conus levels had significantly better outcomes.
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Yang T, Wu L, Deng X, Yang C, Fang J, Zhao L, Wang G, Yang J, Xu Y. Clinical characteristics and surgical outcomes of spinal intramedullary ependymal cysts. Acta Neurochir (Wien) 2014; 156:269-75. [PMID: 24322584 DOI: 10.1007/s00701-013-1964-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Accepted: 11/28/2013] [Indexed: 11/26/2022]
Abstract
OBJECT Intramedullary ependymal cysts are exceedingly rare lesions, and have been previously reported in the literature as case reports. The aim of this study was to discuss the clinical presentation and the outcomes of microsurgery for these benign lesions. METHODS The authors retrospectively reviewed the records of ten patients who underwent microsurgery for intramedullary ependymal cysts. All patients had preoperative and postoperative magnetic resonance imaging. The surgical treatment included gross total resection and biopsy plus a cyst-subarachnoid shunt. The diagnosis of intramedullary ependymal cysts was based on radiological and pathological criteria. All patients were followed up, with a mean duration of 47.6 months. RESULTS Intramedullary ependymal cysts were hypointense on T1-weighted images and hyperintense on T2-weighted images. Contrast-enhanced T1-weighted images showed no enhancement. Gross total resection was achieved in one case. Biopsy of the cyst wall plus cyst-subarachnoid shunt placement was achieved in nine cases. Long-term neurological function was improved in eight patients. No recurrence was observed on magnetic resonance imaging. CONCLUSIONS Ependymal cysts should be considered in the differential diagnosis of intramedullary cysts. For symptomatic patients, early surgery should be performed before neurological deficits deteriorate. Complete decompression and cyst-subarachnoid shunt placement is the optimal treatment and the outcome may be favorable.
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Affiliation(s)
- Tao Yang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No.6 Tiantan Xili, Dongcheng District, Beijing, 100050, China,
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Jha RM, Liu X, Chrenek R, Madsen JR, Cardozo DL. The postnatal human filum terminale is a source of autologous multipotent neurospheres capable of generating motor neurons. Neurosurgery 2013; 72:118-29; discussion 129. [PMID: 23096415 DOI: 10.1227/neu.0b013e318276b445] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Neural progenitor cells (NPCs) are undifferentiated and mitotic and can be induced to differentiate into neurons and glia, the building blocks of the nervous system. NPCs have great therapeutic potential for nervous system trauma and degenerative disorders. They have been identified in the mammalian central nervous system, but current sources are difficult to access surgically and come from regions that are critical for normal brain function. OBJECTIVE To identify and characterize in detail a novel source of human NPCs in the filum terminale (FT), a vestigial structure at the caudal end of the spinal cord, which is easily accessed and plays no functional role in the postnatal nervous system. METHODS Cells were isolated and cultured in vitro from the FT of terminated fetuses and from children and adolescents who had undergone surgical resections for tethered spinal cords. Cell culture techniques, immunohistochemistry, and immunocytochemistry were applied to examine FT cells. RESULTS : FT cells gave rise to neurospheres that proliferated over extended periods of time in culture. These neurospheres were positive for neural stem/progenitor cell markers by immunocytochemical staining. The neurospheres were able to be induced to differentiate in vitro into neurons and glial cells, which were confirmed by the use of antibodies against the cell type-specific markers. Moreover, they have been induced to form motor neurons capable of innervating striated muscle in vitro. CONCLUSION Multipotent NPC cells from the FT are both accessible and expendable. They may allow autologous cell-based transplantation therapy that circumvents immunological rejection.
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Affiliation(s)
- Ruchira M Jha
- Department of Neurobiology, Harvard Medical School, Boston, Massachusetts, USA
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Jha RM, Chrenek R, Magnotti LM, Cardozo DL. The isolation, differentiation, and survival in vivo of multipotent cells from the postnatal rat filum terminale. PLoS One 2013; 8:e65974. [PMID: 23762453 PMCID: PMC3675200 DOI: 10.1371/journal.pone.0065974] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Accepted: 05/03/2013] [Indexed: 01/25/2023] Open
Abstract
Neural stem cells (NSCs) are undifferentiated cells in the central nervous system (CNS) that are capable of self-renewal and can be induced to differentiate into neurons and glia. Current sources of mammalian NSCs are confined to regions of the CNS that are critical to normal function and surgically difficult to access, which limits their therapeutic potential in human disease. We have found that the filum terminale (FT), a previously unexplored, expendable, and easily accessible tissue at the caudal end of the spinal cord, is a source of multipotent cells in postnatal rats and humans. In this study, we used a rat model to isolate and characterize the potential of these cells. Neurospheres derived from the rat FT are amenable to in vitro expansion in the presence of a combination of growth factors. These proliferating, FT-derived cells formed neurospheres that could be induced to differentiate into neural progenitor cells, neurons, astrocytes, and oligodendrocytes by exposure to serum and/or adhesive substrates. Through directed differentiation using sonic hedgehog and retinoic acid in combination with various neurotrophic factors, FT-derived neurospheres generated motor neurons that were capable of forming neuromuscular junctions in vitro. In addition, FT-derived progenitors that were injected into chick embryos survived and could differentiate into both neurons and glia in vivo.
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Affiliation(s)
- Ruchira M. Jha
- Department of Neurobiology, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Ryan Chrenek
- Department of Neurobiology, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Genetics, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Laura M. Magnotti
- Department of Neurobiology, Harvard Medical School, Boston, Massachusetts, United States of America
- * E-mail:
| | - David L. Cardozo
- Department of Neurobiology, Harvard Medical School, Boston, Massachusetts, United States of America
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Direct surgery for spinal arteriovenous fistulas of the filum terminale with intraoperative image guidance. Spine (Phila Pa 1976) 2012; 37:E1524-8. [PMID: 22914702 DOI: 10.1097/brs.0b013e31826f20c0] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A technical case report of direct surgery for spinal arteriovenous fistulas of the filum terminale. OBJECTIVE We present 2 cases of spinal arteriovenous fistulas of the filum terminale directly fed by the anterior spinal artery that were successfully obliterated with intraoperative image guidance such as digital subtraction angiography, intra-arterial dye injection technique, or indocyanine green video angiography. SUMMARY OF BACKGROUND DATA The goal of direct surgery for spinal arteriovenous fistulas is the complete obliteration of shunt vessels while preserving the normal circulation of spinal cord. Safe isolation of feeding arteries, nidus, and draining veins needs to be obtained first. Vascular flow or anatomical orientation of shunt vessels also needs to be ensured with intraoperative image guidance. METHODS Two cases are presented. The first patient (case 1) had the lesion with a nidus formation at the L2 spinal level supplied directly by the anterior spinal artery via left L1 segmental artery. The second patient (case 2) had a lesion at the L4-L5 spinal level also supplied directly by the anterior spinal artery via the left T11 intercostal artery. Standard exposure of the lesion followed intraoperative image guidance to achieve the appropriate vascular flow or anatomical orientation of the shunt vessels. RESULTS Complete obliteration of shunt vessels was successfully achieved without any complications in both cases. CONCLUSION Although intraoperative image guidance is certainly not a prerequisite, the concept of safe and minimally invasive surgery makes it indispensable. It can facilitate identification of crucial or important landmarks where anatomic structures may be distorted.
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Ganau M, Talacchi A, Cecchi PC, Ghimenton C, Gerosa M, Faccioli F. Cystic dilation of the ventriculus terminalis. J Neurosurg Spine 2012; 17:86-92. [DOI: 10.3171/2012.4.spine11504] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
The ventriculus terminalis, an embryological remnant consisting of the ependymal-lined space of the conus medullaris, can occasionally become symptomatic after cystic dilation. In the existing literature, consisting of 32 cases, the preferred type of management (conservative vs surgical) is still debated. The object of this study was to report the surgical results in a consecutive series of 10 adult patients with cystic dilation of the ventriculus terminalis (CDVT), to match them with data retrieved from the relevant literature, and specifically to validate a new recent clinical classification.
Methods
The authors reported 13 new cases of CDVT treated in the Department of Neurosurgery at University Hospital in Verona, Italy. Treatment modalities and clinical and radiological outcomes, both early and at follow-up, were analyzed and compared with a preoperative classification of clinical presentation, as established by de Moura Batista and colleagues (2008).
Results
Surgical treatment seemed to guarantee the resolution of CDVT. Dorsolumbar laminotomy, myelotomy, and cystic drainage were performed in 10 patients. Patients with Type I symptoms (nonspecific complaints) often presented with comorbidities (herniated disc or facet hypertrophy) confusing their clinical status. The surgical treatment of patients with Type I symptoms promoted good results only if the diagnosis of CDVT was definitive and symptoms had rapidly evolved. In patients with Type II (focal neurological deficits) and III (sphincter disturbances) symptoms, surgical treatment sustained improvement even at the late follow-up.
Conclusions
While confirming the usefulness of de Moura Batista and colleagues' classification in its impact on prognosis, the authors propose a revision of the classification with subgroups Type Ia (nonspecific symptoms without clear relation to CDVT), which is best treated conservatively, and Type Ib (rapid onset and invalidating unspecific complaints without comorbidities), which may benefit from surgical evacuation.
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Affiliation(s)
- Mario Ganau
- 1Section of Neurosurgery, Department of Neuroscience, University of Verona
| | - Andrea Talacchi
- 1Section of Neurosurgery, Department of Neuroscience, University of Verona
| | | | | | - Massimo Gerosa
- 1Section of Neurosurgery, Department of Neuroscience, University of Verona
| | - Franco Faccioli
- 4Department of Neurosurgery, University Hospital, Verona; and
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Gaddam SSK, Santhi V, Babu S, Chacko G, Baddukonda RA, Rajshekhar V. Gross and microscopic study of the filum terminale: does the filum contain functional neural elements? J Neurosurg Pediatr 2012; 9:86-92. [PMID: 22208327 DOI: 10.3171/2011.10.peds11102] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The filum terminale (FT) is considered a fibrous structure that extends from conus medullaris of the spinal cord to coccyx. Based on previous studies and from their own experience with intraoperative electrophysiological monitoring of the sacral nervous system, the authors postulate that the FT contains functional neural elements in some individuals. METHODS The FT was dissected from 13 fresh stillborn cadavers (7 male, 6 female; mean gestational age 36 weeks and 1 day). The gross anatomical features were recorded, and connections between the FT and the nerve roots of the cauda equina were noted. These connections, when present, were sectioned for histological studies. The fila (both interna and externa) were also sectioned for histological and immunohistochemical studies. In addition, FT specimens were obtained from 5 patients undergoing sectioning of the FT in an untethering surgical procedure. RESULTS There were 5 gross connections between the FT and nerve roots demonstrating nerve fibers that were positive for S100. The FT showed islands of cells that were positive for GFAP in 10 cases, synaptophysin in 3 cases, S100 in 11 cases, and nestin in 2 cases. The nerve fibers in the FT were myelinated in 2 cases. The conus ended at the L-1 or L-2 vertebral level in all 13 specimens. The dural sac terminated at the S-2 vertebral level in most of the specimens. The 5 FT specimens that were obtained from patients revealed nerve bundles that were positive for S100 in 4 cases and cells that were positive for GFAP in 3 cases. CONCLUSIONS There are gross anatomical connections between the FT and nerve roots that contain nerve fibers. Apart from fibrous stroma, the FT may contain nerve bundles and cells that stain positive for GFAP, synaptophysin, S100, and nestin. These microscopic findings and previous intraoperative electrophysiological studies suggest a probable functional role for the FT in some individuals. At birth, the conus ends at a higher vertebral level (lower L-1 or upper L-2) than L-3.
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Distribution and characterization of progenitor cells within the human filum terminale. PLoS One 2011; 6:e27393. [PMID: 22096566 PMCID: PMC3214055 DOI: 10.1371/journal.pone.0027393] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2011] [Accepted: 10/16/2011] [Indexed: 01/19/2023] Open
Abstract
Background Filum terminale (FT) is a structure that is intimately associated with conus medullaris, the most caudal part of the spinal cord. It is well documented that certain regions of the adult human central nervous system contains undifferentiated, progenitor cells or multipotent precursors. The primary objective of this study was to describe the distribution and progenitor features of this cell population in humans, and to confirm their ability to differentiate within the neuroectodermal lineage. Methodology/Principal Findings We demonstrate that neural stem/progenitor cells are present in FT obtained from patients treated for tethered cord. When human or rat FT-derived cells were cultured in defined medium, they proliferated and formed neurospheres in 13 out of 21 individuals. Cells expressing Sox2 and Musashi-1 were found to outline the central canal, and also to be distributed in islets throughout the whole FT. Following plating, the cells developed antigen profiles characteristic of astrocytes (GFAP) and neurons (β-III-tubulin). Addition of PDGF-BB directed the cells towards a neuronal fate. Moreover, the cells obtained from young donors shows higher capacity for proliferation and are easier to expand than cells derived from older donors. Conclusion/Significance The identification of bona fide neural progenitor cells in FT suggests a possible role for progenitor cells in this extension of conus medullaris and may provide an additional source of such cells for possible therapeutic purposes. Filum terminale, human, progenitor cells, neuron, astrocytes, spinal cord.
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Lim SM, Choi IS, David CA. Spinal arteriovenous fistulas of the filum terminale. AJNR Am J Neuroradiol 2011; 32:1846-50. [PMID: 21852379 DOI: 10.3174/ajnr.a2612] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The filum terminale is an anatomic structure at the end of the spinal cord. Only a few cases of AVFs of the filum terminale have been reported. These AVFs usually consist of a single communication between the anterior spinal artery and a single draining vein. We retrospectively analyzed the clinical and radiologic features and treatment of 4 patients with spinal AVFs of the filum terminale. Clinical manifestations and MR images are similar to those of spinal dural AVFs. All patients underwent surgical or endovascular treatment, resulting in complete occlusion. Clinical outcomes were good to excellent in all patients.
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Affiliation(s)
- S M Lim
- Department of Radiology, Ewha Womans University Hospital, Seoul, Korea
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Tehli O, Hodaj I, Kural C, Solmaz I, Onguru O, Izci Y. A comparative study of histopathological analysis of filum terminale in patients with tethered cord syndrome and in normal human fetuses. Pediatr Neurosurg 2011; 47:412-6. [PMID: 22776912 DOI: 10.1159/000338981] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2011] [Accepted: 04/17/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND The structural changes in filum terminale (FT) may be responsible for tethered cord syndrome (TCS) in children. Although the histological changes in FT related to TCS are well-known, there is no comparative study of the changes which occur in TCS and normal fetal FT samples. The aims of this study are to compare the histological changes which occurred in FT samples of TCS and in fetuses, and to point out these changes. METHODS During the last 2 years, 14 cases of TCS were operated on, the FT was cut and the spinal cord was released. Among them, 6 samples of FT were obtained for histopathological examination. Moreover, 1 FT from an adult cadaver and 4 samples from fetal FT were obtained for the same examination. RESULTS While adipose tissue, fibrosis, hyalinization, and meningothelial proliferation were observed in FT samples of TCS, none of these findings were observed in fetal samples. Elastic fibers were present in all TCS specimens and the adult cadaver, but were not observed in fetuses. Peripheral nerves, ganglion cells and ependymal cells were observed in fetal FT samples. CONCLUSION These changes probably begin at birth.
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Affiliation(s)
- Ozkan Tehli
- Department of Neurosurgery, Gulhane Military Medical Academy, Etlik, Turkey
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Dilatation du ventriculus terminalis chez l’adulte : à propos d’un cas et revue de la littérature. Neurochirurgie 2010; 56:386-90. [DOI: 10.1016/j.neuchi.2009.12.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2009] [Accepted: 12/02/2009] [Indexed: 11/24/2022]
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Varghese M, Olstorn H, Berg-Johnsen J, Moe MC, Murrell W, Langmoen IA. Isolation of human multipotent neural progenitors from adult filum terminale. Stem Cells Dev 2009; 18:603-13. [PMID: 18652547 DOI: 10.1089/scd.2008.0144] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Stem cells have been isolated from several CNS regions, including the spinal cord. However, the terminal end of the spinal cord, filum terminale, has been referred to as a fibrovascular tag without neurogenic potential and of no clinical significance. Recently, we were fortunate to acquire some samples of this tissue. We show for the first time that progenitor cells exhibiting the hallmarks of stem cells can be isolated from adult human filum terminale (FTNPs). More specifically, FTNPs self-renew and proliferate to form neurospheres, and exhibit tripotent differentiation into neurons, astrocytes, and oligodendrocytes. Equally important, FTNPs develop the electrophysiological profile of neurons and glia. Whole-cell patch-clamp recordings show beta-III-tubulin(+) neurons exhibiting overshooting action potentials, displaying both the fast inactivating TTX-sensitive sodium current as well as 4-AP and TEA sensitive potassium currents. To assess potency in vivo, FTNPs were transplanted into the posterior periventricular region of control or ischemic rat brains. Despite a vigorous immune response against the xenograft, FTNPs survived and were found not only in the graft area but had also migrated to the lesioned CA1 region. Notwithstanding the immune response, FTNPs differentiated into astrocytes, but no neuronal differentiation was observed in the transplant milieu tested. However, neuronal differentiation in vivo cannot be ruled out and assessment of the conditions necessary to promote neurogenesis in vivo requires more research. Significantly, no tumor formation or aberrant cell morphology was seen in or adjacent to the graft area. Thus, filum terminale provides a novel source of adult human neural progenitor cells that develop into functional neurons with possible clinical applications.
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Affiliation(s)
- Mercy Varghese
- Vilhelm Magnus Laboratory for Neurosurgical Research, Institute for Surgical Research, University of Oslo, Oslo, Norway.
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Ebner FH, Roser F, Acioly MA, Schoeber W, Tatagiba M. Intramedullary lesions of the conus medullaris: differential diagnosis and surgical management. Neurosurg Rev 2008; 32:287-300; discussion 300-1. [PMID: 18820958 DOI: 10.1007/s10143-008-0173-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2008] [Revised: 08/01/2008] [Accepted: 08/19/2008] [Indexed: 10/21/2022]
Abstract
The medullary conus represents a distinct entity of the spinal cord regarding its anatomical, clinical and microsurgical features. An overview of the pathologic processes of this region is provided. Epidemiological, clinical and neuroradiological characteristics of neoplastic (glial tumors, non-glial tumors, metastasis, primary melanomas) and non-neoplastic lesions (granulomatous lesions, abscess, parasitic infections, vascular, demyelinating and dysembryogenetic lesions) are discussed. Main MR imaging characteristics used to differentiate neoplastic from non-neoplastic lesions consist in pathological spinal cord expansion, gadolinium-enhancement and tumoural cyst formation. Management strategies differ substantially, depending on the kind of lesion. According to the suspected pathological entity radical resection, biopsy or conservative treatments are reasonable options. Intraoperative electrophysiological monitoring is a fundamental part of the surgical setting.
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Affiliation(s)
- Florian H Ebner
- Department of Neurosurgery, Eberhard-Karls-University, Tübingen, Germany.
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Boros C, Lukácsi E, Horváth-Oszwald E, Réthelyi M. Neurochemical architecture of the filum terminale in the rat. Brain Res 2008; 1209:105-14. [DOI: 10.1016/j.brainres.2008.02.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2007] [Revised: 02/04/2008] [Accepted: 02/05/2008] [Indexed: 11/16/2022]
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Ciappetta P, D'urso PI, Luzzi S, Ingravallo G, Cimmino A, Resta L. Cystic dilation of the ventriculus terminalis in adults. J Neurosurg Spine 2008; 8:92-9. [DOI: 10.3171/spi-08/01/092] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
✓The ventriculus terminalis (VT) is a small ependyma-lined cavity within the conus medullaris that is in direct continuity with the central canal of the anterior portion of the spinal cord. Normally, such a cavity is identifiable only histologically in children and adults and can be visualized using common neuroradiological techniques only after dilation. Currently, the mechanisms of isolated dilation are not documented. The present work describes 2 cases of VT in elderly patients. Data from a histological and ultrastructural study of a case of VT dilation are reported, and the results are compared with those obtained from the VT of 5 fetuses to explain the nosological aspects of nontumoral VT lesions. Our data suggest that the site, age, and histological characteristics of the lesion allow us to define VT dilation as a nosological entity distinct from other cystic dilations of the conus medullaris.
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Affiliation(s)
| | | | - Sabino Luzzi
- 1Section of Neurosurgery, Department of Neuroscience, and
| | - Giuseppe Ingravallo
- 2Section of Neuropathology, Department of Pathology, University of Bari Medical School, Bari, Italy
| | - Antonia Cimmino
- 2Section of Neuropathology, Department of Pathology, University of Bari Medical School, Bari, Italy
| | - Leonardo Resta
- 2Section of Neuropathology, Department of Pathology, University of Bari Medical School, Bari, Italy
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Fontes RBV, Saad F, Soares MS, de Oliveira F, Pinto FCG, Liberti EA. Ultrastructural Study of the Filum Terminale and Its Elastic Fibers. Neurosurgery 2006; 58:978-84; discussion 978-84. [PMID: 16639335 DOI: 10.1227/01.neu.0000210224.54816.40] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
OBJECTIVE:
The filum terminale (FT) is a fibrovascular band involved in the pathophysiology of tethered cord syndrome (TCS). Its morphological and ultrastructural properties remain largely unknown even though they are thought to play a role in the generation of TCS in adult patients with normal level conus medullaris.
MATERIALS AND METHODS:
Twenty fresh adult human cadavers had their fila measured and removed. Transversal and longitudinal sections of the proximal, middle, and distal thirds of FT were submitted to light microscopy analysis with four different techniques. Five fila were selected for longitudinal and transversal scanning electron microscopy analysis.
RESULTS:
The bulk of the FT is composed of 5- to 20-μm thick longitudinal bundles of Type 1 collagen separated by 3- to 10-μm intervals, although capillaries and other elements may be present. A delicate (0.05–1.5 μm) meshwork of predominantly Type 3 collagen transversal fibers connects these bundles. Abundant longitudinally oriented elastic and elaunin fibers are found inside collagen bundles. A complex tridimensional structure is evidenced on electron microscopy.
CONCLUSION:
The longitudinal arrangement of collagen bundles and the impressive amount of elastic and elaunin fibers should elicit considerable elastic properties to the FT. An altered elasticity mechanism has been proposed for TCS; further studies are needed with TCS patients to define whether the collagen structure, Type 1/Type 3 proportion, or elastic fiber content are altered, which could lead to new histopathological definitions of TCS, helping neurosurgeons in the difficult management of TCS patients with normal level conus medullaris.
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Affiliation(s)
- Ricardo B V Fontes
- VQM Laboratory, Department of Anatomy, Instituto de Ciencias Biomedicas, and Liga de Neurocirurgia, Faculdade de Medicina, da Universidade de São Paulo, São Paulo, Brazil.
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Song DY, Cho BP, Choi BY, Yang YC, Lee BH, Lim CK, Kang HS. Upregulated and prolonged differentiation potential of the ependymal cells lining the ventriculus terminalis in human fetuses. Neurosci Lett 2005; 386:28-33. [PMID: 16002214 DOI: 10.1016/j.neulet.2005.05.068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2005] [Revised: 05/16/2005] [Accepted: 05/17/2005] [Indexed: 10/25/2022]
Abstract
The ventriculus terminalis (VT) is a dilated cavity within the conus medullaris of the spinal cord. Although the VT was discovered in the mid-nineteenth century, little is known about its characteristics during development in human fetuses. Ependymal cells lining the cavities within the CNS retain high differentiation potential, and are believed to be responsible for the postnatal neurogenesis. To evaluate the differentiation capacity of the ependymal cells lining the VT during development, we examined glial fibrillary acidic protein (GFAP) and proliferating cell nuclear antigen (PCNA) expression in the spinal cord of 18-24-week-old human fetuses. GFAP is a marker for the degree of ependymal cell differentiation in the human fetus, and PCNA is a well-known marker for cell division. Morphological characteristics of the VT were also examined. At the lower portion of the conus medullaris, the central canal abruptly expands dorsally to become the VT. Then the VT widens bilaterally while its anteroposterior diameter reduces gradually in a caudal direction. Finally, the VT becomes a narrow, transverse slit at the level of the lowermost conus medullaris. Compared with those lining the central canal, more numerous ependymal cells lining the VT showed more intensive GFAP and PCNA expression throughout all gestational ages examined. This suggests that, in the developing human spinal cord, ependymal cells lining the VT retain their differentiation potential, including a higher proliferative capacity, until a later stage of development than those lining the central canal.
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Affiliation(s)
- Dae Yong Song
- Department of Anatomy and Institute of Basic Medical Science, Yonsei University Wonju College of Medicine, Ilsan-Dong 162, Wonju, Kangwon-Do 220-701, Republic of Korea
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Adamson DC, Cummings TJ, Friedman AH. Myxopapillary Ependymoma and Fatty Filum in an Adult with Tethered Cord Syndrome: A Shared Embryological Lesion? Case Report. Neurosurgery 2005; 57:E373; discussion E373. [PMID: 16094143 DOI: 10.1227/01.neu.0000166690.35246.dd] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
ABSTRACTOBJECTIVE AND IMPORTANCE:Myxopapillary ependymoma and fatty fila are traditionally thought to arise via completely different pathophysiologies. Recognition of these distinct pathologies in the same patient is important for appropriate treatment and prognosis.CLINICAL PRESENTATION:A 28-year-old woman presented with low back pain, bilateral leg radiculopathies, and mild leg weakness suggestive of tethered cord syndrome. Magnetic resonance imaging revealed lesions in the area of the conus medullaris consistent with a myxopapillary ependymoma and fatty filum.INTERVENTION:Under the surveillance of intraoperative electromyographic monitoring, the patient underwent an L4–S2 laminectomy for transection of the fatty filum and gross total resection of the mass. Histopathological examination confirmed the presence of these two distinct pathologies.CONCLUSION:We report an unusual case of a myxopapillary ependymoma coexisting with a fatty filum in an adult patient. To the best of our knowledge, this association has not yet been reported. This raises the interesting question of a possible associative or causative relationship between these distinct pathologies, which have traditionally been thought to arise from different mechanisms.
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Affiliation(s)
- D Cory Adamson
- Division of Neurosurgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA.
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36
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Réthelyi M, Lukácsi E, Boros C. The caudal end of the rat spinal cord: transformation to and ultrastructure of the filum terminale. Brain Res 2004; 1028:133-9. [PMID: 15527738 DOI: 10.1016/j.brainres.2004.08.069] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2004] [Indexed: 11/13/2022]
Abstract
Contrary to the current belief, the spinal cord of the rat does not terminate with the conus terminalis (CT), but its basic components (central canal, gray matter, white matter) continue in the filum terminale (FT). Proceeding caudally in the conus terminalis, first the motoneuron cell column discontinues in the ventral horn. More caudally the dorsal horns separate from the intermediate zone, and discontinue. The ensuing filum terminale consists of the slit-like central canal lined by ciliated ependymal cells, the periventricular gray matter and the peripheral white matter. Uniform small size neurons and glial cells populate the gray matter. Ultrastructural analysis revealed various types of axodendritic and axosomatic synapses as well as fine unmyelinated axons. The white matter consists mainly of myelinated nerve fibers. The neuronal components of the filum terminale, if they occur also in the human spinal cord, should be involved in the diagnosis and treatment of various diseases, e.g. tethered spinal cord syndrome, vascular malformations and disraphysm.
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Affiliation(s)
- Miklós Réthelyi
- Department of Anatomy, Semmelweis University, Tuzoltó utca 58, H-1098 Budapest, Hungary.
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37
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Bulsara KR, Zomorodi AR, Enterline DS, George TM. The Value of Magnetic Resonance Imaging in the Evaluation of Fatty Filum Terminale. Neurosurgery 2004; 54:375-9; discussion 379-80. [PMID: 14744284 DOI: 10.1227/01.neu.0000103451.63301.0b] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2003] [Accepted: 10/08/2003] [Indexed: 11/19/2022] Open
Abstract
AbstractOBJECTIVETo determine whether there are magnetic resonance imaging (MRI) characteristics of fatty fila that are correlated with neurological deficits, especially in the presence of a normal-level conus medullaris.METHODSLumbosacral MRI scans were reviewed for patients with fatty fila who were treated at Duke University Medical Center during a 5-year period. The patients were divided into three groups. Group I patients (n = 5) had fatty fila that were incidentally detected during evaluations for metastases or infections. Group II patients (n = 16) exhibited isolated low back pain but were in neurologically intact condition. Group III patients (n = 15) exhibited neurological impairments consistent with distal spinal cord dysfunction. Several characteristics were measured on the MRI scans, including the location of the conus medullaris, the filum thickness, and the distance of fat from the conus. These results were assessed for statistically significant correlation with the presence of clinical symptoms.RESULTSThe majority of patients in all three groups demonstrated the normal conus position (L2 or above) and thickened fila. The distance of fat from the conus was the only parameter that demonstrated a statistically significant difference among the groups.CONCLUSIONThe following findings were noted: 1) patients were likely to exhibit neurological deficits at a younger age (<22 yr in Group III versus 47 yr in Groups I and II); 2) a conus level below L2 was associated with neurological deficits (Group III); 3) filum thickness was not correlated with clinical presentation; 4) fat in the filum within 13 mm of the conus medullaris was most predictive of neurological deficits (Group III).
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Affiliation(s)
- Ketan R Bulsara
- Department of Pediatric Neurosurgery, Duke University Medical Center, Durham, NC 27710, USA
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38
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George TM, Bulsara KR, Cummings TJ. The immunohistochemical profile of the tethered filum terminale. Pediatr Neurosurg 2003; 39:227-33. [PMID: 14512685 DOI: 10.1159/000072866] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2003] [Accepted: 02/26/2003] [Indexed: 11/19/2022]
Abstract
The embryopathy underlying tethering of the filum terminale is poorly understood. Knowledge of normal filum development is the foundation upon which to compare normal fila to fila from patients with tethered cord syndrome. Thirty-four fila from patients with tethered cord syndrome were immunostained with caudal neural tube developmental markers H4C4 (CD44), VIN-IS-53, AC4, FP3 and NOT1, and a panel of mature neuroglial, neural crest, epithelial and mesenchymal markers. H4C4 (CD44) and NOT1 exhibited significant alterations in immunoexpression in tethered fila compared to controls. The change in expression may be indicative of altered cell identity in the filum and constitute the predisposition to tethering.
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Affiliation(s)
- Timothy M George
- Department of Pediatric Neurosurgery, Duke University Medical Center, Durham, NC 27710, USA.
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39
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Cummings TJ, George TM. The Immunohistochemical Profile of the Normal Conus medullaris and Filum terminale. ACTA ACUST UNITED AC 2003. [DOI: 10.1159/000071020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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STORER KP, TOH J, STOODLEY MA, JONES NR. The central canal of the human spinal cord: a computerised 3-D study. J Anat 1998; 192 ( Pt 4):565-72. [PMID: 9723983 PMCID: PMC1467810 DOI: 10.1046/j.1469-7580.1998.19240565.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Knowledge of the structure and function of the central canal of the human spinal cord is important in understanding the pathogenesis of syringomyelia. Analysis of the morphology of the central canal is difficult using isolated histological sections. A 3-dimensional reconstruction technique using digitised histological sections was therefore developed to visualise the morphology of the central canal. The technique was used to study the canal in the conus medullaris and filum terminale of 1 sheep and 4 human spinal cords. A variety of morphological features were demonstrated including canal duplication, a terminal ventricle and openings from the canal lumen into the subarachnoid space. The findings suggest the possibility of a functionally important fluid communication in the caudal spinal cord which may have a sink function.
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Affiliation(s)
- K. P.
STORER
- Department of Surgery (Neurosurgery), University of Adelaide, Adelaide, South Australia
| | - J.
TOH
- Department of Surgery (Neurosurgery), University of Adelaide, Adelaide, South Australia
| | - M. A.
STOODLEY
- Department of Surgery (Neurosurgery), University of Adelaide, Adelaide, South Australia
| | - N. R.
JONES
- Department of Surgery (Neurosurgery), University of Adelaide, Adelaide, South Australia
- Correspondence to Professor N. R. Jones, Department of Surgery (Neurosurgery), University of Adelaide, Royal Adelaide Hospital, North Terrace, Adelaide, SA 5000, Australia. Tel: +61 8 82225629; fax: +61 8 82324168; e-mail:
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41
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Paz Solís J, Herguido M, Roda J. Quiste del ventrículo terminal sintomático: ¿una lesión aislada o asociada a la siringomielia? Neurocirugia (Astur) 1997. [DOI: 10.1016/s1130-1473(97)71036-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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42
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Agrillo U, Tirendi MN, Nardi PV. Symptomatic cystic dilatation of V ventricle: case report and review of the literature. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 1997; 6:281-3. [PMID: 9294755 PMCID: PMC3454649 DOI: 10.1007/bf01322453] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/1996] [Revised: 07/26/1996] [Accepted: 08/17/1996] [Indexed: 02/05/2023]
Abstract
We report a case of V ventricular cystic dilatation, presenting with specific neurological symptoms including low back pain, bilateral sciatica, weakness of dorsiflexion, and urinary retention. MRI showed a large cystic dilatation of the ventriculus terminalis. Surgical fenestration of the cyst allowed complete relief from symptoms and remission of the neurological deficit.
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Affiliation(s)
- U Agrillo
- Neurosurgery Division, S. Pertini Hospital, Rome, Italy
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43
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Zec N, De Girolami U, Schofield DE, Scott RM, Anthony DC. Giant cell ependymoma of the filum terminale. A report of two cases. Am J Surg Pathol 1996; 20:1091-101. [PMID: 8764746 DOI: 10.1097/00000478-199609000-00007] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
We describe two histologically unusual cases of ependymoma of the filum terminale. Both tumors occurred in 14-year-old boys. An intradural encapsulated mass attached to the filum terminale was demonstrated radiologically in both cases and totally resected at surgery. In case 1 the neoplasm was uniformly composed of pleomorphic giant cells and was without perivascular pseudorosettes or myxopapillary changes. Case 2 was a myxopapillary ependymoma with multiple foci of pleomorphic giant cells. Neither tumor had prominent mitotic activity, necrosis, or endothelial proliferation. Both tumors were immunopositive for cytokeratin and glial fibrillary acidic protein. Ultrastructural features included basal laminae, interdigitating cell processes, microvilli, cilia, intercellular junctions, and cytoplasmic intermediate filaments. Cytogenetic analysis in case 1 showed a hypodiploid karyotype with monosomy of chromosomes 1, 10, 14, 16, 20, and 22. We interpret both tumors as most consistent with a variant of ependymoma. Because of the unique gigantocellular light microscopic appearance of the entire tumor in case 1, we propose classifying this tumor as a new morphologic subtype: giant cell ependymoma of the filum terminale. The combination of gigantocellular and myxopapillary features in case 2 supports a histogenetic relationship between giant cell ependymoma and myxopapillary ependymoma.
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Affiliation(s)
- N Zec
- Department of Pathology (Neuropathology), Children's Hospital, Boston, MA 02115, USA
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